RENAL HÜCRELİ KARSİNOMUN MİDEYE METASTAZI: OLGU SUNUMU

Öz

Primer mide tümörlerine, metastatik tümörlerinden daha sık rastlanır. Berrak hücreli renal hücreli karsinomun (BHRHK) mideye metastazı çok nadirdir. Bu yazıda BHRHK’un mideye metastazı olgusunu sunduk. Altmış yaşında erkek hasta radikal nefrektomi geçirdi ve adjuvan kemoterapi aldı. Takibinde ikinci yılda pulmoner metastaz izlendi ve relaps için interferon alfa- 2a kullanıldı. Akciğer metastazlarından iki yıl sonra dispepsi ile başvuran hastanın bilgisayarlı tomografik incelemesinde mide duvarında (boyunca) 11 mm kalınlık saptandı. Endoskopik inceleme nöroendokrin tümörü düşündürdü. Histopatolojik incelemede berrak vakuolize sitoplazmalı solid paternde tümöral hücre grupları gözlendi. Tümör hücreleri RCC, PAX8, CD10, Vimentin ile pozitif olup immünhistokimyasal sonuçlar ilk tümör ile benzerdi. Sonuç olarak olguya BHRHK’un mide metastazı tanısı verildi ve çok hedefli bir reseptör tirozin kinaz inhibitörü ile tedavi edildi.

Anahtar Kelimeler

• mide metastazı
• berrak hücre
• renal karsinom
• immünhistokimya

GASTRIC METASTASIS OF RENAL CELL CARCINOMA: A CASE REPORT

Öz

Primary gastric tumors are encountered more frequently than metastatic tumors. The gastric metastasis of clear cell renal cell carcinoma (CCRC) is very rare. We herein report a case of gastric metastasis of CCRC. A sixty-year-old man patient underwent a radical nephrectomy and received adjuvant chemotherapy. Pulmonary metastasis occurred at the second-year follow-up, and interferon alpha-2a was used for relapse. The Computed Tomography examination of the patient presented with dyspepsia two years after pulmonary metastases revealed 11 mm thickness in the (along) gastric wall. Endoscopic examination was suggestive of a neuroendocrine tumor. Histopathologic evaluation of endoscopic biopsies showed tumoral cell groups in a solid pattern composed of clear, vacuolated cytoplasm. These tumor cells were positive for RCC, PAX8 CD-10, Vimentin, and immunohistochemistry findings were similar to the initial tumor at diagnosis. Finally, the patient was diagnosed with CCRC's gastric metastasis and treated with a multi-targeted receptor tyrosine kinase inhibitor.

Anahtar Kelimeler

• gastric metastasis
• clear cell
• renal carcinoma
• immunohistochemistry

Kaynakça

1. 1. Namikawa T, Hanazaki K. Clinicopathological features and treatment outcomes of metastatic tumors in the stomach. Surgery today. 2014;44(8):1392-9.
2. 2. Sakurai K, Muguruma K, Yamazoe S, Kimura K, Toyokawa T, Amano R, et al. Gastric metastasis from renal cell carcinoma with gastrointestinal bleeding: a case report and review of the literature. International surgery. 2014;99(1):86-90.
3. 3. Green LK. Hematogenous metastases to the stomach. A review of 67 cases. Cancer. 1990;65(7):1596-600.
4. 4. Davis GH, Zollinger RW. Metastatic melanoma of the stomach. The American Journal of Surgery. 1960;99(1):94-6.
5. 5. Gupta K, Miller JD, Li JZ, Russell MW, Charbonneau C. Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC): a literature review. Cancer treatment reviews. 2008;34(3):193-205.
6. 6. Zhou, Ming, et al. "Protocol for the Examination of Specimens from Patients with Carcinoma of the Ureter and Renal Pelvis." (2017).
7. 7. Kobayashi O, Murakami H, Yoshida T, Cho H, Yoshikawa T, Tsuburaya A, et al. Clinical diagnosis of metastatic gastric tumors: clinicopathologic findings and prognosis of nine patients in a single cancer center. World Journal of Surgery. 2004;28(6):548-51.
8. 8. Pollheimer MJ, Hinterleitner TA, Pollheimer VS, Schlemmer A, Langner C. Renal cell carcinoma metastatic to the stomach: single‐centre experience and literature review. BJU international. 2008;102(3):315-9.

9. 9. Menuck LS, Amberg JR. Metastatic disease involving the stomach. The American Journal of digestive diseases. 1975;20(10):903-13.
10. 10. Oda I, Kondo H, Yamao T, Saito D, Ono H, Gotoda T, et al. Metastatic tumors to the stomach: analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases. Endoscopy. 2001;33(06):507-10.
11. 11. de Oliveira Campoli PM, Ejima FH, Cardoso DMM, da Silva OQ, Santana Filho JB, de Queiroz Barreto PA, et al. Metastatic cancer to the stomach. Gastric Cancer. 2006;9(1):19-25.
12. 12. Eslick GD, Kalantar JS. Gastric metastasis in renal cell carcinoma: a case report and systematic review. Journal of gastrointestinal cancer. 2011;42(4):296-301.
13. 13. Blake M, Owens A, O'Donoghue D, MacErlean D. Embolotherapy for massive upper gastrointestinal haemorrhage secondary to metastatic renal cell carcinoma: report of three cases. Gut. 1995;37(6):835-7.
14. 14. Kim M-Y, Jung H-Y, Choi KD, Song HJ, Lee JH, Kim DH, et al. Solitary synchronous metastatic gastric cancer arising from t1b renal cell carcinoma: a case report and systematic review. Gut and Liver. 2012;6(3):388.
15. 15. De Palma GD, Masone S, Rega M, Simeoli I, Donisi M, Addeo P, et al. Metastatic tumors to the stomach: clinical and endoscopic features. World journal of gastroenterology: WJG. 2006;12(45):7326.
16. 16. Dassen A, Lips D, Hoekstra C, Pruijt J, Bosscha K. FDG-PET has no definite role in preoperative imaging in gastric cancer. European Journal of Surgical Oncology (EJSO). 2009;35(5):449-55.
17. 17. Sakai Y, Kanomata N, Itami H, Kajimoto K, Sakuma T, Ohbayashi C. Signet-ring cell carcinoma of the stomach metastasizing to renal cell carcinoma: a case report and review of the literature. Kobe J Med Sci. 2010;55(6):E122-31.
18. 18. Patel P, Chaganti R, Motzer R. Targeted therapy for metastatic renal cell carcinoma. British Journal of cancer. 2006;94(5):614-9.
19. 19. Cohen H. McGovern fJ: Renal-cell carcinoma. N engl J Med. 2005;353:2477-90
20. 20. SEER Stat Fact Sheets: Kidney and Renal Pelvis http://seer.cancer.gov/statfacts/html/kidrp.html.