Abstract
BackgroundMetastases to the stomach or gallbladder from any malignancy is rarely noted, and simultaneous metastases to both organs are atypical. We present a unique case of simultaneous multifocal metastases of the stomach and gallbladder from renal cell carcinoma (RCC).Case presentationThe case involved a 60-year-old man, with a past history of RCC (clear cell type, G2, T1b N0 M0 Stage I) treated by a right nephrectomy. Three years after the nephrectomy, a routine gastrointestinal endoscopy found an ulcerative lesion in the greater curvature of the gastric body. The gastric tumor was pathologically proven to be a metastasis from RCC. Furthermore, computed tomography incidentally revealed a mass lesion in the fundus of the gallbladder, which was also diagnosed as a potential metastasis from RCC. As endoscopic ultrasonography of the gastric tumor suggested the tumor potentially invaded to the submucosal layer, gastric wedge resection via a laparoscopic and endoscopic cooperative surgery (LECS) technique was applied to the gastric tumor, and laparoscopic cholecystectomy to the gallbladder tumor was simultaneously performed. Histological examination confirmed that the tumors of the stomach and gallbladder were both metastatic RCC. The hospitalization period after surgery was not eventful, and the patient was discharged on postoperative day 7. Thereafter, the patient required examination every 3 months, did not use anticancer agents, and has survived without relapse to 9 months after the surgery.ConclusionsFor patients with locally resectable RCC metastases, complete metastasectomy may bring long-term tumor control. Moreover, LECS for gastric metastasis is a reasonable approach for minimal invasiveness and an oncologically feasible outcome.
Highlights
Metastases to the stomach or gallbladder from any malignancy is rarely noted, and simultaneous metastases to both organs are atypical
laparoscopic and endoscopic cooperative surgery (LECS) for gastric metastasis is a reasonable approach for minimal invasiveness and an oncologically feasible outcome
Case presentation A 60-year-old man with a past history of renal cell carcinoma (RCC) treated by a right nephrectomy in June 2015 was required to have a follow-up examination at 6-month intervals after surgery, without the use of an anticancer agent
Summary
According to analysis obtained from autopsy specimens [2], the occurrence of metastasis to the stomach constitutes 5.4% of the total number of metastases from solid malignancies. As a similar situation to our present case, Kongnyuy et al [32] recently reported simultaneous and multifocal metastases to ipsilateral left testes, bladder, and stomach from RCC, 7 years after a left nephrectomy. In a review describing endoscopic treatment for RCC gastric metastasis [28], surgical resection was performed in 39.5% of the patients. Japanese research describes treatment approaches for 22 patients with RCC gastric metastasis [36] and reports that endoscopic, surgical, and best supportive care were selected for 12, 8, and 4 patients, respectively. We experienced a rare case of simultaneous multifocal metastases of the stomach and gallbladder from RCC. It is still being discussed, for patients with locally resectable RCC metastases, complete metastasectomy may bring long-term tumor control. LECS for the gastric metastasis is a reasonable approach with minimal invasiveness and an oncologically feasible outcome
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