Management of Very Late Pancreatic Metastasis of Renal Cell Carcinoma 8 Years After Radical Nephrectomy: A Report of a Rare Case
Unusual clinical course, Challenging differential diagnosis
Norah Alayyaf, Abdullah Abdulaziz AlQatari, Amer Altalib, Abdullah Saleh AlQattan, Abdulwahab A. Alshahrani
Department of General Surgery, Hepatobiliary Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia
Am J Case Rep 2021; 22:e927921
Available online: 2020-11-12
The most common primary malignant neoplasm of the kidneys in adults is renal cell carcinoma (RCC), which originates inside the renal cortex and accounts for 80-85% of all primary renal neoplasms. RCCs can spread to many organs, including the liver, lungs, bones, and brain. Disease is quiescent until the late stages of disease in the vast majority of patients.
CASE REPORT: We report a case of 63-year-old woman who presented to her surveillance check-up after a right radical nephrectomy 8 years ago. Computed tomography of the chest, abdomen, and pelvis (CT-CAP) revealed a hypervascular mass in the body of the pancreas measuring 1 cm, consistent with metastatic appearance. Therefore, the tumor board decision was to proceed with spleen-preserving distal pancreatectomy. The final histopathology result showed metastatic clear cell renal cell carcinoma (CCRCC) with negative resection margins. The patient currently is under regular follow-up. The latest CT-CAP was done at 1 year postoperatively, which showed no evidence of recurrence or metastasis.
CONCLUSIONS: Patients with RCCs can develop asymptomatic metastatic lesions years after complete oncological resection of the primary tumor. Furthermore, metastatic RCCs can be misdiagnosed as other primary tumors. Hence, a meticulous long-term follow-up is essential to ensure that recurrence or a new distant metastasis is not missed. RCCs are known for their poor response to chemotherapy and radiation therapy. However, the new targeted therapies have shown a good response rate. Nevertheless, complete oncological resection of the pancreatic metastasis remains the best treatment modality and is associated with a 5-year survival rate of 75%.
Keywords: renal cell carcinoma, Kidney Neoplasms, Neoplasm Metastasis, Pancreatic Neoplasms