Pancreatic metastases from renal cell carcinoma: a case report and literature review of the clinical and radiological characteristics

Hoshino, Yoshinori; Shinozaki, Hiroharu; Kimura, Yuki; Masugi, Yohei; Ito, Homare; Terauchi, Toshiaki; Kimata, Masaru; Furukawa, Junji; Kobayashi, Kenji; Ogata, Yoshiro

doi:10.1186/1477-7819-11-289

Cited by 24 publications

(26 citation statements)

References 42 publications

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“…The most common malignancies to spread to the pancreas via direct extension are carcinomas of the gastrointestinal tract, including gastric, duodenal, ampullary, gallbladder, and transverse colonic. Hematogenous or lymphatic spread can occur, most likely from bronchogenic carcinoma, breast carcinoma, melanomas, colorectal carcinoma, and renal cell carcinoma (91,92). As described in the preceding sections, lymphomatous and plasma cell neoplastic involvement of the pancreas is most commonly associated with systemic or widespread disease.…”

Section: Secondary Tumors: Malignant Metastasesmentioning

confidence: 99%

Nonepithelial Neoplasms of the Pancreas, Part 2: Malignant Tumors and Tumors of Uncertain Malignant PotentialFrom the Radiologic Pathology Archives

Manning

Paal²,

Srivastava

et al. 2018

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Almost all neoplasms of the pancreas are derived from pancreatic epithelial components, including the most common pancreatic mass, primary pancreatic ductal adenocarcinoma (PDAC). Nonepithelial neoplasms comprise only 1%-2% of all pancreatic neoplasms. Although some may arise directly from intrapancreatic elements, many originate from mesenchymal, hematopoietic, or neural elements in the retroperitoneal peripancreatic space and grow into the pancreas. Once these tumors reach a certain size, it can be challenging to identify their origin. Because these manifest at imaging as intrapancreatic masses, awareness of the existence and characteristic features of these nonepithelial neoplasms is crucial for the practicing radiologist in differentiating these tumors from primary epithelial pancreatic tumors, an important distinction given the vastly different management and prognosis. In part 1 of this article, the authors reviewed benign nonepithelial neoplasms of the pancreas. This article focuses on malignant nonepithelial neoplasms and those of uncertain malignant potential that can be seen in the pancreas. The most common malignant or potentially malignant nonepithelial pancreatic tumors are of mesenchymal origin and include soft-tissue sarcomas, solitary fibrous tumor, and inflammatory myofibroblastic tumor. These tumors commonly manifest as large heterogeneous masses, often containing areas of necrosis and hemorrhage. The clinical features associated with these tumors and the imaging characteristics including enhancement patterns and the presence of fat or calcification help distinguish these tumors from PDAC. Hematopoietic tumors, including lymphoma and extramedullary plasmacytoma, can manifest as isolated pancreatic involvement or secondarily involve the pancreas as widespread disease. Hyperenhancing paragangliomas or hypervascular metastatic disease can mimic primary pancreatic neuroendocrine tumors or vascular anomalies.

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Section: Secondary Tumors: Malignant Metastasesmentioning

confidence: 99%

Nonepithelial Neoplasms of the Pancreas, Part 2: Malignant Tumors and Tumors of Uncertain Malignant PotentialFrom the Radiologic Pathology Archives

Manning

Paal²,

Srivastava

et al. 2018

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“…[ 20 21 26 27 ] RCC typically coexpress pan-cytokeratin, vimentin, EMA, CD10, and PAX-8. [ 24 25 ] In our study, the most common immunochemical markers used are pan-cytokeratin, EMA, CD10, and PAX-8. These markers along with neuroendocrine markers can be very helpful in distinguishing RCC from primary pancreatic neuroendocrine neoplasm.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 7 8 9 10 17 18 19 20 21 22 23 ] However, current literature regarding EUS-FNA cytology of metastatic RCC to the pancreas is limited with mostly case reports or small case series. [ 11 24 25 26 27 ] Therefore, we studied a large series of metastatic RCC to the pancreas diagnosed by EUS-FNA cytology from four academic tertiary medical centers. We evaluated sonographic characteristics and cytologic features to determine if EUS-FNA cytology is an accurate tool to diagnose metastatic RCC.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided fine needle aspiration cytology of metastatic renal cell carcinoma to the pancreas: A multi-center experience

et al. 2016

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Introduction:The increasing use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology to examine pancreatic neoplasms has led to an increase in the diagnosis of metastases to the pancreas. Renal cell carcinoma (RCC) is the most common metastasis to the pancreas. Our study examines 33 cases of metastatic RCC to the pancreas sampled by EUS-FNA from four large tertiary care hospitals.Materials and Methods:We searched the cytopathology database for RCC metastatic to the pancreas diagnosed by EUS-FNA from January 2005 to January 2015. Patient age, history of RCC, nephrectomy history, follow-up postnephrectomy, radiological impression, and EUS-FNA cytologic diagnosis were reviewed.Results:Thirty-three patients were identified. The average age was 67.5 years (range, 49–84 years). Thirty-two patients had a previous documented history of RCC. One patient had the diagnosis of pancreatic metastasis at the same time of the kidney biopsy. Thirty-one patients had been treated with nephrectomy. Twenty-seven patients were being monitored annually by computed tomography or magnetic resonance imaging. Twenty-five patients had multiple masses by imaging, but 8 patients had a single mass in the pancreas at the time of EUS-FNA. EUS-FNA of 20 cases showed classic morphology of RCC. Thirteen cases had either “atypical” clinical-radiologic features or morphologic overlaps with primary pancreatic neoplasms or other neoplasms. Cell blocks were made on all 13 cases and immunochemical stains confirmed the diagnosis.Conclusions:EUS-FNA cytology is useful for the diagnosis of metastatic RCC to the pancreas. Cytomorphology can be aided with patient history, imaging analyses, cell blocks, and immunochemical stains.

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“…Pancreatic metastasis of RCC typically present as hypervascularized, contrast-enhancing lesions that are best visible in the arterial phase [10]. A typical CT finding is demonstrated in figure 1.…”

Section: Clinical Presentation and Diagnostic Workupmentioning

confidence: 99%

Pancreatic Metastases from Tumors in the Urogenital Tract

Strobel

Büchler

2015

Gastrointest Tumors

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Background: Isolated pancreatic metastases or pancreatic metastases with limited extrapancreatic disease are uncommon and account for only 2-4% of resected malignant pancreatic lesions in surgical series. However, clear-cell renal cell carcinoma is the predominant primary tumor and accounts for more than 60% of cases with isolated pancreatic metastases. Pancreatectomy is the treatment of choice for most patients with isolated pancreatic metastases from renal cell cancer. Summary: This review provides an overview of clinical presentation and diagnosis as well as surgical management, including patient selection for surgery and surgical technique for pancreatic metastases of renal cell carcinoma. Key Message: Although there is no high-level evidence that surgical resection of pancreatic metastases improves survival, the survival results of several observational series and of systematic reviews are promising and support pancreatic resection as part of a multimodal treatment. The reported median survival and 5-year survival rates after pancreatic resection range from 6 to 10 years and from 55 to 75%, respectively. Pancreatic resection is effective for local control. However, extrapancreatic progression frequently occurs. With the introduction of novel systemic therapy options such as tyrosine kinase inhibitors, the prognosis of metastatic renal cell carcinoma has improved, and this will affect the role of pancreatic resection for metastases. Practical Implications: Pancreatic resection for isolated renal cell carcinoma is safe and effective, may confer a survival benefit and should, therefore, be considered in patients for whom no contraindication for surgery exists.

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Pancreatic metastases from renal cell carcinoma: a case report and literature review of the clinical and radiological characteristics

Cited by 24 publications

References 42 publications

Nonepithelial Neoplasms of the Pancreas, Part 2: Malignant Tumors and Tumors of Uncertain Malignant PotentialFrom the Radiologic Pathology Archives

Nonepithelial Neoplasms of the Pancreas, Part 2: Malignant Tumors and Tumors of Uncertain Malignant PotentialFrom the Radiologic Pathology Archives

Endoscopic ultrasound-guided fine needle aspiration cytology of metastatic renal cell carcinoma to the pancreas: A multi-center experience

Pancreatic Metastases from Tumors in the Urogenital Tract

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