Abstract
BackgroundMetastatic spread to the pancreas is a rare event. Renal cell carcinoma represents one possible site of origin of pancreatic metastases. Renal cell carcinoma often metastasizes late and exclusively to the pancreas, suggesting a special role of renal cell carcinoma among primaries metastasizing to the pancreas. Even rarer, renal cell carcinoma may occur simultaneously with pancreatic ductal adenocarcinoma.Case presentationWe present the case of a 78-year-old male Caucasian patient with a history of clear-cell renal cell carcinoma treated with oncological left nephrectomy 20 years before. The patient was diagnosed with pancreatic ductal adenocarcinoma by fine-needle aspiration cytology. At our institution, he received neoadjuvant therapy with folic acid, fluorouracil, irinotecan, oxaliplatin for borderline-resectable pancreatic ductal adenocarcinoma, and subsequently underwent total pancreatectomy. Upon resection, pancreatic ductal adenocarcinoma as well as two metachronous metastases of clear-cell renal cell carcinoma occurring simultaneously and cospatially with pancreatic ductal adenocarcinoma were diagnosed in the pancreatic body.ConclusionsRenal cell carcinoma metastases of the pancreas are rare and often occur decades after the initial diagnosis of renal cell carcinoma. The combination of renal cell carcinoma metastases and pancreatic ductal adenocarcinoma is even rarer. However, the possibility should be considered by clinicians, radiologists, and pathologists. The special role of renal cell carcinoma as a site of origin of pancreatic metastasis should be further elucidated.
Highlights
Metastatic spread to the pancreas is a rare event
We report the rare case of concomitant neoadjuvant-treated Pancreatic ductal adenocarcinoma (PDAC) and two clear-cell renal cell carcinoma (RCC) metastases in the pancreas of a 78-year-old male patient and present a brief review of literature
The fact that pancreatic metastases of RCC often occur late, taken together with the fact that the pancreas is frequently the only organ to be affected by metachronous RCC metastases, has prompted authors to suggest a “seed and soil” theory in the context of RCC metastases to the pancreas
Summary
Metastatic spread to the pancreas is a rare event. Renal cell carcinoma represents one possible site of origin of pancreatic metastases. The patient was diagnosed with pancreatic ductal adenocarcinoma by fine-needle aspiration cytology. At our institution, he received neoadjuvant therapy with folic acid, fluorouracil, irinotecan, oxaliplatin for borderline-resectable pancreatic ductal adenocarcinoma, and subsequently underwent total pancreatectomy. Pancreatic ductal adenocarcinoma as well as two metachronous metastases of clear-cell renal cell carcinoma occurring simultaneously and cospatially with pancreatic ductal adenocarcinoma were diagnosed in the pancreatic body. Renal cell carcinoma (RCC) can spread to the pancreas, accounting for approximately 5% of all pancreatic metastases [3]. We report the rare case of concomitant neoadjuvant-treated PDAC and two clear-cell RCC (ccRCC) metastases in the pancreas of a 78-year-old male patient and present a brief review of literature.
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