Renal cell carcinoma (RCC) arises from the renal epithelium and accounts for more than 90% of kidney cancers. RCC has a diverse range of clinical manifestations. The classical triad of loin pain, hematuria and abdominal mass is only present in 4%-17% of cases. Here, we demonstrate a unique case of RCC presenting as upper gastrointestinal (GI) symptoms without any specific GI involvement.
A 49-year-old man, presented with ongoing severe heartburn, nausea and vomiting for 5 months. The patient further complained of weight loss over the last 2 months. Routine blood tests were normal except raised C-reactive protein and ALP. Examination revealed a large and tender liver, and he was subsequently referred under the upper GI cancer pathway. Esophagogastroduodenoscopy showed hiatus hernia and gastritis. CT scan revealed an 11 and 9 mm nodule in the left and right lung, respectively. There was a further metastatic 13×7 cm2 mass in the liver and 10×8 cm2 mass arising from the upper pole of the left kidney with convincing evidence of tumor thrombus in left renal vein. The patient was promptly referred under the care of the oncologist team and died within months.
The classical triad of loin pain, hematuria and abdominal mass for RCC is not that common and RCC should be suspected in patients complaining of upper GI pain with nonspecific symptoms. Furthermore, it is not necessary that patients complaining of "heartburn" have a GI cause, as pathology in other thoracic organs present in a similar manner.
International medical case reports journal. 2018 Nov 27*** epublish ***
Utkarsh Ojha, Vinod Ojha
Imperial College School of Medicine, Imperial College London, London, UK, ., Willow Bank Surgery, NHS, Stoke-on-Trent, UK.