CT diagnosis for metastasis of clear cell renal cell carcinoma to the pancreas

Abstract

Rationale:Clear cell renal cell carcinoma (CCRCC) metastasis to pancreas is clinically rare. Misdiagnosis for these cases is frequently due to the low incidence, lack of specific clinical symptoms, and laboratory results.Patient concerns:Three female patients aged 47 years, 69 years, and 76 years, respectively, were admitted to hospital for routine examination after resection of clear cell carcinoma of kidney for 69 months, 57 months, and 123 months, respectively. All 3 cases had no specific clinical symptoms. Routine laboratory tests and common tumor markers including CEA, AFP, CA19-9, and CA125 showed no obvious abnormality.Diagnosis:All 3 cases were finally diagnosed with CCRCC metastasis to pancreas on the basis of CT and pathological findings. On unenhanced CT, foci of the pancreas showed single or multiple nodules or masses with mildly low or equal density and obscure boundary. On enhanced CT, the enhanced mode of foci was similar to CCRCC and showed “fast in fast out.” The main body was confined in the pancreas. The peripheral structure was clear relatively. Obstruction of common bile duct, main pancreatic duct, and local infringement of foci cannot be seen. Additional metastases of right adrenal gland can be seen in one case.Interventions:All 3 cases underwent CT examination and surgical treatment, with complete removal of metastatic tumors.Outcomes:All 3 cases underwent surgical treatment successfully, and recovered successfully after operation.Lessons:The manifestations of pancreatic metastases from CCRCC on CT show certain characteristics, which may be useful to assess the histological features of pancreatic metastases from CCRCC and facilitate the preoperative diagnosis.

Metastatic clear cell sarcoma of the pancreas: A sporadic cancer

“…Most metastases in the pancreas are discovered as a part of widespread systemic disease at the time of diagnosis[ 22 ]. Renal cell carcinoma, colorectal cancer, melanoma, and lung cancer are the most frequent primary malignancies that cause pancreatic metastases; pancreatic metastases from synovial soft tissue sarcoma are extremely uncommon[ 23 - 26 ]. A review of pancreatic metastases of sarcomas other than clear cell sarcoma showed that the primary tumor was located in the lower limbs[ 27 ].…”

Metastatic renal cell carcinoma to the pancreas and other sites—a multicenter retrospective study

“… 1 , 4 , 5 Pancreatic metastases are uncommon, seen in only two to five percent of all malignancies including RCC, melanomas, colorectal carcinomas, breast cancers, and sarcomas. 6 , 7 RCC is the most common primary tumor leading to pancreatic metastases, with pancreatic metastases found in three to ten percent of metastatic RCC cases. 8 …”

“…9 The current literature on oligometastatic RCC pancreas tumors is comprised of individual case studies and small retrospective reviews, with most reviews looking at the utility of pancreatectomy as an option for disease management. 6 , 9 , 10 , 11 For isolated pancreas metastases, a partial or total pancreatectomy may be a feasible option for patients that are appropriate surgical candidates. Given that this can be a highly morbid surgery and some data demonstrates no clear OS benefit with surgery versus systemic therapy, there is interest in determining the role of non-surgical treatment options for patients with pancreatic oligometastatic disease.…”