Abstract
#Renal cell carcinoma (RCC) is the sixth most common #cancer in men and
the eighth most common cancer in women in the United States, with an
estimated 65,150 new cases diagnosed in 2013 [1]. RCC’s classic
presenting triad of hematuria, flank pain and palpable abdominal mass
are only present in about 9 percent of patients and often, RCC is found
incidentally on imaging. At diagnosis, about 16% of cases have evidence
of disease in lymph nodes and 16% with distant metastases [2]. Typical
sites for metastasis include lungs, bone, liver, and brain, [3] whereas
#intestinal metastasis is rare [4]. It is important for #gastroenterologists to acknowledge the possibility of presence of
metastases during endoscopy in these patients. In this case series, we
present three patients with history of renal cell carcinoma with
gastrointestinal metastases. A 52-year-old male with HIV and new onset iron deficiency anemia
presented for further evaluation of acute blood loss anemia with
hemoglobin decrease from 16 to 7.9mg/dl. Six months prior to
presentation, he had EGD with LA Class B #esophagitis and #colonoscopy
with 2 mm sigmoid polyp (biopsy with tubular adenoma). Video Capsule
endoscopy showed an ulcerated lesion in distal ileum with active oozing
(Figure 1A) and a non-bleeding arteriovenous malformation (Figure1B). A
1.5cm ulcerated distal ileum lesion was discovered on single balloon
enteroscopy subsequently with biopsy revealing metastatic carcinoma with
clear cell phenotype, with #immunohistochemistry consistent with primary
renal cell carcinoma. A new diagnosis of metastatic RCC was made by
single balloon enteroscopy.
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