Metastases to the Pancreas Diagnosed by Fine-Needle Aspiration

Abstract

Background: Metastatic cancer infrequently involves the pancreas. When the pancreas hosts a metastatic tumor, cytopathological evaluation of fine-needle aspirate material is a crucial part of the diagnostic process. In this study, we show two institutions' experience with cytopathological diagnosis of pancreatic metastasis. Methods: Databases of institutional experience at The Johns Hopkins Hospital and Ohio State University Medical Center were queried for cases of metastatic tumors in the pancreas that underwent fine-needle aspiration. Demographic and pathological features were compiled and the cytomorphology was reviewed. Results: Forty-two cases of tumor metastasis to the pancreas were found. Over the time of this review, 5,495 aspirates were performed, and 43% (2,389/5,495) had malignant cytological findings. Thus, the 42 cases of metastatic disease to the pancreas comprised 0.8% of all pancreas aspirates and 1.8% of the malignant ones. Renal cell carcinoma was the most common metastasis, followed by melanoma and non-small cell lung carcinoma. Among the other tumors in this series, 2 cases each of rare metastases such as the fibrolamellar variant of hepatocellular carcinoma and solitary fibrous tumor were also seen. Conclusion: The pancreas is rarely involved with metastatic disease, but when it is involved the most common tumor is renal cell carcinoma followed by melanoma and non-small cell lung cancer. Clinical history and awareness of the primary pancreatic mimickers are necessary for arriving at the correct diagnosis. As conventional pancreatic adenocarcinoma is uncommon in children and young adults, history of other tumors - even ones that usually follow an indolent course - is essential.

Cytology diagnosis of metastatic clear cell renal cell carcinoma, synchronous to pancreas, and metachronous to thyroid and contralateral adrenal: Report of a case and literature review

“…19 Malignancies are now followed with PET-CT for detection and further evaluation of new lesions as primary versus metastatic. [10][11][12][13][14] Typically metachronous, with latency period 10 years, 4,[9][10][11]13,14 and ranges from 5 months to 29 years 10 with longest reported as 36 years. [2][3][4][6][7][8]20 Pancreatic metastasis is uncommon in clinical studies 4.5%; nonetheless, 11% in autopsies.…”

Diagnosis of Metastatic Renal Cell Carcinoma on Fine-Needle Aspiration Cytology

“…4 Although metastases to the pancreas are generally rare occurrences, RCC represents the most common primary etiology when metastatic tumors are encountered in the pancreas. [5][6][7][8][9][10] Similarly, metastases to the thyroid gland are uncommon; nonetheless, RCC represents the most commonly encountered metastatic tumor in thyroid FNAs. 11,12 Metastatic RCCs diagnosed in parotid gland FNAs have also been reported.…”

“…11,12 Metastatic RCCs diagnosed in parotid gland FNAs have also been reported. 13 As RCC may be encountered initially in the setting of metastatic disease or many years after the initial diagnosis of the primary tumor, 2,8,9,11,13 it is important for cytopathologists and cytotechnologists to recognize the cytomorphologic features of RCC and its subtypes and to be familiar with ancillary studies that can aid in the diagnosis and subclassification of RCCs.…”

Secondary Tumors and Lymphoma

“…Intracytoplasmic lipids can be appreciable on Papanicolaou's stain. Cell blocks can be useful for confi rmatory immunostaining with a panel including CD10, PAX-8, and the renal cell carcinoma antigen [ 9 ].…”

“…Given the morphological overlap of metastatic melanoma with other entities, immunohistochemical staining for melanoma antigens such as S-100, MITF, MEL-A, and HMB-45 can be useful [ 9 ].…”