Clear Cell Carcinoma Leading to Gastrointestinal Bleed

The incidence of renal cell cancer has risen over the recent years, and with the use of new diagnostic imaging modalities, the detection rate has also increased. Clear cell carcinoma is the most common type amongst them (70% of cases). The most common sites of distant metastases are the lungs, lymph nodes, liver, bone, and brain. This advanced renal cell cancer is being treated by biologicals like cabozantinib, an antiangiogenic tyrosine kinase inhibitor (TKI). This case report highlights an 84-year-old male with a complex medical history, including metastatic renal cell carcinoma (RCC) on cabozantinib therapy, presenting with gastrointestinal bleeding. Despite the infrequency of gastric involvement, evaluating GI bleeds is crucial to rule out such complications. The patient’s hematemesis prompted further investigation, such as an endoscopy, revealing a 7 mm polypoid area with ulceration and active bleeding in the stomach. The endoscopic intervention included snare resection, histologically confirmed as metastatic clear cell carcinoma. Gastric metastasis from RCC is uncommon, often manifesting later in the disease course. The simultaneous occurrence of metastases in other organs is common, emphasizing the significance of gastric findings in indicating RCC progression and severity. The patient’s favorable response to the intervention highlights the diagnostic and therapeutic challenges associated with such cases. This report contributes to the limited literature on RCC-associated gastrointestinal bleeding, illustrating the importance of maintaining a high index of suspicion in patients with atypical presentations. The overall poor prognosis of metastatic RCC further underscores the importance of timely diagnosis and intervention.