Maimonides Medical Center Brooklyn, NY, United States
Sarthak Kulshreshtha, , Larisa Garkusha, MD, Matthew D. Grunwald, MD, Maryanne Ruggiero, MD, Smita Patel, MD, Omar Azar, MD, Mohammad Hamshow, MD, Dmitriy Khodorskiy, MD Maimonides Medical Center, Brooklyn, NY
Introduction: Renal cell carcinoma (RCC) is an important cause of cancer mortality in the United States, and is unfortunately diagnosed at advanced stage. Approximately 25% of patients with RCC have advanced regional disease or distant metastases (MS) at the time of diagnosis. The most common sites of RCC MS include lungs, lymph nodes, bone, liver, and brain. Pancreatic MS (PMS) is a rare occurrence. Here, we present a case of a patient with PMS post-nephrectomy (P-N).
Case Description/Methods: A 58-year-old man with past medical history of RCC status post partial left nephrectomy presented to the emergency department with abdominal pain and elevated lipase level. Computed tomography (CT) revealed a 2.1 x 1.6 cm lobulated mass in the neck/anterior body of pancreas leading to extrinsic mass effect on main pancreatic duct (MPD). The upstream MPD was noted to be moderately dilated, and the parenchyma was diffusely atrophic. Magnetic resonance imaging (MRI) revealed that the mass was vascular, demonstrating early arterial enhancement that progressively increased over subsequent acquisitions, becoming inconspicuous on the pancreas phase and subsequent phases, favoring neuroendocrine tumor. Positron emission tomography (PET)-CT scan revealed a fluorodeoxyglucose (FDG) avid mass with a max SUV of 5.2, concerning for primary pancreatic neoplasm, without hypermetabolic adenopathy or hepatic metastasis. Patient underwent endoscopic ultrasonography (EUS) with fine needle biopsy (FNB) with cytopathology revealing neoplastic cells compatible with RCC.
Discussion: RCC PMS is a rare occurrence which generally occurs later in life and after a long interval P-N. The mechanism of PMS could be through hematogenous or lymphatic route, or due to the fact that tumor cells have high affinity for pancreas parenchyma. Patients with PMS may be asymptomatic, but can develop symptoms based on the size and malignant potential, and could present with abdominal pain, pancreatitis (MPD obstruction), bleed (duodenal invasion), weight loss, and jaundice. CT scan is believed to be the best imaging modality to evaluate for MS. The prognosis of such clinical cases is poor, and, although not recommended, periodic surveillance P-N with CT scan may be beneficial in identifying MS at an earlier stage. Further studies are warranted to better understand the biochemical and pathophysiologic processes and routes of P-N RCC MS in order to identify potential early interventions and decrease associated morbidity and mortality of late diagnoses.
Disclosures: Sarthak Kulshreshtha indicated no relevant financial relationships. Larisa Garkusha indicated no relevant financial relationships. Matthew Grunwald indicated no relevant financial relationships. Maryanne Ruggiero indicated no relevant financial relationships. Smita Patel indicated no relevant financial relationships. Omar Azar indicated no relevant financial relationships. Mohammad Hamshow indicated no relevant financial relationships. Dmitriy Khodorskiy indicated no relevant financial relationships.
Sarthak Kulshreshtha, , Larisa Garkusha, MD, Matthew D. Grunwald, MD, Maryanne Ruggiero, MD, Smita Patel, MD, Omar Azar, MD, Mohammad Hamshow, MD, Dmitriy Khodorskiy, MD. P2160 - A Rare Presentation of Renal Cell Carcinoma Metastasis to the Pancreas Post Partial Nephrectomy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.