Bleeding Gastric Polyp: A Rare Manifestation of Renal Cell Carcinoma 7 years after Nephrectomy

Abstract

Purpose: Renal cell carcinoma can notoriously recur in unusual locations many years after initial cure and presentation as upper GI bleeding from a gastric polyp is rare. Case: An 83 year old diabetic woman was evaluated for one week of exertional dyspnea, fatigue and melena. She had history of clear cell type renal cell carcinoma of left kidney and underwent left nephrectomy seven years ago. Six months before presentation, she was evaluated for worsening iron deficiency anemia. An EGD showed three non-bleeding gastric ulcers and colonoscopy was normal. Patient was started on twice daily proton pump inhibitor. On current presentation, physical examination was within normal limits except melena in rectum. Laboratory examination showed: hemoglobin 8.6 g/dL (range= 12-15) and GFR 40 ml/min/1.73 m2 (normal= >59). She required multiple transfusions with packed red cells. An EGD was performed which revealed 3 ulcerated semi-pedunculated bleeding polyps in fundus and melanic patches in the antral region. All polyps were removed without complications. Histopathology revealed metastatic clear cell carcinoma. Melanic patches were not biopsied and there was no cutaneous or oral pigmentation. CT chest revealed multiple bilateral lung nodules biopsy of which confirmed late recurrence of renal cell carcinoma. Conclusion: High index of suspicion should be maintained for GI metastasis of renal cell carcinoma in patients presenting with GI bleeding and history of this malignancy.Figure: GD showing bleeding gastric polyp and antral melanosis.