Pancreatic Metastases from Tumors in the Urogenital Tract

Abstract

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.

Pancreatic involvement by metastasizing neoplasms as determined by endoscopic ultrasound‐guided fine needle aspiration: A clinicopathologic characterization

“…EUS-FNA is a common method to sample pancreatic tumors, and even if deemed unresectable the procedure can provide a diagnosis from which prognostic data can be then conveyed to the patient, that nonsurgical treatments can be implemented (chemotherapy, stent-placement, etc. 1,3,5,6,10,11,[14][15][16][17][18][19][20][21][22][23][24][25][26] That said, a wide variety of neoplasm types from varying sites of origin have been described, so an open differential must be considered in the pathologic work-up of a metastatic lesion to the pancreas. 7 We have found that metastatic neoplasms to the pancreas account for 4.2% of all pancreatic neoplasms sampled by EUS-FNA.…”

“…25 Another study noted a mean interval period of 81.6 months from the time of nephrectomy for RCC to metastasis to the pancreas. 17,22 The median survival after surgical resection of pancreatic metastatic lesions regardless of neoplasm type was reported to be 34 months. 5,9,14,[21][22][23]25,28 This is likely reflective of the large population of cancer patients treated at our institution and followed for years, somewhat diluting the number of initial diagnoses with diagnoses rendered during long-term surveillance/follow-up.…”

Expression Profiles and Methylation Genes in Clear Cell Renal Carcinoma

“…Вместе с тем в СКК снижена или отсутствует экспрессия цитокера-тина (СK) 7, α-метилацил-коэнзим А-рацемазы (AMACR), катепсина К, CK19, c-kit, Е-кадгерина [7][8][9].…”

“…Сочетание мутации в одном из аллелей гена с соматической мутаци-ей/протяженной делецией или гиперметилиро-ванием CpG-островка промоторной области во втором аллеле приводит к инактивации гена VHL [7,10,11]. VHL -опухолевый супрессор, функци-онирующий в составе внутриклеточного мульти-протеинового комплекса Е3-убиквитинлигазы, осуществляющей деградацию индуцируемого гипоксией транскрипционного фактора (HIF).…”

Pancreatic metastasis of angiosarcoma (Stewart–Treves syndrome) diagnosed using endoscopic ultrasound-guided fine needle aspiration

“…Metastasis to the pancreas is an uncommon condition, representing only about 2% to 4% of malignant lesions in the pancreas in a series of surgical resection. [3] Renal cell carcinoma, colon cancer, and lung cancer are the most common tumors that metastasize to the pancreas, and pancreatic involvement of angiosarcoma is extremely rare. [4–6] …”