Renal cell carcinoma metastatic to pancreas

The American Journal of Surgery 182 (2001) 183–184

Clinical image

Renal cell carcinoma metastatic to pancreas Maher A. Abbas, M.D.a, Joe M. Collins, M.D.a, David C. Mulligan, M.D.a,b,* a Departments of Surgery and Radiology, Mayo Clinic, Scottsdale, AZ, USA Department of Surgery, Mayo Clinic Hospital, 5777 East Mayo Blvd., Phoenix, AZ 85054, USA

b

A 70-year-old man was evaluated for renal transplantation 4 years after bilateral nephrectomy for renal cell carcinoma. Abdominal computed tomography demonstrated a hypervascular mass in the neck of the pancreas with interval growth from 3 cm to 5.8 cm over a 1-year period (Fig. 1). Extension of the tumor into the pancreatic duct was noted (Fig. 2). Biopsy samples obtained by endoscopic ultrasound were consistent with a high-grade vascular neoplasm, possibly representing a neuroendocrine tumor. The patient underwent a subtotal pancreatectomy with splenic preservation and cholecystectomy. Evaluation of the surgical specimen showed metastatic renal cell carcinoma (Fig. 3). The patient’s recovery was uneventful. Although rare, renal cell carcinoma is known to metastasize to the pancreas. Most patients are in their fifth decade

Fig. 2. Abdominal computed tomography reveals posterior extension of the tumor into the pancreatic duct in the head of the pancreas (white arrow).

of life or later, with a slight male predominance [1]. Patients may be diagnosed a few years to more than a decade after the primary malignancy is discovered [1–3]. Most patients are symptomatic at the time of presentation. Lesions are

Fig. 1. Abdominal computed tomography demonstrates a 5.8 cm hypervascular mass in the neck and body of the pancreas (white arrow) with obstruction of a dilated pancreatic duct.

* Corresponding author.

Fig. 3. Surgical specimen evaluation is consistent with metastatic renal cell carcinoma to the pancreas.

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hypervascular and can occur anywhere within the pancreas [1–3]. Similar to renal cell carcinoma extending into the renal vein, metastatic lesions to the pancreas can grow into the main pancreatic duct seeking the path of least resistance (previously we encountered a case of metastatic renal cell carcinoma in the scapula with tumor thrombus in the subclavian vein). Surgical resection of isolated pancreatic metastasis is advised; it is associated with low morbidity and mortality in experienced centers, and can offer some patients their only chance of long-term survival [2– 4].

References [1] Thompson LD, Heffess CS. Renal cell carcinoma to the pancreas in surgical pathology material. Cancer 2000;89:1076 – 88. [2] Kassabian A, Stein J, Jabbour N, et al. Renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. Urology 2000;56:211–15. [3] Tuech J, Pessaux P, Chautard D, et al. Results of duodenopancreatectomy for solitary pancreatic metastasis from renal cell carcinoma. J Hepatobil Pancreat Surg 1999;6:396 – 8. [4] Horvath KD, Chabot JA. An aggressive resectional approach to cystic neoplasms of the pancreas. Am J Surg 1999;178:269 –74.