P4965 - The Forgotten Segment: A Rare Case of D3 Metastatic Renal Clear Cell Carcinoma

Carmen Tormo, MD¹, Kristen Santana, MD², Daniel Campbell, DO³, Steven Kaplan, MD^2
1HCA Aventura Hospital, Aventura, FL; ²Aventura Hospital, Aventura, FL; ³HCA Florida Healthcare, Aventura, FL

Introduction: Duodenal metastases are rare, accounting for 0.3% of gastrointestinal malignancies. About 67% occur in the D2 segment, with D3-D4 involvement being even more unusual. Duodenal tumors represent 4% of all GI tumors. Symptoms are often nonspecific, including abdominal pain, emesis, and weight loss, impeding early detection and treatment.

Case Description/Methods: A 65-year-old male with coronary artery disease on dual antiplatelet therapy and metastatic Renal Cell Carcinoma (RCC) on immunotherapy presented with 3 days of black stools. He reported a similar episode the previous year, evaluated with inconclusive esophagogastroduodenoscopy (EGD) and colonoscopy at another facility. The patient denied weight loss, jaundice, early satiety, nausea, or vomiting. No family history of GI or renal cancer was noted.

Patient underwent urgent EGD which revealed a malignant-appearing lesion in the distal D3 duodenal segment. Biopsy confirmed metastatic clear cell renal cell carcinoma.

Discussion: RCC typically metastasizes to the lungs, liver, and bone. Duodenal metastasis is rare, particularly to D3-D4 segments, with limited cases in literature. Nonspecific symptoms may preclude direct investigation and hamper diagnosis. Our patient's initial presentation with melena is atypical for duodenal RCC metastasis.

The rarity of this metastatic location and difficulty accessing distal duodenal segments during EGD may contribute to underreporting. This case emphasizes the importance of thorough investigation of full duodenal segments in EGD evaluations, especially for patients with known RCC history.

Conclusion: A patient presenting with melena and a known history of RCC should be evaluated for upper gastrointestinal metastasis, particularly of the duodenum. This case presented here underscores the importance of going the extra distance for a detailed investigation of the full duodenal distal segments during EGD investigations.


Disclosures:


Carmen Tormo, MD¹, Kristen Santana, MD², Daniel Campbell, DO³, Steven Kaplan, MD². P4965 - The Forgotten Segment: A Rare Case of D3 Metastatic Renal Clear Cell Carcinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.