Malignant phyllode tumor metastatic to the duodenum

Phyllode tumor (PT) is extremely rare tumor of the breast. Distant metastasis occurs in 10-20% of patients with malignant phyllode tumor. The most common sites of metastases are the lungs and bones. Although theoretically any organ may have metastasis, an isolated duodenum metastasis has not been documented as yet in the English-language literature. We report herein a case with a isolated duodenal metastasis from PT of breast in a 31 year-old-woman who underwent right mastectomy 4 years before because of the recurrent malignant PT. She presented to our hospital with massive upper gastrointestinal bleeding. Clinical evaluation revealed a huge mass originated from duodenum. Urgent laparotomy and pancreaticoduodenectomy were carried out in order to remove the bleeding duodenal mass. The pathologic examination of the resected specimen showed a malignant spindle cell tumor consistent with metastatic malignant PT. Our case of gastrointestinal bleeding due to an isolated duodenal metastasis as a result of hematogenous spread from malignant phyllode tumor of breast is unique in the English literature and pancreaticoduodenectomy is a curative treatment for patients with isolated duodenal involvement.     

Islet Cell Tumor Presenting as Massive Upper Gastrointestinal Bleeding in Pregnancy

A 27-yr-old woman presented in the 6th month of pregnancy with massive gastrointestinal bleeding due to erosion of a pancreatic islet cell tumor into the duodenum. Most islet cell tumors present with neuroendocrine manifestations; massive bleeding is a very rare presenting sign. This is the first reported case of a pregnant woman with massive bleeding from islet cell tumor erosion who underwent successful resection and delivery of a healthy term child 3 months later.     

Duodenal bleeding revealing a renal cell carcinoma

The pancreas is an uncommon site of metastasis from renal cell carcinoma. The metastasis is generally diagnosed during the follow-up of patients who underwent nephrectomy for renal cell carcinoma. In our observation, duodenal bleeding led to the diagnosis of both pancreatic metastasis and renal carcinoma. The diagnosis of pancreatic metastasis should be suspected when a pancreatic mass is associated with past or synchronous renal carcinoma. The outcome after resection of pancreatic metastasis is better than after resection of pancreatic adenocarcinoma. Surgical resection of pancreatic metastasis should be considered when possible.     

Isolated gall bladder metastasis from renal cell carcinoma.

Gall bladder metastasis from renal cell carcinoma is rare. We report a 46-year-old man with isolated gall bladder metastasis from renal cell carcinoma 11 months after radical nephrectomy. He underwent cholecystectomy and frozen section revealed the metastatic tumor. Sixteen months later, the patient is free of disease.     

Metastatic renal cell carcinoma involving the rectum

BACKGROUND AND AIMS: Metastatic spread of a distant tumor to the rectum is extremely rare. To our knowledge, there have been no published reports of hematogenic metastasis from a renal cell carcinoma to the rectum. PATIENTS AND METHODS: A patient with a renal cell carcinoma was initially treated by a radical right nephrectomy. RESULTS: Nine months after the surgery he started to have multiple episodes of hematochezia. Colonoscopy showed a nodular lesion located in the distal rectum, and biopsy revealed an undifferentiated carcinoma. The patient then underwent abdominoperineal resection of the rectum, and histological examination showed metastatic renal clear cell carcinoma. CONCLUSION: This case represents an exceedingly rare condition, which has never been reported before.     

Solitary synchronous metastatic gastric cancer arising from t1b renal cell carcinoma: a case report and systematic review

Metastasis to the stomach from renal cell carcinoma (RCC) is extremely rare. Usually, gastric metastasis seems to be a late event in patients with RCC and is accompanied by disseminated tumor spread to other organs. Solitary synchronous gastric metastasis from small, localized RCC has rarely been reported. We report a case of 79-year-old man with synchronous gastric metastasis presenting with a single erosive lesion from pT1 RCC. The patient underwent radical nephrectomy and endoscopic resection for metastatic gastric cancer. The resected specimen showed an ill-defined tumor, approximately 0.6 cm long, with a clear resection margin. The morphologic features of the tumor cells were consistent with those of metastatic RCC of the clear cell type. At 6 months's follow-up, the patient did not show local recurrence or additional metastasis on upper endoscopy and computed tomography scan.     

Unusual presentation of rectal adenocarcinoma

Metastatic tumors in the gastrointestinal tract are rare with an overall prevalence of 1-4 per cent in the postmortem series. Lung cancer, renal cell carcinoma, breast carcinoma and malignant melanoma are considered the most common primary tumors metastatic to the small bowel. Local duodenal metastasis from colonic cancer and cecum have been reported, but metastasis to the duodenum from rectosigmoid adenocarcinoma has not been reported before. We report the first case of metastasis in the duodenum from an adenocarcinoma of the rectum presented as a recurrent acute prerenal azotemia caused by volume depletion which had resulted from duodenal obstruction.     

Metastatic renal cell carcinoma to head of the pancreas successfully treated by left nephrectomy and pancreatoduodenectomy

We describe a patient with renal cell carcinoma with synchronous metastasis to the head of the pancreas who underwent left nephrectomy and pancreatoduodenectomy. The 57-year-old man was referred to us because of jaundice. Computed tomography of the abdomen showed irregular masses in the left kidney and head of the pancreas. Endoscopic retrograde cholangiopancreatography revealed a filling defect at the head of the pancreas. Renal angiography demonstrated the hypervascular nature of the lesion. No other tumor lesions were discovered. The patient underwent left nephrectomy and pancreatoduodenectomy. Postoperative histopathologic examination revealed clear cell-type renal cell carcinoma in both the renal and pancreatic lesions. At follow-up 3 years later, the patient was alive without evidence of recurrent disease. We present a rare case and assess the role of aggressive surgical management for this unusual problem.     

Rare cause of upper gastrointestinal bleeding owing to hepatic cancer invasion: A case report

Upper gastrointestinal bleeding refers to bleeding that arises from the gastrointestinal tract proximal to the ligament of Treitz. The primary reason for gastrointestinal bleeding associated with hepatocellular carcinoma is rupture of a varicose vein owing to pericardial hypotension. We report a rare case of gastrointestinal bleeding with hepatocellular carcinoma in a patient who presented with recurrent gastrointestinal bleeding. The initial diagnosis was gastric cancer with metastasis to the multiple lymph nodes of the lesser curvature. The patient underwent exploratory laparotomy, which identified two lesions in the gastric wall. Total gastrectomy and hepatic local excision was then performed. Pathological results indicated that the hepatocellular carcinoma had invaded the stomach directly, which was confirmed immunohistochemically. The patient is alive with a disease-free survival of 1 year since the surgery. Hepatocellular carcinoma with gastric invasion should be considered as a rare cause of upper gastrointestinal bleeding in hepatocellular carcinoma patients, especially with lesions located in the left lateral hepatic lobe. Surgery is the best solution.     

Renal cell carcinoma and synchronous thyroid metastasis with neoplastic thrombosis of the internal jugular vein: report of a case

A case of thyroid metastasis of a renal clear cell carcinoma is presented. The fine-needle aspiration cytology pointed out the primary tumor origin. The patient underwent robot-assisted radical nephrectomy and contextual thyroidectomy. During the operative procedure, a neoplastic thrombus extending from the thyroid metastasis and protruding into the internal jugular vein was found. As a result, thrombectomy and ligation of the internal jugular vein were required. In cases of single synchronous thyroid metastases form RCC, radical surgery should be advisable. Robotic approach allows to associate major surgery procedures, as nephrectomy, with radical metastasectomy.     

Upper Gastrointestinal Bleeding Due to Superior Mesenteric Artery to Duodenum Fistula: Rare Complication of Metastatic Lung Carcinoma

Although metastases from primary carcinoma of the lung to the small intestine appear to be more common than previously suspected, they rarely produce symptoms. Such metastases may present as bowel perforations. Overt gastrointestinal bleeding has been described only as a prelude to perforation. We describe the case of a 55-yr-old man with carcinoma of the lung that had metastasized to the brain and to the third part of the duodenum. The duodenal metastasis presented with massive upper gastrointestinal hemorrhage. The metastasis was seen to be actively bleeding at endoscopy, and a direct fistula from a branch of the superior mesenteric artery to the third part of the duodenum was shown angiographically. Arterial invasion and destruction by tumor was confirmed at postmortem examination. This complication of metastatic carcinoma of the lung has not been previously described in the English literature.     

Uncommon etiology of gastrointestinal bleeding: duodenal metastases from renal cell carcinoma

Because of its unpredictable behavior, renal cell carcinoma is one of the most controversial neoplasms. On the one hand, patients frequently show metastases at diagnosis because of its slight manifestations, while on the other, the neoplasm can remain stable after nephrectomy and can then metastasize many years later. When this happens, the metastases usually involve more than 2 organs. The most frequent sites of metastases are the lung and lymph nodes, followed by the bones and liver, while duodenal involvement is rare. Indeed, intestinal metastases are found in only 2% of autopsies and of these, renal cell carcinoma metastases account for 7.1%. We present a case of a solitary late recurrence presenting as upper gastrointestinal bleeding 19 years after nephrectomy for clear cell renal carcinoma.     

Metastatic renal cell carcinoma to the pituitary gland presenting with hypopituitarism.

A 57-year-old man with pituitary metastasis from renal cell carcinoma is reported. He underwent right nephrectomy and total pancreatectomy for renal cell carcinoma and its pancreatic metastasis, respectively. Imaging studies showed an intrasellar mass lesion. The examination revealed panhypopituitarism, diabetes insipidus and bitemporal hemianospia. Metastatic renal cell carcinoma was diagnosed by the biopsy of the pituitary tumor. Metastatic renal cell carcinoma to the pituitary gland, which is extremely rare, appears to have unique features of presenting with hypopituitarism and visual disturbance more frequently than other metastatic pituitary tumors.     

Multiple metastases from renal carcinoma 15 years after nephrectomy

A 72-year-old man was admitted to our hospital complaining of an axillary mass. He underwent left total nephrectomy for renal cell carcinoma (RCC) 15 years previously (in 1990). Since further evaluation yielded no evidence of extra renal metastases, he was followed up in the outpatient clinic. On admission, there was a hard tumor in the right axilla. Ultrasonography demonstrated a vascular tumor with a smooth surface, 26 by 24mm. Laboratory findings were generally close to normal, including tumor markers. Chest contrast-enhanced dynamic CT showed that the tumor was enhanced. Furthermore, abdominal contrast-enhanced dynamic CT revealed some enhancing lesions within the right side of the rectus muscle of abdomen and pancreas head as well. Open simple axillary mass biopsy was performed on August 2 and the tumor was histologically confirmed as a metastasis of the RCC to the axillary. His overall status was normal, and he underwent an operation for the pancreas tumor and the tumor in the rectus muscle of the abdomen. On histological examination, both excised specimens were found to be metastases of RCC. During 2 years follow-up period in the outpatient clinic, additional metastasis has not been observed in any organ. Since this case confirms the potential of RCC for late and multiple distant metastases, careful long-term follow-up after radical nephrectomy is needed.     

A rare combination consisting of primary hyperaldosteronism and glucagonoma

A 59-yr-old man with multiple pancreatic tumors is presented. Previously, he had undergone left adrenalectomy for primary hyperaldosteronism and left nephrectomy for renal cell carcinoma at the ages of 39 and 55 yr, respectively. This time, 3 yr after removal of renal cancer, two solid lesions in the pancreas associated with hyperglucagonemia were detected. Under a diagnosis of pancreatic metastasis from renal cell carcinoma or islet cell tumor of the pancreas, distal pancreatectomy with splenectomy and enucleation of the tumor in the pancreas head were performed. Microscopically, a glucagonoma, measuring 2.3 mm in diameter, was detected among five pancreatic metastases from renal cell carcinoma. Four years after surgery, the patient remains well, without signs of recurrence despite multiple pancreatic metastases. This is the first report of such a rare combination consisting of aldosterone-secreting adrenal adenoma and glucagonoma.     

Unexpected outcome after sclerotherapy of simple renal cyst

ABSTRACT: BACKGROUND: Simple renal cysts usually have benign clinical features. We report a rare case of papillary renal cell carcinoma (RCC) associated with a large recurrent simple cyst following sclerotherapy. Case Presentation A 47-year-old Japanese woman received minocycline sclerotherapy for a large (9 cm in diameter) simple left renal cyst in May 2005. The cyst regrew, and second-line sclerotherapy with ethanol was performed in November 2005. Three years later, she developed papillary RCC on the wall of the recurrent renal cyst. Radical nephrectomy was performed, but the patient died of metastatic disease 15 months after surgery. CONCLUSION: Malignant transformation from recurrent simple renal cyst to RCC may occur in the years following sclerotherapy, underscoring the need for long-term follow-up. Key words: papillary renal cell carcinoma, simple renal cyst, sclerotherapy, malignant transformation.     

Coexistence of papillary renal cell carcinoma and gastrointestinal stromal tumor in a case.

Gastrointestinal stromal tumors are rare causes of gastrointestinal bleeding. In most cases, these tumors are localized in the stomach and small intestine, more rarely in the esophagus and colon. Papillary renal cell carcinoma and gastrointestinal stromal tumor may occur as recurrent familial tumors related to mutations in the protooncogenes, c-MET and c-KIT, both of which are tyrosine kinase receptor molecules. However, these two tumors can sometimes occur simultaneously in sporadic cases. Some authors blame imatinib mesylate (Gleevec), which is traditionally used in gastrointestinal stromal tumor therapy, as the etiological factor in certain secondary tumors, especially papillary renal cell cancer. In this paper, we present the appearance and growth of papillary renal cell carcinoma in a patient receiving Gleevec therapy for gastrointestinal stromal tumor.     

Pancreatic metastasis from renal cell carcinoma causing massive gastrointestinal bleeding in von Hippel-Lindau disease.

Patients with von Hippel-Lindau disease (VHLD) may develop pancreatic lesions, including cysts, serous cystadenomas and islet cell tumors. However, only a few cases of pancreatic metastasis have been reported. We present a case of VHLD with multiple pancreatic metastases from renal cell carcinoma. One of the metastases invaded the duodenum, causing massive bleeding.     

Nephron-sparing surgery versus radical nephrectomy in the treatment of renal cell carcinoma up to 7 cm

To compare the oncological outcome of nephron-sparing surgery versus radical nephrectomy in renal cell carcinoma up to 7 cm by retrospectively reviewing our surgical experience. MATERIALS AND METHODS. Data collected from 1290 consecutive patients, who underwent surgery for renal carcinoma, have been stored since 1983 into a dedicated database. The cases with unilateral carcinoma up to 7 cm, pT1a/pT1b/pT3a N0/Nx M0, followed up for a minimum of 12 months if disease-free were reviewed. RESULTS. 732 patients were selected (mean follow-up: 72 months); 329 had a tumor less than 4 cm in diameter (182 cases of nephron-sparing surgery, 147 cases of nephrectomy), while for 403 of them the tumor was 4 cm or more (57 cases of nephron-sparing surgery, 346 cases of nephrectomy). The comparison between tumors less and equal to/more than 4 cm showed worse progression and disease-free survival rates for the latter, even though the type of surgery (nephron-sparing or radical) had no significant impact. Patients with extracapsular carcinoma ≥4 cm, treated with nephron-sparing surgery, had a particularly poor prognosis. CONCLUSIONS. The conservative management can be cautiously suggested for renal cancers up to 7cm, since the prognosis worsens proportionally with the diameter increase, with no statistical difference for both nephron-sparing and radical surgery. Nephron-sparing surgery proved to be the suitable treatment modality also for pT3a tumors measuring <4 cm, whereas when the tumor size increases, an adequate intraoperative evaluation of peritumoral tissues is essential to rule out fat infiltration. These results comply with the few similar studies available in literature, and suggest the possibility of designing a prospective study aiming at comparing conservative and radical surgery in the management of renal carcinoma up to 7 cm.     

Refining indications for contemporary surgical treatment of renal cell carcinoma metastatic to the pancreas

Background:

The pancreas is a rare location for metastatic disease, with only 2–11% of all pancreatic tumours being of non-primary origin. It is also uncommon for renal cell carcinoma (RCC) to metastasize to the pancreas (1–3% of cases) and, when it does, it typically occurs substantially after index nephrectomy. It is not known whether all pancreatic metastases need be resected because today''s chemo- and biological therapies are increasingly effective in controlling advanced disease.

Methods:

Six patients with a variety of symptoms are discussed. Four patients presented with recurrent gastrointestinal bleeding, ranging from occult to life-threatening in severity.

Results:

The four patients with gastrointestinal bleeding had RCC metastases that had eroded into the duodenum and were successfully controlled by palliative pancreaticoduodenectomy or completion pancreatectomy. The other two patients were treated using different chemotherapeutic or biological agents.

Conclusions:

Renal cell carcinoma metastases to the pancreas typically occur long after index nephrectomy. Although clinical presentation is variable, palliative resection should be reserved for those who develop complications, such as upper gastrointestinal bleeding, and, in other series, obstructive jaundice. Routine debulking resections do not appear to be indicated because current biological therapies effectively and reliably control disease over long periods.