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

Disclosures

J Med Case Reports. 2020;14(234) 

In This Article

Results

The total population studied in our review yielded 21,157 patients with GC and 1744 patients with renal carcinoma. The subgroups of patients with GC and renal carcinoma presenting with a synchronous tumor numbered 354 and 82, respectively. A total of 45 cases of synchronous tumors with GC and renal carcinoma were found in our study. Figure 7 shows, schematically, the population and how it was obtained.

Figure 7.

Diagram explaining our total population and the result of gastric/renal synchronous cases

Within the information search, 45 patients with a diagnosis of synchronous cancer were integrated and are described in Table 1 and Table 2. However, in the studies with an epidemiological design described in Table 1, it was not possible to collect particular data about the cases because they described patients with synchronous cases in general and not exclusively synchronous gastric cancer with kidney cancer.

Of the total number of cases reported in the literature with synchronous GC and kidney carcinoma, the highest prevalence was found in elderly patients (> 60 years), with males outnumbering females 2:1. The most commonly reported risk factor was smoking.[2,4,17,18,20,22–25] The most frequent clinical presentations were upper or lower gastrointestinal (GI) bleeding, nonspecific abdominal pain, weight loss without apparent cause, and absence of upper/lower urinary tract symptoms in most of the cases.

Multiple combinations of surgical treatments are described, including partial gastrectomy/radical nephrectomy,[5] subtotal gastrectomy/partial nephrectomy,[6,19] total gastrectomy/radical nephrectomy,[17,20] endoscopic gastric resection/radical nephrectomy,[24] partial gastrectomy/total nephrectomy,[17] mucosectomy/renal active surveillance,[18] and total gastrectomy/renal active surveillance.[22] Among the surgical approaches for gastric cancer, partial gastrectomy was predominant, followed by total gastrectomy and subtotal gastrectomy. Two patients were diagnosed at an early stage, and conservative endoscopic approaches were adopted for treatment. With regard to the management of patients with renal carcinoma, multiple reviews revealed that radical nephrectomy was the most frequently performed surgical intervention, followed by total nephrectomy, partial nephrectomy, and two cases treated with active surveillance. Diagnostic renal carcinoma was more frequently on the left side with nephrectomy (partial, total, or radical).[5,6,19,22–24]

Our review showed the prevalence of clinical stages in GC, with stage IA being the most frequent, followed by stages IB, IIA, and IIIA.[2,6,17,20,26] On the other hand, stage II was the most frequent found for renal carcinoma.[6,20]

It was revealed that the most common histopathological findings of GC were described as poorly differentiated,[2,4,20] moderately differentiated,[19,22] and well differentiated,[17,26] in that order of presentation. The findings in the group of patients with renal carcinoma were cell carcinomas[2,3,6,19,24] as the most frequent histopathological result, with other rare reported cases of chromophobe cell[5,20,23] and transitional cell carcinoma.[2]

In addition, some cohort studies (presented in this review)[2–4,17,18,23,24,26] revealed that survival and prognosis are improved in early clinical stage/grade and when both tumors were resected at the same surgical time.

The heterogeneous characteristics of the reviewed studies, the low number of relevant articles found, and the lack of specific studies in the literature limit the ability to make solid recommendations, and represent the main limitations of this systematic review.

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