Renal Clear-Cell Carcinoma Metastases in the Pancreas

Yulia Stepanova 1 Aleksander Teplov 2 Olesya Chekhoyeva 1 Andrey Krieger 3 Dmitry Ionkin 3 Vladimir Vishnevsky 3
1Radiology, A.V. Vishnevsky Institute of Surgery, Russia
2Urology, A.V. Vishnevsky Institute of Surgery, Russia
3Abdominal Surgery, A.V. Vishnevsky Institute of Surgery, Russia

Metastatic lesion of the pancreas is an extremely rare disease, which occupies 2-5% of all pancreatic tumors, and these figures rise to 11% according to autopsies of patients with malignant tumors. Metastatic lesion of the pancreas from primary renal clear-cell carcinoma (RCC) occurs most often (65-74%).

OBJECTIVE: to analyze the results of diagnosis and treatment of RCC metastases in the pancreas.

Materials and methods. 214 patients with RCC (21-73 years, men - 133 (62,1%), women - 81 (37,9%) were treated at A.V. Vishnevsky Institute of Surgery from April 2011 to present. 18 (8,4%) patients with metastatic RCC lesions of various organs diagnosed during this time, while 1 patient was diagnosed with metastases 2 times (metachronous). All lesions were morphologically/cytologically verified as metastatic RCC. Target organs of RCC metastasis was pancreas in 9 (50,0%) cases.

RESULTS: In 2 patients, the metastases were synchronic with a kidney tumor. Metastases location in the pancreas: head – 3, body – 2, tail – 1, head+tail – 1, body+tail – 2. Multiple multifocal lesion of the pancreas was in 2 (22,2%) patients. Metastases in the pancreas are combined with liver metastases in 1 case. Dimensions secondary structures ranged from 5 mm to 43 mm.

The most informative diagnostic method in detecting of focal lesions of the pancreas is computed tomography (CT) with bolus contrast enhancement. In CT-study in the native phase, metastatic tumors merged with the pancreatic parenchyma and it was possible to suspect the presence of pathology only from the uneven contour of the organ. In the arterial phase of the study, RCC metastases were defined as hypervascular formations. In tumors over 1.5 cm, single or multiple hypodense necrosis zones in the center can be detected. In the later venous and delayed phases, a decrease in the density of formation was observed, the foci merged with the image of the parenchyma of the gland Significant difficulties for interpretation are small tumors that are similar in structure to hormonally active neuroendocrine neoplasm. Surgery: pancreas resection – 5 (with splenectomy – 2), pancreatoduodenal resection – 2, pancreatectomy+splenectomy – 1, cryodestraction – 1. Nephrectomy and kidney resection were also performed. In case of combination with liver metastases RFA was performed. Long-term results: liver metastasis after 4 years – 1. 5-year survival was 75%.

CONCLUSIONS: Revealed solitary or multiple hypervasculare focal lesions of the pancreas in patients after nephrectomy for RCC should be regarded primarily as secondary.

Yulia Stepanova
Yulia Stepanova