Rare presentation of renal cell cancer as dysphagia: Case report

Dr Manmeet S. Padda at Gastroenterology and Hepatology, DHAT, Scott and White Baylor Medical Center, McKinney, TX, USA and colleagues have reported a rare case of renal cell cancer presenting as dysphagia. The case has appeared in the Journal of Medical Case Reports.

Metastasis from distal solid organs to the esophagus is very rare. Renal cell cancer with esophageal metastasis is extremely rare.

A 56-year-old Caucasian man presented for evaluation of intermittent dysphagia to solids for the past few weeks. He had no significant past medical history. He had the sensation of food getting stuck in substernal area. Otherwise, he reported good appetite and no weight loss. A physical examination revealed a well-nourished man with no palpable mass or lymph nodes. An abdominal examination revealed no localized tenderness or organomegaly. No family history of stomach or colon malignancy was reported. An esophagogastroduodenoscopy (EGD) examination revealed a single 6 mm nodule at GEJ and Los Angeles grade A (less than 5 mm mucosal breaks) distal esophagitis. A pathology examination from the GEJ nodule showed squamous mucosa with mucosal ulcer and associated acute and chronic inflammatory infiltrates. Nests of atypical cohesive cells with clear cytoplasm, and mild nuclear pleomorphism were noted in submucosa. Multiple immunostains were performed to further characterize atypical cells with following staining pattern: vimentin (+), PAX-8 (+), CD10 (focally and weakly positive), and epithelial membrane antigen (EMA; focally and weakly positive). These cells were negative for RCC, thyroid transcription factor 1(TTF1), S100 protein, CD68, cytokeratin 5/6, pancytokeratin, p63, cytokeratin 7 and 20, p40, and pan melanoma marker. Histological features and staining patterns were consistent with atypical clear cell infiltrate involving squamous mucosa, which was consistent with metastatic RCC. A computed tomography study of his chest, abdomen, and pelvis performed with orally and intravenously administered contrast showed unremarkable esophagus and no mediastinal lymphadenopathy.