Cancer Res Treat.  2008 Jun;40(2):97-99.

A Case of Multiple Intussusceptions in the Small Intestine Caused by Metastatic Renal Cell Carcinoma

• Eo WK
• Kim GY
• Choi SI

Abstract

Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is rare. Small bowel metastasis from RCC can induce obstruction or bleeding, and perforation can also be induced in rare case. Yet RCC metastasis to the small bowel is unlikely to be a direct cause of intussusceptions. A few cases of intussusceptions caused by small intestinal metastasis of RCC have been reported, but multiple small intestinal intussusceptions are extremely rare. We report here on a 47-year-old male patient who presented to the emergency room with acute abdominal pain. He had undergone radical nephrectomy 2 years previously due to left RCC. The abdominal CT scan revealed enhanced masses with the "target" sign that suggested enteric intussusceptions in the jejunum. Eight pedunculated masses within the small intestinal lumen led to intussusceptions at 30 and 150 cm distal to Treitz ligament. Three segmental resections of the small intestine and functional end to end anastomosis were done. The patient recovered uneventfully from this operation. To the best of our knowledge, this is the 1st report of metastases from RCC that presented as synchronous intraluminal polypoid tumors, and these tumors served as the lead points for two intussusceptions in the jejunum.

Keyword

Renal cell carcinoma; Small intestine; Intussusception

MeSH Terms

Abdominal Pain
Carcinoma, Renal Cell
Emergencies
Hemorrhage
Humans
Intestine, Small
Intussusception
Jejunum
Ligaments
Male
Middle Aged
Neoplasm Metastasis
Nephrectomy

Figure

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  Fig. 1 CT scan reveals enhanced masses with the "target" sign, suggesting enteric intussusception in the jejunum.

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  Fig. 2 Mucosal surface of the small intestine shows multiple poylpoid masses.

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  Fig. 3 The cut surface of the polypoid mass is gray white and solid. The polyp has a stalk and surface ulceration.

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  Fig. 4 On the scanning view, a polypoid mass shows ulceration. (H-E stain, ×1).

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  Fig. 5 The renal cell carcinoma is composed of clear and granular cells that are surrounded by delicate fibrovascular stroma. (H-E stain, ×200).

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