Gastric carcinoma and renal cell carcinoma as an atypical presentation of multiple primary malignancies: a case report and review of the literature

Abstract

Background: Gastric carcinoma (GC) with second primary malignancy (SPM) is the most frequent combination within the multiple primary malignancies (MPM) group. The presentation of a GC associated with a synchronized SPM in the kidney is extremely rare and unusual. This study presents a rare case of synchronous tumors, describes the main associated risk factors, and emphasizes the need to rule out SPM.

Main body: We present the case of a 63-year-old Hispanic woman with a history of smoking, weight loss, and gastrointestinal (GI) bleeding. GC was diagnosed by endoscopy, and during her workup for metastatic disease, a synchronous SPM was noted in the left kidney. The patient underwent resection of both tumors with a satisfactory postoperative course. A systematic review of the literature was performed using the Medline/PubMed, Science Direct, Scopus, and Google Scholar databases. A search of the literature yielded 13 relevant articles, in which the following main risk factors were reported: the treatment utilized, the grade and clinical stage, histopathological report, and in some cases survival. It is concluded that advanced age (> 60 years) and smoking are the main associated risk factors.

Conclusion: Gastric carcinoma is the second most frequent neoplasm of the GI tract and the main neoplasm that presents a SPM. MPM screening is recommended in patients with gastric cancer. The clinical discovery of MPM of renal origin is rare and hence the importance of the current report.

Keywords: Clear cell renal carcinoma; Gastric tumor; MPM; Partial gastrectomy; Radical nephrectomy; Renal tumor; SPM; Seal ring cells; Smoking; Synchronous.

Fig 1.

CT scan in which the left kidney cancer is observed with dimensions of 140 × 97 × 85 mm

Fig 2.

Product of partial gastrectomy (antrum and pylorus) that measures 100 × 60 × 40 mm; the cut of this area is identified

Fig. 3

Left kidney surgical piece that measures 160 × 100 × 75 mm, in the upper pole and mid-region solid multinodular lesion

Fig. 4

GC. Histopathological examination of antrum and pylorus (Hematoxylin and Eosin (H&E) staining x 40). In the lamina propria, individual cells of medium size are observed, with moderate pleomorphism and some in a signet ring

Fig. 5

RCC. Histopathological examination of the left kidney (H&E ×20) where large cell sheets with optically clear cytoplasm and round nuclei of fine chromatin are observed

Fig. 6

PRISMA flow diagram detailing the search and identification strategy for the studies used in data synthesis

Fig. 7

Diagram explaining our total population and the result of gastric/renal synchronous cases