Pancreatic metastasis from renal cell carcinoma

Abstract

Pancreatic metastasis from renal cell carcinoma is exceptional, but may appear many years after initial diagnosis and radical nephrectomy of an apparently limited tumour. We report one case of an asymptomatic isolated pancreatic metastasis discovered fortuitously, 21 years after right radical nephrectomy for a low-grade renal cancer. In 1969, a 47-year-old man underwent right nephrectomy for renal cell carcinoma of “low-grade malignancy”. At this time, no metastases were evident and he remained well on follow-up.

Surgical Treatment of Pancreatic Metastases from Renal Cell Carcinomas

“…Gohij et al [4] reported 11 cases in 1990, Stankard and Karl [5] updated the number of cases to 16 in 1992, and the remaining cases were reported by Rypens et al [6], Takeuchi et al [7], Diaz Dominguez et al [8], Marcote Valdivieso et al [9], Reale et al [10], Dousset et al [11], Nakeeb et al [12], Sauvanet et al [13], and Badia et al [14]. …”

“…Nevertheless, a number of investigators claim that it is not necessary to perform FNAB in view of the fact that an aggressive surgical strategy can be taken for granted [12]. In this connection, analysis of the cases reported in the literature reveals that we can be sure that FNAB was performed only in 4 cases: in 2 of these the biopsy sample was hemorrhagic [6, 22], and in the other 2 it was diagnostic [5, 13]. In addition, we have to rule out the possibility of a primary pancreatic clear-cell cancer which would in any event be a rare variant of pancreatic adenocarcinoma.…”

“…Eight of these 10 patients presented symptoms at the time of diagnosis, and 6 of 8 were submitted to pancreaticoduodenectomy [7, 8, 9, 11, 12, 14], 1 of 8 to total splenopancreatectomy [10] and 1 of 8 to intermediate pancreatectomy [13]. The case reported by Rypens et al [6] had a lesion of the pancreatic tail discovered by means of an US examination performed for another disease and was treated by partial pancreatectomy. One case reported by Sauvanet et al [13] had a lesion of the head of the pancreas and was symptom free and treated by duodenopancreatectomy.…”

“…The difference was statistically significant (p < 0.01), thus confirming the greater risk of complications when the technique used involves atypical resections. In the 2 cases of atypical resection reported in the literature [6, 13], one report [6] fails to give details on the postoperative course, while the other [13] describes dehiscence of the pancreaticogastric anastomosis as a complication which was also resolved by nasogastric suction, somatostatin analogues, and total parenteral nutrition. Despite the higher incidence of pancreatic fistulas, we believe that adjusted resection of the pancreas for metastases from RCC is in any event to be advocated, as there are no reports on local recurrences, as well as the possibility of additional remote secondaries, the shorter duration of surgery, and the ever-present desire to preserve pancreatic parenchyma and healthy adjacent organs such as duodenum, stomach, and spleen.…”

Solitary Pancreatic Metastasis of Renal Cell Cancer Treated by Pancreaticoduodenectomy: A Case Report

“…[10] Since the interval between the primary diagnosis and metastatic disease can be long, [11,12] solitary metastasis to the pancreas often is an unsuspected clinical problem and is not high in the differential diagnoses of a pancreatic mass. [13,14] The mechanism of pancreatic metastases may involve direct invasion (tail involvement in left RCC) or lymphatic and hematogenous spread. Hematogenous spread is common when neoplastic thrombus is present in the renal vein.…”