A Synchronous Pancreatic Metastasis from Renal Clear Cell Carcinoma, with Unusual CT Characteristics, Completely Regressed after Therapy with Sunitinib

Abstract

We present a case report of a 75-years-old woman affected by renal clear cell carcinoma with a synchronous pancreatic metastasis and a metachronous lung metastasis. This case has two peculiarities. First the pancreatic metastasis was treated just with medical therapy, that is, Sunitinib, instead of the surgical therapy that is mostly considered. Secondly, the pancreatic lesion showed different characteristics on the computed tomography scan compared to the usual pancreatic metastases from renal clear cell carcinoma. The pancreatic metastasis totally regressed after medical treatment and nowadays, four years after the diagnosis, the patient is disease-free.

Isolated Pancreatic Metastases of Renal Cell Carcinoma—A Paradigm of a Seed and Soil Mechanism: A Literature Analysis of 1,034 Observations

“…Targeted therapies with multi-tyrosine kinase inhibitors, MTOR inhibitors, VEGF inhibitors and immunotherapies proved to be highly effective in mRCC (238)(239)(240)(241)(242)(243). The improvement also concerned the results of medical treatment of the few isPM patients reported so far (163,178,190,(244)(245)(246)(247). Future prospective studies will have to show the significance of surgical or drug therapy, or combinations of both, for respectable isPM (166,182,186,191).…”

“…8,10,14,15,19,20,23,35,48,50,57,65,82,86,88,94,101,102,108,112,118,121,137,156,173,178,181,204,221); metachronous isPMs:(6, 7, 9, 11-13, 16-18, 21, 22, 25-34, 36-47, 49-59, 61, 62, 64, 66- 80, 83-93, 95, 97-99, 102-108, 111-115, 117, 119-124, 126-129, …”

Observations on Solitary Versus Multiple Isolated Pancreatic Metastases of Renal Cell Carcinoma: Another Indication of a Seed and Soil Mechanism?

“…Since the results in that regard were already previously presented in detail [24,25], the results updated with the new included cases [130,134,143,153,159,165,167,169,170,173,176,182,184,185,186,187,188,189,190,191,192,193,194] are listed here in the form of a summary.…”

“…That is not the case, since no clustering of metachronous liver metastases is detectable epidemiologically. d. A high significance of a systemic-haematogenic metastatic route, however, emphasises that out of 27 extra-pancreatic, resectable metastases which developed time-wise between renal carcinoma surgery and diagnosis of pancreas metastases, 20 (72%) were undoubtedly of a haematogenic, systemic origin [25,153], and out of the 94 metastases which developed after the resection of the pancreas metastases, 70 (74.1%) were also undoubtedly of a haematogenic-systemic origin [25,130,167,169,170]. Consequently, the predominant number of metastases which were occasionally observed before the development or after the removal of pancreatic metastases are of a systemic haematogenic origin.…”

“…That the SVR with metastasising renal cell carcinoma is influenced by the total tumor mass and therefore also by the number of metastases is to be expected, but it was only examined later in studies. When an effective drug treatment for metastasising renal cell carcinoma became available for the first time with the establishment of targeted therapies [169,203,204,205,206], the question as to prognostic factors gained clinical importance and resulted in corresponding studies. These studies [207,208,209,210], which differ little with regard to patient selection, determination of the tumor burden, and drug treatment show concordantly that the baseline tumor burden correlates significantly negatively with the overall survival time.…”