Endoscopy 2007; 39: E52
DOI: 10.1055/s-2006-945127
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Gastrointestinal bleeding from gastric metastasis of renal cell carcinoma, treated by endoscopic polypectomy

A. Pezzoli1 , V. Matarese1 , S. Boccia1 , L. Simone1 , S. Gullini1
  • 1 Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital, Ferrara, Italy
Further Information

A. Pezzoli, MD

Department of Gastroenterology and Gastrointestinal Endoscopy

University Hospital Sant’Anna
Corso Giovecca 203
44100 Ferrara
Italy

Fax: +39-05-32236932

Email: a.pezzoli@ospfe.it

Publication History

Publication Date:
26 February 2007 (online)

Table of Contents

Metastatic tumors of the stomach are very rare. We report here a case of successful endoscopic treatment of gastrointestinal hemorrhage from gastric metastases of a renal cell carcinoma (RCC), 5 years after radical resection.

A 78-year-old man was admitted because of anemia. His medical history was noteworthy for radical resection of an RCC 5 years earlier. Upper gastrointestinal endoscopy showed three actively bleeding polypoid lesions of 2 - 3 cm within the body of the stomach (Figure [1]). The polyps were removed by electrosurgical snare resection after injection of epinephrine solution in the stalk. No further bleeding was observed after the procedure.

Zoom Image

Figure 1 Endoscopic view of bleeding polypoid lesions in the stomach.

Unexpectedly, at histological examination of the polyps, clear cells were seen, suggesting a metastasis of an RCC (Figure [2]). The patient was referred to the oncology department and died 6 months later but he did not present other bleeding episodes during that period.

Zoom Image

Figure 2 Histological examination showing clear cell kidney carcinoma associated with gastric mucosa (hematoxylin and eosin; × 140).

The incidence of metastatic involvement of the stomach is extremely low (0.2 %-0.7 %) even in autopsy studies [1] [2]. The majority of the patients described had an ulcer-like bleeding lesion and were treated with embolization [3], with epinephrine injection [4], or surgically [2]; we are not aware of any other report of endoscopic resection of gastric metastases. We performed this procedure because our patient’s lesions looked like bleeding polyps and we did not suspect their histological nature. Nevertheless this treatment was effective in stopping the bleeding, and we avoided surgical resection in this patient with disseminated RCC and at high operative risk. For patients with metastatic gastric tumors, surgical resection is still recommended in selected cases as an effective palliation [2] [3] [4] [5], but endoscopic therapy of these lesions seems a reasonable option for those patients not eligible for surgery, as was shown in our patient.

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB

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References

A. Pezzoli, MD

Department of Gastroenterology and Gastrointestinal Endoscopy

University Hospital Sant’Anna
Corso Giovecca 203
44100 Ferrara
Italy

Fax: +39-05-32236932

Email: a.pezzoli@ospfe.it

#

References

A. Pezzoli, MD

Department of Gastroenterology and Gastrointestinal Endoscopy

University Hospital Sant’Anna
Corso Giovecca 203
44100 Ferrara
Italy

Fax: +39-05-32236932

Email: a.pezzoli@ospfe.it

Zoom Image

Figure 1 Endoscopic view of bleeding polypoid lesions in the stomach.

Zoom Image

Figure 2 Histological examination showing clear cell kidney carcinoma associated with gastric mucosa (hematoxylin and eosin; × 140).