Magara Nanako, Takahashi Naoto, Takano Yuta, Takeshita Kenji, Toya Naoki, Yano Fumiaki, Eto Ken
Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
Surg Case Rep. 2024 Oct 28;10(1):245. doi: 10.1186/s40792-024-02036-z.
Metastatic gastric tumors are rare and malignant melanoma, breast cancer, lung cancer, and esophageal cancer are common as primary lesions. On the other hand, renal cell carcinoma is easy to metastasize hematogenously to the whole body. However, metastasis to the stomach is rare and the detailed treatment of gastric metastasis is not mentioned. In this study, we report an uncommon case of gastric metastasis from renal cell carcinoma that underwent surgical full-thickness resection and reviewed the literature for treatment options.
The patient was a female in her 60s and in January 2007, she underwent a transabdominal left nephrectomy for clear cell carcinoma of the left kidney. The pathological diagnosis was pT2N0M0 stage II. In October 2017, a total pancreatectomy with D2 dissection was performed for multiple pancreatic masses, in which the pathological diagnosis was pancreatic metastasis of renal cell cancer. In May 2019, an esophagogastroduodenoscopy for heartburn revealed redness and erosion in the greater curvature of the residual gastric body. The pathological diagnosis was gastric metastasis from renal cell carcinoma. No metastatic findings were observed and gastric wedge resection was performed. Pathological diagnosis of the resected specimen showed a 4-mm tumor, mainly within the mucosa and partly extended to the submucosal layer in 500 µm. The resected specimen had a clear resection margin.
In this study, we report a case in which a full-thickness resection was performed for gastric metastasis 12 years after renal cancer surgery and 2 years after pancreatic metastasis surgery. The patient survived 4 years and 8 months after gastric wedge resection. Although gastric metastasis often takes the form of submucosal tumors, it is necessary to select full-thickness resection for R0 resection, even in small and flat lesions.
转移性胃肿瘤较为罕见，常见的原发灶为恶性黑色素瘤、乳腺癌、肺癌和食管癌。另一方面，肾细胞癌易于通过血行转移至全身。然而，转移至胃的情况罕见，且未提及胃转移的详细治疗方法。在本研究中，我们报告了一例罕见的肾细胞癌胃转移病例，该病例接受了手术全层切除，并回顾了相关文献以探讨治疗方案。
患者为一名60多岁的女性，2007年1月因左肾透明细胞癌接受了经腹左肾切除术。病理诊断为pT2N0M0 II期。2017年10月，因多发性胰腺肿块进行了D2根治性全胰切除术，病理诊断为肾细胞癌胰腺转移。2019年5月，因烧心行食管胃十二指肠镜检查，发现残胃体大弯处发红和糜烂。病理诊断为肾细胞癌胃转移。未观察到其他转移灶，遂行胃楔形切除术。切除标本的病理诊断显示为一个4毫米的肿瘤，主要位于黏膜内，部分延伸至黏膜下层500微米。切除标本的切缘清晰。
在本研究中，我们报告了一例在肾癌手术后12年和胰腺转移手术后2年对胃转移灶进行全层切除的病例。患者在胃楔形切除术后存活了4年8个月。尽管胃转移通常表现为黏膜下肿瘤，但即使是小而扁平的病变，为实现R0切除也有必要选择全层切除。
