renal cell carcinoma ( rcc ) has a propensity to metastasize along the hematogenous route . about 20% to 25% of patients with rcc have distant metastases at presentation,1 and another 50% develop distant metastases or local recurrence after nephrectomy.2 metastasis can occur at any time , and the most frequent sites include the lungs , bones , liver , and brain . however , rccs can also metastasize to unusual sites , including the pancreas , thyroid , adrenal gland , skeletal muscle , and skin.3 clinical courses vary among patients with rcc who initially present with metastatic disease or who develop tumor dissemination during follow - up . rcc metastases to the stomach , including solitary synchronous gastric metastases from small , localized rccs , are extremely rare.4 we here describe a patient with a solitary synchronous metastatic gastric cancer originating from a small rcc who was treated with endoscopic resection . we also review the clinical characteristics of , therapeutic modalities for , and clinical outcomes of , patients with this disease . he had previously undergone surgery for a duodenal ulcer as well as an open cholecystectomy . , we did not detect abdominal tenderness or a mass , and laboratory tests revealed no abnormal findings . upper endoscopy showed an erosive lesion , approximately 0.6 cm in length , in the anterior wall of the midbody ( fig . a biopsy of the lesion showed tumor cells , consistent with metastatic rcc of the clear cell type . computed tomography ( ct ) showed a mass , approximately 5 cm long , in the right kidney , but there was no evidence of lymph node enlargement or metastatic lesions in the abdomen ( fig . positron emission tomography showed an isometabolic mass ( maximum standardized uptake value [ maxsuv ] , 2.7 ) in the right kidney ( fig . the resected specimen showed a well - defined lobulated mass , 5.23.83.5 cm in size , in the lower pole of the right kidney . the tumor cells had clear cytoplasm and round monotonous nuclei , both typical of clear cell carcinoma ( fig . the tumor was confined to the renal parenchyma , and no lymphovascular or renal vein invasion was apparent . microscopic examination of the resected specimen showed an ill - defined tumor , about 0.6 cm long , with clear resection margins , a finding consistent with metastatic rcc ( fig . upper endoscopy and a ct scan performed 6 months later showed no evidence of local recurrence or additional metastasis . although metastatic gastric cancers are uncommon , those observed are frequently metastases of lung cancer , breast cancer , and malignant melanoma.5 - 8 the clinical symptoms most commonly requiring endoscopy of patients with gastric metastasis include anemia , gastrointestinal bleeding , dyspepsia , and epigastric pain . metastases are most common in the gastric body , and are more likely to be single rather than multiple . grossly , such lesions can resemble submucosal tumors , with or without central depressions , or primary gastric cancers.8 the outcome of patients with metastatic gastric cancer is generally poor , because concomitant metastases to other organs are common.5 metastasis to the stomach from rcc is extremely rare,8 although we identified as many as 36 such patients ( including the patient described here , but excluding those identified on autopsy ) by systematic review of articles in english using a computerized search of the pubmed database ( table 1).1,9 - 37 we found that gastric metastases from rcc were more common in males than in females ( 26 males vs 9 females ) . median age at presentation was 67 years ( range , 48 to 84 years ) . among the most frequent clinical symptoms were upper gastrointestinal bleeding , anemia , and epigastric pain . the most frequent location of metastatic lesions was the gastric body , followed by the fundus and the antrum . the average period from rcc surgery to the presentation of gastric metastasis was approximately 6.5 years ( range , 0 to 24 years ) . twenty - one patients showed disseminated tumor spread to other organs , most frequently to the lungs . two patients presented with metastatic gastric cancer arising from rcc before detection of a renal mass ; one patient was diagnosed with advanced rcc with metastatic gastric cancer as well as lung and bone metastases,32 and the second patient , described here , had a single gastric metastasis arising from a small rcc without evidence of additional metastases . fourteen previously reported patients underwent surgical resection ( total / partial gastrectomy or wedge resection ) ; 3 ( including the patient described here ) received endoscopic resection / excision ; 7 were treated with systemic therapy including interferon , tamoxifen , sunitinib malate , or chemotherapy ; 6 received palliative embolization or endoscopic ablation for control of bleeding ; whereas 7 received no specific therapy . the clinical course in patients with rcc and metastasis to the stomach appears to be unpredictable . generally , the outcome of patients with rcc and gastric metastases is poor.5 some patients die within a few weeks , whereas six ( including ours ) showed no tumor recurrence at a median of 17 months ( range , 6 to 36 months ) after metastatectomy.20 - 22,28,35 of 10 patients with solitary gastric metastases , 6 underwent surgical metastatectomy , 2 underwent endoscopic resection ( snare polypectomy and endoscopic submucosal dissection ) , 1 was treated with sunitinib malate , and 1 received no therapy . five patients showed no evidence of tumor recurrence at a median of 12 months ( range , 6 to 18 months ) after metastatectomy , and one patient lived for 7 years after diagnosis . although the optimal treatment for patients with solitary gastric metastasis arising from rcc remains unclear , patients with potentially surgically resectable primary rcc and a solitary resectable metastatic cancer are candidates for nephrectomy and metastatectomy.38 patients in generally good condition showed prolonged survival after nephrectomy and complete resection of the metastatic lesion.4,38 - 40 similarly , complete metastatectomy may offer survival benefits in patients with solitary gastric metastases arising from rcc.21,28 the optimal treatment modality in a patient with a small , solitary gastric metastasis confined to the mucosa and submucosa may be endoscopic resection .