Metastatic renal cell carcinoma to pancreas and gastrointestinal tract: a clinicopathological study of 3 cases and review of literature

Abstract

Background: Renal Cell Carcinoma (RCC) metastasizes in approximately 20-30% cases. The most common sites for metastases are the lungs, bones, liver, and brain. Metastases of RCC in the gastrointestinal tract (GIT) are very rare. Metastatic RCC has a poor prognosis. We herein present a case series of three patients with metastatic disease in the colon, duodenum, and pancreas following complete resection of RCC.

Methods: Hematoxylin and Eosin and immunohistochemical slides of 3 cases of RCC metastatic to GIT were reviewed. These cases were diagnosed between 2002 and 2019 at French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan, and Aga Khan University Hospital (AKUH), Karachi, Pakistan. We also present a detailed review of published literature.

Results: We reviewed cases of three patients, two females and one male, with a mean age of 57.3 years (range 40-67 years) who underwent nephrectomy for RCC. They developed metastases in the colon, pancreas, and duodenum, respectively 12-168 months (median time 156 months) following primary tumor resection. The patient with metastatic RCC in colon presented with abdominal pain and constipation. An ulcerated mass was found on colonoscopy 30 cm from the anal verge. Diagnosis of RCC with rhabdoid features was confirmed in both primary and metastatic tumors. The second patient developed a metastatic nodule in the head of pancreatic while the third patient developed metastatic nodules in the duodenum and pancreas which were detected by Computed Tomography (CT) scanning. Histopathological examination confirmed the presence of clear cell RCC in the metastatic nodules in both cases.

Conclusion: Metastatic RCC should be considered in the differential diagnosis of mass in the gastrointestinal (including pancreaticobiliary) tract especially in presence of a past history of RCC. These patients should be screened thoroughly by physical examination and appropriate imaging studies.

Keywords: Clear cell; Colon; Metastasis; Pancreas; Renal cell carcinoma; Rhabdoid.

Fig. 1

Grossly after opening of the segment of rectum, there was an exophytic mass with lobulated surface (a). On microscopic low power, a submucosal neoplasm arranged in sheets, alveolar and rhabdoid patterns was seen (b). The neoplastic cells were pleomorphic having abundant eosinophilic cytoplasm, enlarged hyperchromatic eccentric nuclei and prominent nucleoli (c). IHC stains were positive for PAX8 (d)

Fig. 2

CT scan findings reveals a mass in pancreatic head (a). Microscopically, the tumor cells were large and have distinct cell borders with central round hyperchromatic nuclei and abundant clear cytoplasm (b). IHC stains were positive for RCC (c) and PAX8 (d)