Metastatic Renal Cell Carcinoma Mimicking Colon Cancer

Abstract

Purpose: Renal cell carcinoma frequently metastasizes to lungs, lymph nodes, bones and liver. Large intestinal metastasis is uncommon. We report a case of metastatic renal cell carcinoma to the cecum three years after radical nephrectomy. Methods: N/A Results: An 84-year-old male with right renal cell carcinoma required radical nephrectomy three years ago, presented with a few episodes of hematochezia. He denied abdominal pain, nausea, vomiting or diarrhea. Past medical history was significant for diabetes mellitus, hypertension and atrial fibrillation. Physical examination was unremarkable other than severely pale conjunctivae and systolic murmurs. Laboratory data revealed a hemoglobin of 5.5 g/dL. A Colonoscopy was performed and demonstrated a large, protruding, partially obstructing cecal mass with surrounding ischemic colitis and a small ischemic ulcer at the proximal transverse colon. A biopsy was taken from the mass; however the pathological findings were consistent with tissue necrosis but no malignancy. CT chest and abdomen demonstrated a 1.3 cm. right lower lobe pulmonary mass, multiple hypodense hepatic lesions and a pericecal mass with mesenteric lymphadenopathy. CEA level was within normal limits. Primary colon cancer with distant metastasis was suspected. He underwent laparotomy. During the operation it was noticed that the tumor which was located above the cecum, was densely adherent posteriorly into the retroperitoneum at the area of previous nephrectomy, as well as laterally into the lateral peritoneal reflection. Right hemicolectomy was performed. Pathological examination demonstrated high grade, clear cell type tumor in the cecum with extension through serosal surface and pericolonic fat. The diagnosis of metastatic renal cell carcinoma similar to the tumor resected 3 years earlier was made. The patient was given Temsirolimus as single agent chemotherapy for metastatic renal cell carcinoma. Conclusion: Recurrence of renal cell carcinoma is sometimes found after radical nephrectomy and has been noted up to 24 years after diagnosis. The recurrence period is unpredictable; therefore lifelong follow up is need in patients with history of renal cell cancer even when curative nephrectomy was achieved. Additionally, endoscopists should consider intestinal metastasis of this unusual tumor in patients with history of renal cell cancer.