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\begin{document}

\title{Metastatic renal cell carcinoma presenting as a duodenal mass}



\author[1]{Spyridon Vrakas}%
\author[1]{Epameinondas  Skouloudis}%
\author[1]{Georgios Koutoufaris}%
\author[1]{Kassiani  Manoloudaki}%
\author[1]{Vasilis Xourgias}%
\affil[1]{Peripheral General Hospital of Peiraias Tzaneio}%


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  \date{June 14, 2024}


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\begin{abstract}
We report a case of renal cell carcinoma metastasis to the duodenum.%
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\textbf{Metastatic renal cell carcinoma presenting as a duodenal mass}

\textbf{Spyridon Vrakas\textsuperscript{1}, Epameinondas
Skouloudis\textsuperscript{1}, Georgios Koutoufaris\textsuperscript{1},
Kassiani Manoloudaki\textsuperscript{2}, Vasilis
Xourgias\textsuperscript{1}}

\textsuperscript{1}Department of Gastroenterology, Tzaneion General
Hospital, Piraeus, Greece 2Department of Pathology, Tzaneion General
Hospital, Piraeus, Greece

\textbf{Correspondence}

Spyridon Vrakas, Tzaneion General Hospital, Zanni \& Afentouli 1 18536,
Piraeus, Greece, Email: sbrakas@yahoo.gr

\textbf{Key Clinical Message}

Renal cell carcinoma metastasis rarely affects the gastrointestinal
tract and should be included in the differential diagnosis in patients
with iron deficiency anemia and a history of RCC.

\textbf{Abstract}

We report a case of renal cell carcinoma metastasis to the duodenum.

\textbf{Keywords}

Renal cell carcinoma, Metastasis, Duodenum

\selectlanguage{greek}Α \selectlanguage{english}55-year old woman was admitted to our hospital for iron deficiency
anemia, with hemoglobin 7.4g/dl and low transferrin saturation (9\%).
From medical history, she underwent right radical nephrectomy due to
clear cell carcinoma eight years ago. The patient was transfused with 2
units of red blood cells and underwent colonoscopy without pathological
findings. Esophagogastroduodenoscopy revealed a mass in the second part
of the duodenum (Figure 1) and biopsies were taken. Histopathology
examination showed sheets of clear cells (Figure 2).
Immunohistochemistry was positive for CD10, PAX8, EMA, Cam5-2, vimentin,
while CK7 was negative (Figure 2). Diagnosis of metastatic renal cell
carcinoma (RCC) was confirmed. Computer tomography showed metastases to
the lungs, liver, brain and duodenum. The left kindey revealed no
abnormalities. Oncology department was consulted and patient was planned
for immunotherapy.

Recurrence of RCC is unpredictable, and rarely affects the
gastrointestinal tract. RCC recurrs in the form of single or multiple
metastatic lesions. The most common sites of metastases are liver,
lungs, bones, and brain. Duodenum is a rare site of RCC
metastasis\textsuperscript{1,2}. The time from resection of the primary
tumor until the diagnosis of metachronous metastasis varies and long
term follow up is needed.

\textbf{CONSENT STATEMENT}

Informed consent has been obtained from patient for the publication of
this clinical image.

\subsection*{AUTHOR CONTRIBUTIONS}

{\label{author-contributions}}

VS, ES, MK and XV: contributed to the writing and approval of the final
manuscript.

\textbf{CONFLICT OF INTEREST}

None declared.

\textbf{ETHICAL STATEMENT}

Written informed consent was obtained from patient. This case report did
not receive any funding. Authors have access to all source data for this
case report.

\textbf{DATA AVAILABILITY STATEMENT}

Data supporting the findings of this study are available from the
corresponding author on request.

\textbf{REFERENCES}

1) Saito M, Senjo H, Kanaya M, Izumiyama K, Mori A, Tanaka M, Morioka M,
Miyashita K, Ishida Y. Late duodenal metastasis from renal cell
carcinoma with newly developed malignant lymphoma: A case report. Clin
Oncol 2018;8(4):549-552

2) Grossen A, Kastens DJ, Salem G. Metastatic Renal Cell Carcinoma to
the Gastrointestinal Tract. Clin Gastroenterol Hepatol.
2020;18(13):e153.\selectlanguage{english}
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