Solitary Pancreatic Metastasis from Renal Cell Carcinoma Concomitant with Early Gastric Cancer 17 Years After Nephrectomy: Report of a Case

The pancreas is an uncommon site for metastasis from renal cell carcinoma. We report the case of a 70-year-old man in whom a solitary pancreatic metastasis from renal cell carcinoma, found 17 years after nephrectomy, was successfully resected, combined with gastrectomy for early gastric cancer. We also discuss the relevant literature, including all the reports of pancreatic metastasis from renal cell carcinoma found in Medline. More than half the cases, like ours, were asymptomatic. A good prognosis can be expected once the pancreatic metastatic lesions are surgically excised, especially if it is a solitary metastasis. Therefore, surgical resection of pancreatic metastases is recommended to achieve the best chance of long-term survival. Special attention must be paid to the possibility of recurrence, even more than 10 years after nephrectomy for renal cell carcinoma, and imaging modalities should be part of the routine follow-up to detect metastases at an early stage.     

Renal cell carcinoma metastatic to the pancreas: Results of surgical management

Metastatic tumors to the pancreas are uncommon. Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas. The purpose of the current report is to evaluate the surgical management and long-term outcome of patients with metastatic renal cell carcinoma. A retrospective review of patients undergoing pancreatic resection for renal cell carcinomas metastatic to the pancreas or periampullary region between April 1989 and May 1999, inclusive, was performed. Time from initial presentation, other metastatic sites, surgical outcomes, and long-term survival were evaluated. During the 10-year time period, 10 patients underwent pancreatic resection for renal cell carcinoma metastases. Ofthose, six underwent pancreaticoduodenectomy and two underwent distal pancreatectomy, whereas the two remaining patients underwent total pancreatectomy for extensive tumor involvement throughout the entire gland. The mean time from nephrectomy for resection of the primary tumor to reoperation for periampullary recurrence was 9.8 years (median 8.5 years). The range was 0 to 28 years, with one patient presenting with a synchronous metastasis. The mean age of the patients was 61.2 years with 60% of patients being male and 90% being white. Pathologic findings included histologically negative lymph nodes and negative surgical margins in all patients. One patient had tumor involving the retroperitoneal soft tissue, but final margins were negative. The mean live patient follow-up was 30 months (median =1.5 months), with eight patients remaining alive. The Kaplan-Meier actuarial 5-year survival was 75%, with the longest survivor still alive 117 months following resection. The patient with retroperitoneal soft tissue involvement died 4 months after resection. The pancreas is an uncommon site of metastasis for renal cell carcinoma, typically occurring years after treatment of the primary tumor. When the metastatic focus is isolated and the tumor can be resected in its entirety, patients can experience excellent S-year survival rates. The current report suggests that pancreatic metastases from renal cell carcinoma should be managed aggressively with complete resection when possible. Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract, San Diego, Calif., May 2l–24, 2000.     

Pancreatic metastasis of renal cell carcinoma: a case report and review of the literature

The pancreas is an uncommon site of metastases from renal cell carcinoma; however in the literature late pancreatic metastases are described. In this report a 74 years-old asymptomatic man was referred for evaluation of a mass in the distal portion of the pancreas, found on CT 4 years after right nephrectomy for a renal cell carcinoma. A distal pancreatectomy and splenectomy were performed and histopathological analysis revealed to be a metastases from renal cell carcinoma. A postoperative pancreatic fistula was treated in a conservative way. The patient is alive and doing well 3 years after pancreatic surgery. This clinical report suggests that late pancreatic metastases are rare but not impossible and should be taken into consideration during a careful long-term follow-up for renal carcinoma. In addition, as it is also desumed by the Literature on survival, pancreatic metastases should be treated when possible with radical resection.     

Solitary and Multiple Isolated Metastases of Clear Cell Renal Carcinoma to the Pancreas: An Indication for Pancreatic Surgery

Background Isolated pancreatic metastases (isPMs) of clear cell renal carcinoma are rare. Most of them are solitary; some are multiple. The reported rates and the clinical implications of multiple isPMs from clear cell renal cancer vary. Therefore, the available literature was analyzed to shed light on the clinical significance of these extremely rare metastatic lesions. Methods A literature search brought to light 236 cases of isPMs (both solitary and multiple) from renal cell carcinoma. These were analyzed. Results A total of 12% of the metastases were synchronous with the primary tumor, and 88% were metachronous, occurring 10.0 ± 6.5 years (mean ± SD) after nephrectomy. A predilection for a specific part of the pancreas was not identifiable. The localization of the renal cell cancer (left or right kidney) did not have any effect on the site of the metastases. Seventy-four (39%) of the metastases to the pancreas were multiple (3.2 ± 1.5). Their epidemiology did not differ from that of solitary metastatic lesions. Actuarial 3- and 5-year survival rates after radical resection were 78% and 78%, respectively, for multiple versus 75% and 64% for solitary metastases. Conclusions The epidemiological data do not support a direct local lymphogenous or venous spread from the primary tumor to the pancreas. They rather suggest a systemic spread. Because of the positive outcome, radical removal of both solitary and multiple metastases should be attempted in eligible patients.     

����ת������ϸ�������������ƣ���3�����棩

??Surgical treatment of pancreatic metastases from renal cell carcinoma : A report of 3 cases LIN Xian-chao, HUANG He-guang, CHEN Yan-chang, et al.Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG He-guang, E-mail: heguanghuang2@163.com
Abstract Objective To investigate the value of surgery in the management of pancreatic metastases from renal cell carcinoma??PMRCC??.Methods The clinical data of 3 patients with PMRCC who underwent pancreatectomy in Fujian Medical University Union Hospital between October 2010 and April 2018 were reviewed??including general information??accessary examination??perioperative data and follow-up status. Results Of the 3 patients??2 patients had multiple lesions of the pancreas and the other one had a single lesion of pancreas. All of the 3 cases were asymptomatic. Primary cancer was renal clear cell cancer in all of them and the mean time from resection of the primary tumor to pancreatic metastases was 7 years ??range 3-15 years??. Two patients underwent laparoscopic distal pancreatectomy with splenectomy and 1 underwent total pancreatectomy. Intra-abdominal infection was observed in 2 patients after pancreatic surgery and no pancreatic fistula occurred.Postoperative pathological diagnosis was metastatic renal cell carcinoma in all of the 3 patients. One patient died at 22 months after the pancreatic surgery and the other 2 patients were disease free with a follow-up of 15 and 39 months respectively. Conclusion The prognosis of PMRCC is good. Surgical treatment is suitable for isolated PMRCC, especially for the metastases in the body and tail of pancreas.     

Renal carcinoma metachronous metastases to the gall-bladder and pancreas--case report

Renal carcinoma metastases to the gastrointestinal tract are seldom reported in medical literature. The study presented a case of a 76-year old female patient who underwent nephrectomy, due to T2N0M0 clear cell renal carcinoma and was additionally diagnosed with two metachronous metastases to the gall-bladder and pancreas. Abdominal ultrasound performed 32 months after nephrectomy demonstrated the presence of cholelithiasis and gall-bladder polyp. Laparoscopic cholecystectomy was performed. Clear cell renal carcinoma metastasis restricted to the gall-bladder mucosa was diagnosed on the basis of the histopathological examination. After surgery the patient remained under follow-up. In December, 2009 (47 months after nephrectomy) abdominal computer tomography (CT) revealed the presence of a tumor located in the tail of the pancreas. Distal pancreatic resection and splenectomy was performed. The histopathological examination confirmed the presence of clear cell renal carcinoma metastasis. The patient is in good general condition, under follow-up at the Oncological Outpatient Clinic.     

Solitary pancreatic metastasis from renal cell carcinoma

A case of asynchronous bilateral renal cell carcinoma with pancreatic metastasis is described. Left nephrectomy and tumorectomy in the right kidney were performed. Solitary metastasis to the pancreas without symptoms was treated by distal pancreatectomy with tumor and splenectomy. Although bilateral renal cell carcinomas were histologically renal cell carcinoma (clear cell subtype, grade 2), the resected pancreatic tumor was renal cell carcinoma with sarcomatoid change. Therefore, the metastatic tumor had a more malignant potential than the primary tumor. The pancreatic metastasis was seen at 6 years 10 months and 2 years 6 months after left nephrectomy and enucleation of the right renal tumors, respectively. The patient is alive without disease and is being treated by alpha-interferon for 12 months after distal pancreatectomy. A careful long-term follow-up of the patient with renal cell carcinoma seems to be necessary.     

Pancreatic metastases: An increasing clinical entity

Pancreatic metastases, although uncommon, have been observed with increasing frequency recently, especially by high-volume pancreatic surgery centers. They are often asymptomatic and detected incidentally or during follow-up investigations even several years after the removal of the primary tumor. Renal cell cancer represents the most common primary tumor by far, followed by colorectal cancer, melanoma, sarcoma and lung cancer. Pancreatic metastasectomy is indicated for an isolated and resectable metastasis in a patient fit to tolerate pancreatectomy. Both standard and atypical pancreatic resection can be performed: a resection strategy providing adequate resection margins and maximal tissue preservation of the pancreas should be pursued. The effectiveness of resection for pancreatic metastases is mainly dependent on the tumor biology of the primary cancer; renal cell cancer is associated with the best outcome with a 5-year survival rate greater than 70%.     

Pancreatic metastasis from renal cell carcinoma 25 years after radical nephrectomy

We report a case of pancreatic metastasis from renal cell carcinoma detected 25 years after radical nephrectomy. A 74-year-old man, who had undergone radical nephrectomy for renal cell carcinoma at age 49, was found by computed tomography to have a strongly enhanced mass on the pancreatic head. The patient underwent pancreaticoduodenectomy and the pathological diagnosis was metastatic renal cell carcinoma. This was evidently a slow growing tumor because the metastatic pancreas tumor was well demarcated and the metastasis was found 25 years after the primary operation. Aggressive surgical treatment of isolated metastatic lesions offers a chance of long-term survival. Patients with a history of RCC should undergo a long-term follow-up to detect and evaluate metastasis to pancreas as well as other organs.     

Singular late metastasis of renal cell carcinoma in the pancreas. An unusual pancreatic tumor

We present the rare case of a solitary pancreatic metastasis of renal cell cancer being the only manifestation of tumordissemination. In 1993 the patient underwent a transperitoneal nephrectomy for removal of a clear cell renal cancer. In 1998 during follow up we detected a pancreatic tumor which was treated by pancreas resection, splenectomy and resection of the colon transversum. The histology revealed a metastasis of the previously resected renal cancer. The postoperative recovery was impaired by the development of an abcess in the former pancreatic region. During the first year of follow up we did not find any signs for local or distant tumor recurrence. Pancreas resection adapted to the location of the tumor is the treatment of choice for isolated solitary late metastases of renal cell cancer.     

胰腺转移性肾细胞癌的手术治疗（附3例报告）

目的 探讨手术治疗胰腺转移性肾细胞癌（PMRCC）的价值。方法 回顾性分析2010年10月至2018年4月福建医科大学附属协和医院3例手术PMRCC病人的临床资料,包括一般资料、临床表现、辅助检查、手术情况、术后随访情况等。结果 3例PMRCC,2例肿瘤为多发,1例肿瘤为单发。3例病人均无临床症状,原发肿瘤均为肾透明细胞癌,胰腺转移距肾癌手术时间间隔为3～15年,平均7年。2例行腹腔镜胰体尾+脾切除术,1例行全胰十二指肠切除术。3例均无胰瘘,2例术后并发腹腔感染。术后病理学检查结果均为胰腺转移性透明细胞癌。1例病人胰腺术后生存时间为22个月,另2例分别随访15个月及39个月仍无瘤生存。结论 PMRCC总体预后较好,手术治疗适用于孤立性PMRCC,尤其是胰体尾病例。     

Pancreatic resection for renal cell carcinoma metastasis: An exceptionally rare coexistence

IntroductionPancreatic metastases are uncommon and only found in a minority of patients with widespread metastatic disease at autopsy. The most common primary cancer site resulting in pancreatic metastases is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma.Presentation of caseHerein, we report a 63-year-old male patient who presented −3.5 years after radical nephrectomy performed for renal cell carcinoma (RCC)-with a well-defined lobular, round mass at the body of the pancreas demonstrated by abdominal Magnetic Resonance Imaging (MRI). The patient underwent distal pancreatectomy combined with splenectomy and cholecystectomy. Histopathological examination revealed clusters of epithelial clear cells, immunohistochemically positive for RCC marker, and negative for CD10 and CA19-9. A final diagnosis of clear RCC metastasizing to pancreas was obtained in view of the past history of RCC, microscopy and the immunoprofile. This was the second metachronous disease recurrence after a previous metastatic involvement of the liver, developed 19 months from the initial diagnosis. The patient has remained well at a 6 month follow up post-resection.DiscussionSolitary pancreatic metastases may be misdiagnosed as primary pancreatic cancer. However, imaging including computed tomography (CT) and MRI, may discriminate between them. Surgical procedures could differentiate solitary metastasis from neuroendocrine neoplasms. The optimal resection strategy involves adequate resection margins and maximal tissue preservation of the pancreas.ConclusionRecently, an increasing number of surgical resections have been performed in selected patients with limited metastatic disease to the pancreas. In addition, a rigid follow-up scheme, including endoscopic ultrasound (EUS) and CT is essential give patients a chance for a prolonged life.     

Pancreatic late recurrence of bilateral renal cell carcinoma after conservative surgery

The appearance of solitary late metastases of renal cell carcinoma has seldom been documented. A female patient, who 13 years previously underwent left radical nephrectomy and right lower polar resection for bilateral simultaneous renal cell carcinoma, presented with a solitary pancreatic metastasis which was successfully treated with pancreaticoduodenectomy. The major points of interest of this report are the occurrence of a primary bilateral tumor, the initial treatment with conservative surgery and the site of late recurrence. The diagnostic and prognostic implications of late metastases of renal tumors are discussed.     

Results after pancreatic resection for metastatic lesions

Background Unlike primary pancreatic carcinoma, isolated metastatic lesions to the pancreas are uncommon. Although the value of surgical resection is poorly documented, resection may be deemed appropriate in selected cases. The aim of this study was to review our experience with the operative management of pancreatic metastases Methods Sixteen patients who underwent pancreatic resection for the treatment of metastatic disease were identified from a prospective pancreatic database. The clinical features of and results after resection were examined. Results Renal cell carcinoma was the most frequent primary histopathology (10 of 16; 62%). In the remaining patients, the primary histopathology was non-small-cell lung cancer (n=3), sarcoma (n=1), melanoma (n=1), or transitional cell carcinoma of the bladder (n=1). A prolonged disease-free interval (median, 7.5 years) was characteristic of most patients. Operative procedures performed included eight pancreaticoduodenectomies, seven distal pancreatectomies, and one total pancreatectomy. The operative mortality was 6%, and the morbidity was 25%. The overall 2- and 5-year actuarial survival rates were 62% and 25%, respectively. A trend toward improved survival was observed in the renal cell carcinoma patients, but this finding was not statistically significant. Conclusions Long-term survival after pancreatic resection for metastatic disease is achievable, and patients with primary renal cell carcinoma seem to have a more favorable prognosis. Surgical resection should thus be offered to selected patients with isolated metastatic disease to the pancreas.     

Surgical treatment of pancreatic metastases from renal carcinoma

OBJECTIVES: Pancreatic metastases from renal carcinoma are poorly known. The aim of this study was to report clinical and radiological manifestations, the treatment performed, and the observed survival in 7 patients with this rare entity. RESULTS: All patients were operated on. One patient had nonresectable tumor. Six patients underwent curative resection. There was one postoperative death. Follow-up after pancreatectomy ranged from 6 months to 3 years. Two patients developed extra-pancreatic metastases one year and 3 years after pancreatectomy respectively. CONCLUSIONS: Pancreatic metastases from renal carcinoma are rare and often occur several years after nephrectomy. However their resection is often possible and allows a good long-term survival. PATIENTS AND METHODS: From 1988 to 2000, 7 patients (5 men and 2 women, mean age = 66 years) with pancreatic metastases from a renal cell carcinoma were observed in the same center. One patient had synchronous metastasis; in the 6 others, metastases were diagnosed 4 to 16 years after nephrectomy, and were revealed by pain (n = 2), gastrointestinal bleeding (n = 1), faintness (n = 1) or routine follow-up (n = 2). The diagnosis of metastases was made by contrast-enhanced abdominal CT-scan.     

Pancreatic resection for metastatic renal cell carcinoma to the pancreas

Although extremely rare, for most primary malignancies, the presence of metastases to the pancreas is a harbinger of diffuse systemic involvement. Clear cell renal cell carcinoma (RCC) of the kidney differs in that respect. Metastatic deposits tend to be isolated and diffuse systemic involvement may be absent. An Institutional Review Board-approved retrospective review of three cases of histologically confirmed RCC metastases to the pancreas was performed. We present their preoperative workup, surgical treatment, histopathological findings, and postoperative course. Three patients, all women, underwent distal pancreatectomy and splenectomy. Mean time period between nephrectomy and findings of pancreatic metastasis was 11.6 years. One patient had a major complication with a pancreatic fistula. Two patients have developed extrapancreatic recurrences. Resection of RCC metastases to the pancreas may offer a survival advantage in a select group of patients. Development of metastatic deposits after a prolonged disease-free period may actually be a negative prognostic indicator, implying a rapid and uncontrollable change in tumor biology.     

Pancreatic metastasis from renal cell carcinoma 13 years after a nephrectomy: report of a case

The pancreas is an uncommon site of metastasis from renal cell carcinoma. We herein present the case of a 59-year-old woman in whom pancreatic metastasis from renal cell carcinoma, found 13 years after undergoing a nephrectomy, was successfully resected and who has since showed no evidence of recurrence or metastasis. The efficacy of performing a pancreatectomy for metastatic renal cell carcinoma is also presented. We recommend careful long-term follow-up in patients with a history of renal cell carcinoma. Imaging modalities should be used during the routine follow-up to detect any asymptomatic metastases at an early stage.     

Pancreatic metastasis of naso-sinusal epithelioma. Apropos of a case]

The authors report a pancreatic metastasis of sinusal squamous cell carcinoma in a 69 year-old man, 18 years after the first excision of the primary neoplasm. The metastases appearing in a patients having previously presented several tumors, was detected by a rising CA 19-9 level and a pancreas head enlargement at the CT. The diagnosis was identified at laparotomy by tumor biopsy. The vascular involvement of the tumor obliged to perform double bypass. 103 cases of pancreatic metastases, published in the literature from 1983 to 1991, are reviewed. Generally the pancreatic mass is visualized by CT but the diagnosis is only carried out on microscopy. Treatment depends on anatomical and pathological characteristics of primary and secondary tumours. Solitary metastasis of renal carcinoma origin have the best prognosis after radical surgery. In other cases palliative procedures are widely used. First case of pancreatic metastasis originated from recurrent sinusal squamous cell carcinoma with poly-tumoral clinical presentation.     

Surgical Treatment of Metastatic Tumors to the Pancreas: A Single Center Experience and Review of the Literature

Background Unlike primary pancreatic carcinoma, metastases to the pancreas are rare, and their resection may be performed as palliative treatment. The aim of this study was to review our experience with the operative management of pancreatic metastases. Materials and Methods Between January 1994 and December 2004 13 patients (nine women and four men; median age: 59 years; range: 36–79 years) were admitted to our institution with metastatic lesion to the pancreas. The clinical features of the treatment and results were examined. Results Primary tumors were renal cell carcinoma (n = 5), lobular carcinoma of the breast (n = 3), endometrioid carcinoma of the ovary (n = 1), colonic adenocarcinoma (n = 1), jejunal leiomyosarcoma (n = 1), melanoma (n = 1), and non-small-cell lung cancer (n = 1). The median interval between primary tumor and pancreatic metastases was 36 months (range: 5–192 months). Six patients (46%) were asymptomatic, while the other seven patients presented with jaundice, pain, and duodenal obstruction. Two patients with extrapancreatic disease underwent palliative surgery, and the remaining 11 patients underwent operative procedures that included seven pancreaticoduodenectomy and four distal pancreatectomies with splenectomy. Postoperative mortality was nil, and the morbidity rate was 30%. The two patients who underwent palliative surgery died after 7 and 9 months, respectively. The median survival of the resected patients was 26 months (range: 13–95 months). Five patients died of disease, eight are alive at the time of this report. Conclusion A trend towards improved survival, even if not statistically significant, was observed in the renal carcinoma patients reported here. Surgical resection can be performed safely in selected patients with isolated metastases to the pancreas, achieving long-term survival as well as good palliation.     

Small renal cell carcinoma with pancreas metastasis: a case report

A 53-year-old-man was treated in the Department of Surgery for a pancreatic tumor because asymptomatic, nodular masses, 4 cm-in diameter were discovered in the tail of the pancreas on computed tomography (CT). The pancreatic masses were metastases of renal cell carcinoma on pathological examination. Contrast-enhanced CT and abdominal magnetic resonance imaging showed a small, 1.3 cmdiameter mass in the right kidney. The size of the renal tumor was small, but it appeared to have high malignancy because of spread to the pancreas. We chose radical nephrectomy in consideration of intrarenal spread of carcinoma. The resected specimen was diagnosed pathologically as clear cell carcinoma, G2＞ G1, pT1apN0M0, exp, INFα, v (-), ly (-). At follow-up one year after surgery, there was no evidence of recurrence.