Solitary Pancreatic Metastasis from Renal Cell Carcinoma: A Case Report from India with a Review of Literature

ABSTRACT: Metastatic cancer to the pancreas accounts for less than 2% of all pancreatic malignancies, with renal cell carcinoma being the predominant type. We report the case of an elderly patient detected with a solitary lesion in the head of the pancreas, 6 years after a nephrectomy for renal cell carcinoma. The patient underwent a pancreaticoduodenectomy for the same. A review of literature showed isolated pancreatic metastasis to be rare, ranging from 0.5 to 3%. Patients are usually asymptomatic, unless the tumor enlarges. Spread usually takes place by the hematogenous route or via lymphatics, direct spread being very unusual. Surgical resection seems to be the standard of care for isolated metastasis from renal cell carcinoma as the other modalities of treatment seem unresponsive. Typically, patients undergo a pancreaticoduodenectomy or distal pancreatectomy depending on the location of the tumor. Atypical resections are done in certain situations. Surgery is carried out in favourable candidates and a thorough evaluation needs to be done intraoperatively for multiple metastases. Histology revealed a metastatic renal cell carcinoma confirmed on immunohistochemistry. All margins were free of tumor without lymphnodal involvement. Eight months after the surgery the patient is doing well. As compared to primary pancreatic cancer, metastasis from renal cell carcinoma has a higher resectability rate. Solitary metastasis to the pancreas has a good prognosis especially in renal cell carcinoma, with a 5 years survival rate of 43 to 88%. KEYWORDS: Renal Cell Carcinoma; Pancreatic Metastasis; Pancreaticoduodenectomy Internet Journal of Medical Update 2012 January;7(1):62-5