Korean J Radiol.  2017 Jun;18(3):452-460. 10.3348/kjr.2017.18.3.452.

Gastrointestinal Involvement of Recurrent Renal Cell Carcinoma: CT Findings and Clinicopathologic Features

• Park HJ
• Kim HJ
• Park SH
• Lee JS
• Kim AY
• Ha HK

• KMID: 2427300
• DOI: http://doi.org/10.3348/kjr.2017.18.3.452

Abstract

OBJECTIVE
To retrospectively evaluate the CT findings and clinicopathologic features in patients with gastrointestinal (GI) involvement of recurrent renal cell carcinoma (RCC).
MATERIALS AND METHODS
The medical records were reviewed for 15 patients with 19 pathologically proven GI tract metastases of RCC. The CT findings were analyzed to determine the involved sites and type of involvement; lesion size, morphology, and contrast enhancement pattern; and occurrence of lymphadenopathy, ascites and other complications.
RESULTS
The most common presentation was GI bleeding (66.7%). The average interval between nephrectomy and the detection of GI involvement was 30.4 ± 37.4 months. GI lesions were most commonly found in the ileum (36.8%) and duodenum (31.6%). A distant metastasis (80%) was more common than a direct invasion from metastatic lesions. The mean lesion size was 34.1 ± 15.0 mm. Intraluminal polypoid masses (63.2%) with hyperenhancement (78.9%) and heterogeneous enhancement (63.2%) were the most common findings. No patients had regional lymphadenopathy. Complications occurred in four patients, with one each of bowel obstruction, intussusception, bile duct dilatation, and pancreatic duct dilatation.
CONCLUSION
GI involvement of recurrent RCC could be included in the differential diagnosis of patients with heterogeneous, hyperenhanced intraluminal polypoid masses in the small bowel on CT scans along with a relative paucity of lymphadenopathy.

Keyword

Gastrointestinal tract; Renal cell carcinoma; Metastasis; Computed tomography

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Renal Cell/*diagnostic imaging/pathology
Diagnosis, Differential
Female
Gastrointestinal Hemorrhage/diagnostic imaging/pathology
Gastrointestinal Neoplasms/diagnostic imaging/secondary
Humans
Intussusception/diagnostic imaging
Lymphatic Diseases
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Nephrectomy
Retrospective Studies
*Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Gastric metastasis from recurrent renal cell carcinoma in 47-year-old man.This patient had undergone left nephrectomy 5 years earlier.A. Axial CT image showing strongly enhancing, homogeneous intraluminal polypoid mass arising from gastric fundus (arrows). B. Esophagogastroduodenoscopy revealing lobulated, protruding hyperemic mass with friable mucosa in gastric fundus. C. Gross specimen from stomach after wedge resection. Well-margined, lobulated soft tissue mass with multifocal hemorrhage was observed. Metastatic renal cell carcinoma was confirmed through histopathologic analysis, with mass found to involve submucosal layer of gastric wall.

• 

  Fig. 2 Direct invasion of metastatic cancer from pancreatic head to duodenum in 63-year-old man.This patient had undergone radical left nephrectomy 9 years before.A, B. CT scans showing lobulated, heterogeneous soft tissue mass arising from pancreatic head. Mass directly involved medial wall of duodenum, penetrating mural layer of duodenal wall (arrows, A) with suspected ulceration (arrowhead). Distal portion of the main pancreatic duct was diffusely dilated (arrows, B). C. Gross appearance of pancreatectomy specimen was consistent with CT findings of exophytic mass involving medial wall of duodenal second portion with ulceration (arrowheads). Pathologic diagnosis was metastatic renal cell carcinoma.

• 

  Fig. 3 Ileal metastatic lesion causing obstruction in 62-year-old man who had undergone right nephrectomy 7 years earlier.A. Axial CT image showing lobulating intraluminal polypoid hypervascular mass in proximal ileum (arrows). Proximal small bowel loops were dilated with small bowel feces signs (arrowheads). B. Coronal reconstructed CT scan showing intraluminal mass (arrows) and diffuse dilatation of proximal bowel. Note small amount of perienteric fluid collection (arrowheads). C. Gross appearance of resected bowel. Firm, polypoid mass involving submucosal layer was confirmed as being metastatic renal cell carcinoma.

• 

  Fig. 4 Intussusception caused by jejunal lesion from recurrent renal cell carcinoma in 53-year-old man who had undergone left nephrectomy 9 months earlier.A. Axial CT image showing jejunal intussusception (arrows) with multiple intraluminal masses at other sites (white arrowheads) and peritoneal seeding lesions (black arrowheads). B. Coronal reconstruction image depicting lobulated, hypervascular mass (arrows) at tip of intussusceptum. Note seeding nodules (black arrowheads). C. Gross specimen from segmental jejunal resection, showing several intra-and extraluminal masses. Lesions were pathologically diagnosed as metastatic renal cell carcinoma.

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