Relapsed metachronous pancreatic metastasis from renal cell carcinoma (RCC). Report of a case and review of literature

Abstract

AIM: The pancreas is a preferred site of metastasis from renal cell carcinoma (RCC), that may occur even after many years from a radical nephrectomy. Surgical R0 resection remains the only potentially curative treatment for solitary tumor.
The possibility of a multifocality of the lesions (20-45%) must be considered. 

MATERIAL OF STUDY: We report a case of metachronous pancreatic metastasis from RCC that occurred twice. After five years from a right polar inferior nephrectomy for a RCC, two nodular lesions were identified in the body-tail of the pancreas and were treated with distal pancreatectomy and splenectomy. After six months the CT imaging revealed a nodular lesion of few millimeters in the residual pancreatic body; we followed the slow growth and in October 2012, when the size reached 2 cm, the patient was operated to remove the residual portion of pancreatic body. After 16 months of follow-up the patient is well and there isn’t relapse of disease. 

DISCUSSION: Patients with metachronous pancreatic lesions represent a particular group with a more indolent course of RCC, the appearance of metastases after a prolonged interval from nephrectomy is related to a more favorable prognosis.
Radical lymph-node dissection is not necessary for the uncommon involvement of peripancreatic nodes, condition that explains the positive outcomes achieved with surgery. 

CONCLUSION: Patients with resected metastasis present an 88% survival rate at 5 years versus 47% observed in nonoperated  patients; studies provide encouraging results in survival and quality of life of surgically treated patients.