Solitary pancreatic metastasis from renal cell carcinoma 6 years after nephrectomy

Abstract

Metastatic cancer to the pancreas is rare and accounts for less than 2% of all pancreatic malignancies. Renal cell cancer, malignant melanoma, lung, colon and breast carcinoma are among the few tumors known to metastasize to the pancreas. The pancreas is a rare site of solitary metastasis, but it is often involved in diffuse metastatic disease. We report a case of a female patient with a solitary mass in the neck of the pancreas following right nephrectomy performed 6 years previously for renal cell carcinoma (RCC). An endoscopic ultrasound (EUS) revealed a well-defined lesion in the neck of the pancreas. Patient underwent EUS-guided fine-needle aspiration and cytopathology confirmed the diagnosis of a metastatic RCC. Solitary pancreatic metachronous metastasis from RCC may rarely occur. The interval between nephrectomy and pancreatic metastasis may be long.

Keywords: endoscopic ultrasound-guided fine needle aspiration; renal cell carcinoma; solitary pancreatic metastasis.

Figure 1

A well-defined mass at the neck of pancreas as seen by endoscopic ultrasound

Figure 2

The pancreatic mass showing elasticity score 4

Figure 3

Pancreatic mass fine-needle aspiration cytology smear; group of malignant tumor cells having large pleomorphic hyperchromatic nuclei and clear vacuolated cytoplasm, with complete loss of polarity (Papanicolaou, ×HP)

Figure 4

Pancreatic mass fine-needle aspiration cytology, cell block; group of malignant tumor cells having clear cytoplasm beside pancreatic ducts lined by columnar cells having bland basal nuclei (H and E, ×MP)