Recurrent renal cell carcinoma presenting as gastrointestinal bleed. A case report

Recurrence in renal carcinoma after primary therapy is a rare but known event. The recurrences are often asymptomatic, but could manifest in varied forms depending on the organ involved. In this report, we present a case wherein the recurrent tumor had ulcerated into the duodenal lumen manifesting as an upper gastrointestinal bleed. A 58-year-old male patient underwent radical nephrectomy on the right side for renal cell carcinoma (T2, N0, M0). Three years and 5 months later, the patient presented with an acute episode of upper gastrointestinal bleed. The recurrence was diagnosed by biopsy through endoscopy and evaluated by computed tomography (CT) scan. The patient was managed with an en bloc pancreatico-duodenectomy after metastatic evaluation and is disease free for 2 years. Recurrences in renal cell carcinoma can show varied presentation. Only 2 cases of gastrointestinal bleed of recurrent renal cell carcinoma are reported. High index of suspicion and long term follow-up are required. Aggressive surgical management for recurrence of renal cell carcinoma is warranted as good prognosis could be expected in the absence of metastasis.