Upper Gastrointestinal Hemorrhage Secondary to Gastric Metastases of Renal Cell Carcinoma Treated by Endoscopic Polypectomy

Abstract

Purpose: A 79-year-old man with a history of metastatic renal cell carcinoma in remission and peptic ulcer disease presented with melena. He was hypotensive with bp 70/30 and anemic with Hb 5.7 g/dL. After stabilization in the ICU, upper endoscopy was performed revealing numerous pedunculated polyps with superficial ulceration, the largest of which was 6 cm and had an overlying clot. Snare polypectomy was performed after endoloop placement. Mild oozing was noted and was treated with epinephrine injection and placement of three hemoclips. The next two largest polyps were removed similarly. Pathology revealed that all polyps were metastatic renal cell carcinoma, clear cell type. The patient did well over the next day with stable Hb and was discharged home to follow-up with his primary and oncology. Renal cell carcinoma with gastric metastases is exceedingly rare (0.2-0.7%), as demonstrated by a paucity of literature on this subject matter. Literature review revealed thirteen cases to date. Our case is unique in that it is only the second reported case of endoscopic polypectomy for treatment of gastric metastases from renal cell carcinoma and the first in a patient presenting with hemodynamic instability. Also, the findings were unexpected given the fact that our patient presented with melena seven months prior and was found to have a fundic ulcer negative for malignancy on pathology. No polyps or polypoid lesions were noted at that time.Figure: Large six centimeter polyp with overlying clot treated with polypectomy. Histology revealed renal cell carcinoma.Figure: Attenuated gastric foveolar epithelium overlies a submucosal focus of renal cell carcinoma.