Duodenal Metastasis from Renal Cell Carcinoma presenting as Gastrointestinal Bleed

Malignant causes account for 1–4% of upper gastrointestinal bleeding (GI-bleed). In absence of widespread nodal and visceral metastatic disease, isolated duodenal metastasis from renal cell carcinoma (RCC) is very rare. Consequently, gastrointestinal bleeding from renal cell carcinoma metastases is an infrequent and often un-recognized manifestation of this disease. Here, we describe case of a 52 year-old man in whom metastasis arising from renal cell carcinoma developed in the duodenum 8 years after nephrectomy as the first relapse. The patient presented with severe anemia due to occult GI bleed. The diagnosis was confirmed by endoscopic biopsy and immuno-histochemistry (IHC).Palliative local resection of the tumor was attempted, however, patient had progression of the disease and developed liver metastasis with pleural effusion and succumbed to his disease. Since, late recurrence/metastasis is characteristic of renal cell carcinoma, careful long-term follow-up is needed to pick up an early relapse. To our knowledge, this is the 20th case of duodenal metastasis from RCC and the first case from Kashmir valley of Indian sub-continent reported in literature. JMS 2012;15(1):65-68.