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.
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.
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
