Rising Incidence of Solid Organ Tumors Metastasizing to the Pancreas

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Introduction: Unlike primary pancreatic carcinoma, metastatic lesions of the pancreas are uncommon and account for approximately 2% of pancreatic malignancies. Identification of the etiology of a pancreatic mass is important, particularly if malignancy is suspected. Metastatic disease to the pancreas should be considered within the differential of a pancreatic mass. Methods: Aim: To determine the incidence of metastatic cancer presenting as a solitary pancreatic mass. Methods: Retrospective chart review of patients referred for Endoscopic ultrasound (EUS) evaluation of a solid pancreatic mass from January 2015 to June 2018. All patients with a final diagnosis of malignancy after EUS-FNA of a pancreatic mass were included. Results: Out of 640 charts reviewed, 116 patients were diagnosed with cancer by EUS-FNA. 92 out of 115 (80%) patients were identified to have primary adenocarcinoma of the pancreas, 12 out of 115 (10.5%) with primary neuroendocrine tumors of the pancreas, and 11 out of 115 (9.5%) with metastasis to the pancreas from another primary cancer. Of the metastatic cases, the distant primary tumor was from renal cell carcinoma in 4/11, colon carcinoma 3/11, squamous cell carcinoma of the lung 3/11, and urothelial carcinoma 1/11. 10 out of 11 patients had a prior history of cancer ranging from 1 to 12 years (Mean 6 years) from the time of diagnosis of the primary tumor to the time of metastatic disease to the pancreas. 10/11 presented as a solitary mass in the pancreas without any evidence of metastatic disease elsewhere. Of these solitary masses, 5/11 appeared to be resectable pancreatic tumors on initial imaging before EUSFNA. Limitation: Unable to correct the referral bias to a tertiary center. Conclusion: There appears to be a higher incidence (9.5% in our series) of metastatic cancer to the pancreas as compared to prior reports (up to 2%). In our experience, EUS-FNA allowed to diagnose (5/11) cases with metastatic cancer when initial imaging suggested a resectable primary pancreatic tumor. Metastatic cancer to the pancreas should be considered in patients with prior history of cancer presenting with solitary pancreatic mass (90 % of our cases had a cancer history). In these patients, tissue diagnosis by EUS-FNA becomes particularly important, especially if surgical resection is being considered (45% of the cases in our series).