CEN Case Reports

, Volume 7, Issue 1, pp 39–43 | Cite as

Metastatic renal cell carcinoma to the small bowel: three cases of GI bleeding and a literature review

  • Jessica L. Mueller
  • Richard A. Guyer
  • Joel T. Adler
  • John T. Mullen
Case Report


Approximately 25–30% of patients with renal cell carcinoma (RCC) have metastatic disease at the time of diagnosis, where the most common sites of metastasis are the lung (50–60% of patients with metastatic disease), bones (30–40%), liver (30–40%), and brain (5%). Although RCC metastasis to the small intestine is thought to be exceedingly rare, with predominantly isolated case reports and a few case series in the literature, we present below three additional cases at our institution of metastatic RCC to the small bowel presenting as GI bleeding. A literature review demonstrates that the number of published case reports has been increasing in recent years. We hypothesize that in the era of targeted chemotherapy and VEGF inhibitors to treat RCC that patients are living longer and have more time for their primary tumors to metastasize to the small bowel and become symptomatic, causing metastatic RCC to the small bowel to be less rare than previously thought.


Renal cell carcinoma Small bowel metastasis Upper GI bleed 


Compliance with ethical standards

Conflict of interest

The authors declare that no conflicts of interest exist.

Human and animal rights

This retrospective chart review study involving human participants was conducted in accordance with the ethical standards of the institutional research committee at MGH (IRB approval # 2008P000578).

Informed consent

According to our IRB committee, informed consent from all participants included in this study was not required given the fact that all included patient data and images are de-identified, and thus the study was deemed to be of minimal risk to the participants.


  1. 1.
    Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med. 1996;335:865–75.CrossRefPubMedGoogle Scholar
  2. 2.
    Vani M, Nambiar A, Geetha K, Kundil B. Metastatic renal cell carcinoma causing small intestinal polyps with intussusception: a report of two cases. J Clin Diagn Res. 2017;11:13–5.CrossRefGoogle Scholar
  3. 3.
    Medic I, Enriquez ML, Somer RA. Metastatic renal cell carcinoma to jejunum: an unusual case presentation. Urol Case Rep. 2017;18:34–6.CrossRefGoogle Scholar
  4. 4.
    Gorski RL, Jalil SA, Razick M, Jalil AA. An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel. Int J Surg Case Rep. 2015;15:130–2.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bellio G, Cipolat Mis T, Kaso G, Dattola R, Casagranda B, Bortul M. Small bowel intussusception from renal cell carcinoma metastasis: a case report and review of the literature. J Med Case Rep. 2016;10:222.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ismali I, Neuen BL, Mantha M. Solitary jejunal metastasis from renal cell carcinoma presenting as small bowel obstruction 19 years after nephrectomy. BMJ Case Rep. 2015.
  7. 7.
    Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, Jensen ET, Lund JL, Pasricha S, Runge T, Schmidt M, Shaheen NJ, Sandler RS. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149(7):1731–41.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Rotondano G. Epidemiology and diagnosis of acute nonvariceal upper gastrointestinal bleeding. Gastroenterol Clin North Am. 2014;43:643–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Maluf-Fiho F, Martins BC, de Lima MS, Leonardo DV, Retes FA, Kawaguti FS, Sato CF, Hondo FY, Safatle-Ribeiro AV, Ribeiro U Jr. Etiology, endoscopic management and mortality of upper gastrointestinal bleeding in patients with cancer. United Eur Gastroenterol J. 2013;1:60–7.CrossRefGoogle Scholar
  10. 10.
    Zuccaro G. Epidemiology of lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008;22:225–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Siegel RL, Miller KD, Jemal A. Cancer statistics 2015. CA Cancer J Clin. 2015;65:5–29.CrossRefPubMedGoogle Scholar
  12. 12.
    Minardi AJ Jr, Zibari GB, Aultman DF, McMillan RW, McDonald JC. Small-bowel tumors. J Am Coll Surg. 1998;186:664–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Willis RA. The spread of tumours in the human body. Secondary tumours of the intestines. London: Butterworth & Co., Ltd; 1973. pp. 209–13.Google Scholar
  14. 14.
    Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, Oudard S, Negrier S, Szczylik C, Kim ST, Chen I, Bycott PW, Baum CM, Figlin RA. Sunitinib versus interferon alpha in metastatic renal-cell carcinoma. N Eng J Med. 2007;356:115–24.CrossRefGoogle Scholar
  15. 15.
    Park HJ, Kim HJ, Park SH, Lee JS, Kim AY, Ha HK. Gastrointestinal involvement of recurrent renal cell carcinoma: CT findings and clinicopathologic features. Korean J Radiol. 2017;18:452–60.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Mishra S, Hazra SP, Priyadarshi V, et al. Synchronous jejunal metastasis presenting as intussusception in a case of advanced RCC: a rare presentation. Indian J Surg. 2015;77:59–61.CrossRefPubMedGoogle Scholar
  17. 17.
    Trojaniello C, Vitale MG, Trojaniello B, et al. Severe blood loss anaemia and recurrent intussusceptions as first presentation of bowel metastatic renal cell carcinoma: a case report and review of the literature. Mol Clin Oncol. 2017;7:654–60.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Jessica L. Mueller
    • 1
  • Richard A. Guyer
    • 1
  • Joel T. Adler
    • 1
  • John T. Mullen
    • 1
  1. 1.Department of SurgeryMassachusetts General HospitalBostonUSA

Personalised recommendations