P3399 - A Rare Case of Rapidly Developing Gastric Metastasis From Renal Cell Carcinoma

Osama Alshakhatreh, MD¹, Ahmad Abulawi, MD¹, Khaled Elsokary, DO¹, Hasan B. Aydin, MD¹, Raya Alashram, MD¹, Stephen Hasak, MD, MPH^2
1Albany Medical Center, Albany, NY; ²Albany Medical College, Albany, NY

Introduction: Gastric metastasis is a rare occurrence, with lobular breast carcinomas and melanomas typically associated with such disease. Renal cell carcinomas (RCC), although prone to metastasizing to lungs, bones, and liver, seldom metastasizes to the stomach. Here, we present a case of RCC demonstrating an unusual and rapid development of gastric metastasis, manifested by melena.

Case Description/Methods: A 51-year-old male, incidentally diagnosed with left clear cell RCC in 2020 and subsequently treated with radical nephrectomy, presented three years later with melena. Initially, the patient underwent active surveillance until thoracic spinal metastasis developed a year later. Treatment commenced with Pembrolizumab and Lenvatinib, and later switched to Ipilimumab and Nivolumab. In 2023, the patient experienced melena and anemia, prompting imaging that uncovered numerous lung and liver metastases, along with a right adrenal nodule. Subsequent esophagogastroduodenoscopy (EGD) unveiled two small papules in the gastric fundus exhibiting stigmata of recent bleeding (Figure A). Pathological analysis confirmed metastatic renal cell carcinoma (Figure B).

Discussion: Gastric metastasis from RCC is exceptionally rare, typically detected approximately seven years post-RCC diagnosis. Despite its infrequency, studies indicate RCC accounts for 7-10% of gastric metastases. Patients often present with gastrointestinal bleeding, anemia, and occasionally with abdominal pain. Endoscopic examination commonly reveals submucosal polypoid-like lesions in the middle third of the stomach, sometimes these lesions can be ulcerated and extending to the upper and lower thirds. Checkpoint inhibitor-based combination therapy is the primary treatment for advanced RCC, associated with improved outcomes and prolonged progression-free survival. However, our case demonstrates an accelerated onset of gastric metastasis despite such therapy.



Disclosures:


Osama Alshakhatreh, MD¹, Ahmad Abulawi, MD¹, Khaled Elsokary, DO¹, Hasan B. Aydin, MD¹, Raya Alashram, MD¹, Stephen Hasak, MD, MPH². P3399 - A Rare Case of Rapidly Developing Gastric Metastasis From Renal Cell Carcinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.