Gastric Carcinoma and Renal Cell Carcinoma as an Atypical Presentation of Multiple Primary Malignancies

A Case Report and Review of the Literature

J. A. Martín-Pérez; C. Torres-Silva; R. Tenorio-Arguelles; D. A. García-Corona; S. Silva-González; J. A. Dominguez-Rodriguez; I. De Alba-Cruz; J. F. Nagore-Ancona; J. A. González-Luna; K. A. López-Bochm


J Med Case Reports. 2020;14(234) 

In This Article

Abstract and Introduction


Background: Gastric carcinoma (GC) with second primary malignancy (SPM) is the most frequent combination within the multiple primary malignancies (MPM) group. The presentation of a GC associated with a synchronized SPM in the kidney is extremely rare and unusual. This study presents a rare case of synchronous tumors, describes the main associated risk factors, and emphasizes the need to rule out SPM.

Main Body: We present the case of a 63-year-old Hispanic woman with a history of smoking, weight loss, and gastrointestinal (GI) bleeding. GC was diagnosed by endoscopy, and during her workup for metastatic disease, a synchronous SPM was noted in the left kidney. The patient underwent resection of both tumors with a satisfactory postoperative course. A systematic review of the literature was performed using the Medline/PubMed, Science Direct, Scopus, and Google Scholar databases. A search of the literature yielded 13 relevant articles, in which the following main risk factors were reported: the treatment utilized, the grade and clinical stage, histopathological report, and in some cases survival. It is concluded that advanced age (> 60 years) and smoking are the main associated risk factors.

Conclusion: Gastric carcinoma is the second most frequent neoplasm of the GI tract and the main neoplasm that presents a SPM. MPM screening is recommended in patients with gastric cancer. The clinical discovery of MPM of renal origin is rare and hence the importance of the current report.


In 1930, Warren and Gates first described the concept of multiple primary malignancies (MPN).[1] Subsequently, the definition of a synchronous tumor was standardized, according to the time of diagnosis of the second primary malignancy (SPM), with the SPM diagnosed within a period of time no greater than 6 months after the diagnosis of the primary tumor. This definition is the one used for SPM identification in the literature review.[2–7]

In the case of the presence of gastric carcinoma (GC) with SPM, the incidence is higher in Asian countries.[8–13] SPMs are mainly observed in the colon, followed by the breast and the lung; a malignancy in the kidney is rare.[14–16] The incidence of synchronous stomach-kidney tumors worldwide is around 0.13–0.42%. Up to 40% are diagnosed with SPM in the early stages and 9% are diagnosed in advanced stages.[17–19]

GC, according to reviews, is the neoplasm with the highest presence of SPM.[3,18–20] Currently, there is no standardized study protocol for the evaluation of SPMs in GC.

The objective of this study is to present a case of synchronous renal cell carcinoma in a patient with GC, as well as to describe the associated risk factors and emphasize the need to rule out the possibility of a SPM during the clinical staging of the primary malignancy.