Severe blood loss anaemia and recurrent intussusceptions as first presentation of bowel metastatic renal cell carcinoma: A case report and review of the literature

Trojaniello,Claudia; Vitale,Maria  Giuseppa; Trojaniello,Biagio; Lentini Graziano,Maria    Luisa; Coccaro,Mariarosa; Cartenì,Giacomo; Montesarchio,Vincenzo

doi:10.3892/mco.2017.1365

Severe blood loss anaemia and recurrent intussusceptions as first presentation of bowel metastatic renal cell carcinoma: A case report and review of the literature

Authors:
- Claudia Trojaniello
- Maria Giuseppa Vitale
- Biagio Trojaniello
- Maria Luisa Lentini Graziano
- Mariarosa Coccaro
- Giacomo Cartenì
- Vincenzo Montesarchio
View Affiliations

Affiliations: Oncology Unit, Azienda Ospedaliera dei Colli, Ospedale Monaldi, I-80131 Naples, Italy, UOSC Oncologia Medica, Azienda Ospedaliera di Rilievo Nazionale ‘Antonio Cardarelli’, I-80131 Naples, Italy, U.O. Urgenze Chirurgiche ed Accettazione Generale, Ospedale San Paolo ASL Napoli 1 Centro, I-80131 Naples, Italy
Published online on: August 7, 2017 https://doi.org/10.3892/mco.2017.1365
Pages: 654-660

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Renal cell carcinoma (RCC) may metastasize to almost any organ, but bowel metastases are highly unusual. A 75-year-old man presented with symptoms and signs of severe anaemia due to bowel bleeding and abdominal pain due to recurrent bowel intussusception. The patient underwent surgery and was identified to have intraluminal metastases from metastatic RCC. To the best of our knowledge, few cases of metastases from RCC manifesting as synchronous intraluminal polypoid tumours have been described in the literature. The present report focused on the importance of two aspects that must be considered: The role of accurate diagnosis and of surgery treating intestinal metastases that may lead to symptom control and prolonged survival.

View Figures

View References

1	I numeri del cancro in Italia. 2014.https://www.registri-tumori.it
2	Maldazys JD and deKernion JB: Prognostic factors in metastatic renal carcinoma. J Urol. 136:376–379. 1986. View Article : Google Scholar : PubMed/NCBI
3	Moch H, Gasser T, Amin MB, Torhorst J, Sauter G and Mihatsch MJ: Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: A Swiss experience with 588 tumors. Cancer. 89:604–614. 2000. View Article : Google Scholar : PubMed/NCBI
4	Leibovich BC, Lohse CM, Crispen PL, Boorjian SA, Thompson RH, Blute ML and Cheville JC: Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. J Urol. 183:1309–1315. 2010. View Article : Google Scholar : PubMed/NCBI
5	Waters WB and Richie JP: Aggressive surgical approach to renal cell carcinoma: Review of 130 cases. J Urol. 122:306–309. 1979. View Article : Google Scholar : PubMed/NCBI
6	Griffiths LH and Thackray AC: Parenchymal carcinoma of the kidney. Br J Urol. 21:128–151. 1949. View Article : Google Scholar : PubMed/NCBI
7	Staderini F, Cianchi F, Badii B, Skalamera I, Fiorenza G, Foppa C, Qirici E and Perigli G: A unique presentation of a renal clear cell carcinoma with atypical metastases. Int J Surg Case Rep. 11:29–32. 2015. View Article : Google Scholar : PubMed/NCBI
8	Hegde RG, Gowda HK, Agrawal RD, Yadav VK and Khadse GJ: Renal cell carcinoma presenting as small bowel obstruction secondary to a metastatic ileal intussusception. J Radiol Case Rep. 8:25–31. 2014.PubMed/NCBI
9	Nozawa H, Tsuchiya M, Kobayashi T, Morita H, Kobayashi I, Sakaguchi M, Mizutani T, Tajima A, Kishida Y, Yakumaru K, et al: Small intestinal metastasis from renal cell carcinoma exhibiting rare findings. Int J Clin Pract. 57:329–331. 2003.PubMed/NCBI
10	Pavlakis GM, Sakorafas GH and Anagnostopoulos GK: Intestinal metastases from renal cell carcinoma: A rare cause of intestinal obstruction and bleeding. Mt Sinai J Med. 71:127–130. 2004.PubMed/NCBI
11	Klatte T, Patard JJ, de Martino M, Bensalah K, Verhoest G, de la Taille A, Abbou CC, Allhoff EP, Carrieri G, Riggs SB, et al: Tumor size does not predict risk of metastatic disease or prognosis of smal renal cell carcinomas. J Urol. 179:1719–1726. 2008. View Article : Google Scholar : PubMed/NCBI
12	Decastro GJ and McKiernan JM: Epidemiology, clinical staging, and presentation of renal cell carcinoma. Urol Clin North Am. 35:581–592, vi. 2008. View Article : Google Scholar : PubMed/NCBI
13	Roviello F, Caruso S, Moscovita Falzarano S, Marrelli D, Neri A, Rampone B, De Marco G, Perrotta ME and Mariani F: Small bowel metastases from renal cell carcinoma: A rare cause of intestinal intussusception. J Nephrol. 19:234–238. 2006.PubMed/NCBI
14	Honda W, Ohmiya N, Hirooka Y, Nakamura M, Miyahara R, Ohno E, Kawashima H, Itoh A, Watanabe O, Ando T and Goto H: Enteroscopic and radiologic diagnoses, treatment, and prognoses of small-bowel tumors. Gastrointest Endosc. 76:344–354. 2012. View Article : Google Scholar : PubMed/NCBI
15	Bhatia A, Das A, Kumar Y and Kochhar R: Renal cell carcinoma metastasizing to duodenum: A rare occurrence. Diagn Pathol. 1:292006. View Article : Google Scholar : PubMed/NCBI
16	Takeda T, Shibuya T, Osada T, Izumi H, Mitomi H, Nomura O, Suzuki S, Mori H, Matsumoto K, Kon K, et al: Metastatic renal cell carcinoma diagnosed by capsule endoscopy and double balloon endoscopy. Med Sci Monit. 17:CS15–CS17. 2011. View Article : Google Scholar : PubMed/NCBI
17	Vashi PG, Abboud E and Gupta D: Renal cell carcinoma with unusual metastasis to the small intestine manifesting as extensive polyposis: Successful management with intraoperative therapeutic endoscopy. Case Rep Gastroenterol. 5:471–478. 2011. View Article : Google Scholar : PubMed/NCBI
18	Sridhar SS, Haider MA, Guindi M and Moore MJ: A case of small bowel obstruction due to intraluminal metastases from metastatic renal cell cancer. Oncologist. 13:95–97. 2008. View Article : Google Scholar : PubMed/NCBI
19	Deguchi R, Takagi A, Igarashi M, Shirai T, Shiba T, Watanabe S, Kurumada T, Miwa T, Sadahiro S and Yasuda M: A case of ileocolic intussusception from renal cell carcinoma. Endoscopy. 32:658–660. 2000. View Article : Google Scholar : PubMed/NCBI
20	Van der Poel HG, Roukema JA, Horenblas S, van Geel AN and Debruyne FM: Metastasectomy in renal cell carcinoma: A multicenter retrospective analysis. Eur Urol. 35:197–203. 1999. View Article : Google Scholar : PubMed/NCBI
21	Adamo R, Greaney PJ Jr, Witkiewicz A, Kennedy EP and Yeo CJ: Renal cell carcinoma metastatic to the duodenum: Treatment by classic pancreaticoduodenectomy and review of the literature. J Gastrointest Surg. 12:1465–1468. 2008. View Article : Google Scholar : PubMed/NCBI
22	Farthouat P, Faucompret S, Louis C, Debourdeau P, Pero C and Breda Y: Gastrointestinal hemorrhage due to jejunal metastases from kidney cancer. Ann Chir. 125:797–798. 2000. View Article : Google Scholar : PubMed/NCBI
23	DeCastro CA, Dockerty MB and Mayo CW: Metastatic tumors of the small intestines. Surg Gynecol Obstet. 105:159–165. 1957.PubMed/NCBI
24	Saitoh H, Nakayama M, Nakamura K and Satoh T: Distant metastasis of renal adenocarcinoma in nephrectomized cases. J Urol. 127:1092–1095. 1982. View Article : Google Scholar : PubMed/NCBI
25	Loualidi A, Spooren PF, Grubben MJ, Blomjous CE and Goey SH: Duodenal metastasis: An uncommon cause of occult small intestinal bleeding. Neth J Med. 62:201–205. 2004.PubMed/NCBI
26	Saitoh H: Distant metastasis of renal adenocarcinoma. Cancer. 48:1487–1491. 1981. View Article : Google Scholar : PubMed/NCBI
27	Smith SJ, Carlson HC and Gisvold JJ: Secondary neoplasms of the small bowel. Radiology. 125:29–33. 1977. View Article : Google Scholar : PubMed/NCBI
28	Cherian SV, Das S, Garcha AS, Gopaluni S, Wright J and Landas SK: Recurrent renal cell cancer presenting as gastrointestinal bleed. World J Gastrointest Oncol. 3:99–102. 2011. View Article : Google Scholar : PubMed/NCBI
29	Herrans AF, Diez CJ and Garcìa BJ: “Factores pronósticos en el ade-nocarcinoma de riñón”. Tumores de riñón. Ediciones Doyma. Madrid. 2001.
30	Alt AL, Boorjian SA, Lohse CM, Costello BA, Leibovich BC and Blute ML: Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer. 117:2873–2882. 2011. View Article : Google Scholar : PubMed/NCBI
31	Coleman MJ, Hugh TB, May RE and Jensen MJ: Intussusception in the adult. Aust N Z J Surg. 51:179–181. 1981. View Article : Google Scholar : PubMed/NCBI
32	Karahan N, Bozkurt KK, Cırış IM, Songür Y, Akin M, Cetın M and Koşar A: Duodenojejunal invagination caused by small bowel metastasis of renal cell carcinoma. Turk J Gastroenterol. 22:355–357. 2011. View Article : Google Scholar : PubMed/NCBI
33	Tutar NU, Töre HG, Aydin HM, Geyik E, Coskun M and Niron EA: Case report: Jejuno-jejunal nvagination from metastatic renal cell carcinoma. Br J Radiol. 81:e115–e117. 2008. View Article : Google Scholar : PubMed/NCBI
34	Venugopal A, Mahesh S, Lekha V, Jacob G, Gandhi MD, Bedi MM, Sharma M, Jacob M and Ramesh H: Intussusception due to ileal metastases from renal cell carcinoma. Trop Gastroenterol. 28:35–36. 2007.PubMed/NCBI
35	Tolia BM and Whitmore WF Jr: Solitary metastasis from renal cell carcinoma. J Urol. 114:836–838. 1975. View Article : Google Scholar : PubMed/NCBI
36	Eo WK, Kim GY and Choi SI: A case of multiple intussusceptions in the small intestine caused by metastatic renal cell carcinoma. Cancer Res Treat. 40:97–99. 2008. View Article : Google Scholar : PubMed/NCBI
37	Gayer G, Zissin R, Apter S, Papa M and Hertz M: Pictorial review: Adult intussusception-a CT diagnosis. Br J Radiol. 75:185–190. 2002. View Article : Google Scholar : PubMed/NCBI
38	Bar-Ziv J and Solomon A: Computed tomography in adult intussusception. Gastrointest Radiol. 16:264–266. 1991. View Article : Google Scholar : PubMed/NCBI
39	Iko B, Teal J, Siram SM, Chinwuba CE, Roux VJ and Scott VF: Computed tomography of adult colonic intussusception: Clinical and experimental studies. AJR Am J Roentgenol. 143:769–772. 1984. View Article : Google Scholar : PubMed/NCBI
40	Montali G, Croce F, De Pra L and Solibiati L: Intussusception of the bowel: A new sonographic pattern. Br J Radiol. 56:621–623. 1983. View Article : Google Scholar : PubMed/NCBI
41	Verschelden P, Filiatrault D, Garel L, Grignon A, Perreault G, Boisvert J and Dubois J: Intussusception in children: Reliability of US in diagnosis-a prospective study. Radiology. 184:741–744. 1992. View Article : Google Scholar : PubMed/NCBI
42	Sasaki M, Murakami Y, Takesue Y, Yokoyama Y, Morifuji M, Hayashidani Y, Koyama M and Sueda T: Double intussusceptions in the small intestine caused by metastatic renal cell carcinoma: Report of a case. Surg Today. 36:85–88. 2006. View Article : Google Scholar : PubMed/NCBI
43	Johnson WA and Straus FH: Intussusception of the small intestine produced by metastatic renal carcinoma. Surgery. 32:991–996. 1952.PubMed/NCBI
44	Haynes IG, Wolverson RL and O'Brien JM: Small bowel intussusception due to metastatic renal carcinoma. Br J Urol. 58:4601986. View Article : Google Scholar : PubMed/NCBI
45	Khan AB: Ileocaecal intussusception due to metastatic renal carcinoma. Br J Urol. 67:657–658. 1991. View Article : Google Scholar : PubMed/NCBI
46	Savoye-Collet C, Thoumas D, Dunet F, Lemercier E, Benozio M and Dacher JN: CT diagnosed jejunal intussusception revealing metastatic renal cell carcinoma. JBR-BTR. 84:153–154. 2001.PubMed/NCBI
47	Gayer G, Zissin R, Apter S, Papa M and Hertz M: Pictorial review: Adult intussusception-a CT diagnosis. Br J Radiol. 75:185–190. 2002. View Article : Google Scholar : PubMed/NCBI
48	Begos DG, Sandor A and Modlin IM: The diagnosis and management of adult intussusception. Am J Surg. 173:88–94. 1997. View Article : Google Scholar : PubMed/NCBI
49	Rampersad RD, Ramcharan R and Maharaj D: Small bowel intussusception: A rare complication of renal cell carcinoma. West Indian Med J. 55:68–69. 2006.PubMed/NCBI
50	Bahli ZM and Panesar KJ: Solitary jejunal metastasis from renal cell carcinoma. J Ayub Med Coll Abbottabad. 19:62–63. 2007.PubMed/NCBI
51	Eo WK, Kim GY and Choi SI: A case of multiple intussusceptions in the small intestine caused by metastatic renal cell carcinoma. Cancer Res Treat. 40:97–99. 2008. View Article : Google Scholar : PubMed/NCBI
52	Rustagi T, Rangasamy P and Versland M: Duodenal Bleeding from metastatic renal cell carcinoma. Case Rep Gastroenterol. 5:249–257. 2011. View Article : Google Scholar : PubMed/NCBI
53	Vazquez C, Berrueta J, De Simone F, Tcheckmedyian A, Gonzalez N, Bernachin J, Perrota A, Curi J, Mariño A and Olano C: Small-intestinal bleeding due to metastatic renal cell cancer. Endoscopy. 43 Suppl 2:UCTN:E132011. View Article : Google Scholar
54	Yang J, Zhang YB, Liu ZJ, Zhu YF and Shen LG: Surgical treatment of renal cell carcinoma metastasized to the duodenum. Chin Med J. 125:3198–3200. 2012.PubMed/NCBI
55	Zhao H, Han K, Li J, Liang P, Zuo G, Zhang Y and Li H: A case of wedge resection of duodenum for massive gastrointestinal bleeding due to duodenal metastasis by renal cell carcinoma. World J Surg Oncol. 10:1992012. View Article : Google Scholar : PubMed/NCBI
56	Kerkeni W, Bouzouita A, Jarraya H, Selmi MS, Cherif M, Derouich A, Kourda N, Dziri C, Zermani R, Ben Slama MR and Chebil M: Ileocolic intussusception from metastatic renal cell carcinoma. Prog Urol. 23:73–75. 2013.(In French). View Article : Google Scholar : PubMed/NCBI
57	Aissa A, Kherifech M, Alouini R, Hajji H and Stita W: Multiple intussusceptions revealing metastases from renal carcinoma to the small intestine. J Visc Surg. 149:e223–e224. 2012. View Article : Google Scholar : PubMed/NCBI
58	Longo R, Gattuso D, Luchetti R, Giannetti C, Mero A, Bernardi C and Gasparini G: Atypical multiple ileum metastases of renal cell carcinoma. J Gastrointest Cancer. 44:477–480. 2013. View Article : Google Scholar : PubMed/NCBI
59	Ismail I, Neuen BL and Mantha M: Solitary jejunal metastasis from renal cell carcinoma presenting as small bowel obstruction 19 years after nephrectomy. BMJ Case Rep. pii: bcr2015210857. 2015. View Article : Google Scholar
60	Gorski RL, Jalil SA, Razick M and Jalil AA: An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel. Int J Surg Case Rep. 15:130–132. 2015. View Article : Google Scholar : PubMed/NCBI
61	Budmiger MA, Nagy V, Hürlimann S and Metzger J: Triple jejuno-jejunal intussusception due to metastatic renal cell carcinoma. J Surg Case Rep. 2015:pii: rjv047. 2015.
62	Geramizadeh B, Mostaghni A, Ranjbar Z, Moradian F, Heidari M and Khosravi MB: An unusual case of metastatatic renal cell carcinoma presenting as melena and duodenal ulcer, 16 years after nephrectomy; a case report and review of the literature. Iran J Med Sci. 40:175–180. 2015.PubMed/NCBI