Researchers herein reported a case of renal cell carcinoma (RCC) with gastric metastasis, particularly accompanied by multiple cancer thrombi, and conducted a systematic review of the literature identifying 73 cases of RCC with gastric metastasis. The clinicopathological characteristics, therapies, and outcomes of these patients are analyzed.

• The reported case was of a 66-year-old man with a history of a right radical nephrectomy because of RCC; after 6 months of targeted therapy, 18F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scanning was performed for gastric metastasis and cancer thrombi.

• A large mass in the gastric fundus and cancer thrombi in the right atrium, inferior vena cava, and splenic vein with intense tracer uptake were observed on 18F-PSMA PET/CT.

• Multiple bones and abdominal lymph nodes were the other metastases sites with increased tracer uptake.

• Higher mortality was recorded for patients with gastric and multiple-site metastases relative to patients with solitary metastasis (17 vs 1).

• A shorter survival time was recorded for patients with synchronous gastric metastasis than metachronous gastric metastasis (6 vs17 months).

• Overall findings emphasize the necessity and relevance of postoperative follow-up of multiple imaging modalities to monitor recurrence and metastasis.

• The detection sensitivity of RCC can be improved using PSMA PET/CT, especially in metastatic clear cell renal cell carcinoma (ccRCC), and it could present a basis for disease staging, restaging, and therapeutic efficacy evaluation.