Pancreas metastasis from renal cell carcinoma with intraductal growth into the main pancreatic duct 20 years after nephrectomy for the primary lesion

Abstract

A 70-year-old man who had undergone left nephrectomy for renal cell carcinoma 20 years earlier was admitted for the treatment of hematuria. Contrast-enhanced computed tomography (CT) revealed a tumor in the pancreatic head. Cytological diagnosis was metastasis of renal clear cell carcinoma by EUS-FNA. He was referred to our department for surgical intervention. Dynamic CT showed a hypervascular lesion of 40mm in diameter at the pancreas head in the arterial phase and suspected intraductal growth into the main pancreatic duct. FDG-PET revealed high accumulation in the lesion (SUV max 6.56). The tumor was proximal to the superior mesenteric vein and tumor thrombus was also observed. The patient underwent subtotal stomach-preserving pancreatoduodenectomy with concomitant superior mesenteric vein resection. The pancreatic body was transected at the distal side of tumor extension, using intraoperative ultrasonography. We herein report this case because pancreatic metastasis of renal cell carcinoma with intraductal growth into the main pancreatic duct is very rare.