Metastases to the pancreas

1
Metastases to the pancreas
2
History

• 74 year old male
• 1994 left renal cell carcinoma excised
• Jan 2003 aortic root/valve replacement postop
  dialysis
• Oct 2004 subcutaneous nodule leg
• metastatic renal cell carcinoma
• Nov 2004 CT abdomen pancreatic mass
• bone scan clear

3
Infusion CT showing large brightly enhancing
lesion pancreatic head with displacement of
pancreatic body and tail medially and absent left
kidney
4
Management

• offered resection (total pancreatectomy)
• surgery 7-12-04 (included splenectomy)
• temporary post-op dialysis
• discharged 23-12-04
• well when last seen clinic early March 05

5
Pathology

• main mass 70x55x40mm
• renal clear cell carcinoma
• 3 additional tumour nodules in body/tail
• all lymph nodes clear

6
Discussion

• renal metastases to pancreas not rare
• mean time post nephrectomy gt 5 years
• often isolated to pancreas but gt30 multifocal
• 5 year survival after resection in most series gt
  50 (much better than for pancreatic primary!)
• best results with anatomical resection (high leak
  rate and incomplete resections with enucleation)
  see series of 22 cases from Verona in BJS 2003
  90 555-559

7
General thoughts

• obviously highly selected group (but curious
  tumour goes to and stays within pancreas in many
  patients!)
• subcutaneous nodule made diagnosis obvious in
  this case, but we have now done around 15
  pancreatic resections for renal metastases
• radiology with a brightly enhancing mass highly
  suggestive
• long-term results justify aggressive management