Metastatic renal cell carcinoma presenting as chronic bleeding from the stomach: a rare case report

Renal cell carcinoma (RCC) most commonly metastasizes to the lung, adrenals, brain and pancreas, but metastasis to the stomach is uncommon. We present a 77-year-old male who underwent left nephrectomy 9 years previously for RCC with known metastatic disease to the lungs, diaphragm and stomach, and required multiple transfusions for acute blood loss anemia. A previous esophagogastroduodenoscopy revealed a large, friable, ulcerated mass at the gastric cardia. Biopsies of the mass demonstrated clear-cell carcinoma compatible with metastatic RCC. After multiple attempts at endoscopic, procedures and embolization were unsuccessful at controlling bleeding, the patient was treated with palliative total gastrectomy with Roux-en-Y gastric bypass. At discharge, the patient had been hemodynamically stable and tolerating a liquid diet. This case report highlights the presenting symptomology of RCC, explores the rarity of gastric metastases, and reviews current literature on management strategies for these patients.