Solitary colonic metastasis from renal cell carcinoma presenting as a surgical emergency nine years post-nephrectomy
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WORLD JOURNAL OF SURGICAL ONCOLOGY Open Access
CASE REPORT
Solitary colonic metastasis from renal cell carcinoma presenting as a surgical emergency nine years post-nephrectomy Case report
Alka M Jadav1, Sri G Thrumurthy*1,2 and Bernard A DeSousa3
Abstract Late colonic metastasis following curative surgery for renal cell carcinoma has rarely been described. We present the first reported case of solitary colonic renal cell carcinoma metastasis presenting as an intra-abdominal bleed, nine years post-nephrectomy. Background The worldwide incidence of renal cell carcinoma (RCC) is approximately 209 000 new cases per year with a mortality of 102 000 deaths per year. This accounts for 3% of all adult malignancies. Metastatic disease may be present in up to 25% of patients at the time of diagnosis [1,2]. Intestinal metastasis from RCC is uncommon. The commonest site of distant metastasis in 1451 autopsy cases with RCC was in the lungs (76%), followed by lymph nodes, bones and liver [3]. RCC very rarely metastasizes to the colon - a comprehensive Medline search revealed only 7 reported cases to date, of post-nephrectomy colonic metastasis from RCC [4-10]. This case represents the first incidence of late colonic RCC metastasis presenting as a surgical emergency in the way of an intraabdominal bleed. Case Presentation A 65-year-old woman presented to casualty with acute abdominal pain and collapse. The only significant history was of a left nephrectomy for clear cell renal carcinoma nine years previously, from which she had made a full recovery, recently being discharged from further followup. The patient recalled that her RCC had been excised with tumour-free margins - no further information was available. Examination revealed generalised abdominal tenderness with a normal haemoglobin of 11.4 g/dL. Portable * Correspondence: [email protected] 1
Department of Lower Gastrointestinal Surgery, Royal Preston Hospital, Preston, PR2 9HT, UK
ultrasound scan excluded an abdominal aortic aneurysm. A few hours later, she became haemodynamically unstable with marked abdominal distension. Repeat bloods showed a drop in haemoglobin to 7.7 g/dL. There had been no sign of haematemesis, melaena or fresh rectal bleeding. At emergency laparotomy, an actively bleeding mass was found attached to the surface of the mid-transverse colon. This was excised locally with the resulting colonic defect closed in 2 layers. No other lesions were noted within the abdominal cavity. Macroscopic examination revealed a 6 × 6 cm soft brown tumour with central necrosis. Histology of the lesion demonstrated a clear cell tumour - a metastasis from the original renal cell carcinoma removed nine years previously. Subsequent computed tomography (CT) of the thorax and abdomen excluded any further metastatic disease. As such, a conservative approach without immunotherapy was adopted and the patient was followed-up with regular clinical examination and CT scans. No evidence of further recurrence has been demonstrated six years following her laparotomy.
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