Spontaneous rupture of a metastasis to the gastric wall as initial manifestation of a renal cell carcinoma. Case report and review of the literature

Introduction: The incidence of tumor metastasis to the upper GI-region in p atients with renal call carcinoma is very uncommon. Gastric metastatic tumo rs in these patients have been mainly reported in autopsy series. In genera l hematemesis, melena and anemia according to upper GI bleeding are the mai n clinical problems in patients with tumor metastasis to the stomach. Case report: A 56 year old man presented to the emergency room with an intr aabdominal bleeding of unknown origin. The patient was explored transperito neally. A ruptured tumor of the gastric wall could be identified as the sou rce of bleeding. Histologic examination of the resected gastric tumor showe d morphologic appearance consistent with the metastasis of a renal cell car cinoma. Further diagnostic means revealed a tumor of the left kidney and th e patient underwent radical nephrectomy 15 days after laparotomy. The histo morphologic examination of the renal tumor showed a renal cell carcinom tha t was identical with the histology of the resected gastric mass. We didn't find other cases in the literature that described a spontaneous rupture of a metastasis to the gastric wall as initial manifestation of a renal cell c arcinoma. Conclusions: Metastatic disease involving the stomach in patients with rena l carcinoma is very rare. But a gastrointestinal metastasis should be thoug ht of in these patients and if there is clinical evidence a gastrointestina l endoscopy should be performed.