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Riemenschneider KA, Farooqui W, Penninga L, Storkholm JH, Hansen CP. The results of surgery for renal cell carcinoma metastases of the pancreas. Scand J Gastroenterol 2024; 59:354-360. [PMID: 38042983 DOI: 10.1080/00365521.2023.2286911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/19/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Pancreatic metastases from renal cell carcinoma (RCC) are rare. This study evaluated the surgical pathology and outcomes after resection of RCC metastases to the pancreas. MATERIAL AND METHODS A retrospective review of from 1 January 2011 to 31 December 2021, of patients who underwent pancreatic surgery for metastases from RCC. Data were retrieved from a prospectively managed database and patient demographics, comorbidities, pathology, perioperative outcomes, and overall survival were analyzed. Median overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method. RESULTS There were 25 patients (17 males, 8 females, median age 66 range 51 - 79 year), all with metachronous metastases. Median time from resection of the primary to operation for pancreatic RCC was 95.6 (12.0 - 309.7) months. Twenty-four patients were operated with intended cure (four pancreaticoduodenectomies, three total pancreatectomies, 17 distal pancreatectomies) and one patient had abortive surgery due to dissemination. Postoperative surgical complications occurred in nine patients (36%), and one patient died during hospital stay. Eight patients (33.3%) developed exocrine and/or endocrine insufficiency after pancreatic resection. Fifteen patients (60%) had recurrence 21.7 (4.9 - 61.6) months after pancreatic operation. Five patients (25%) died from RCC during follow-up 46.3 (25.6 - 134.8) months after pancreatic resection. Five-year OS and DFS were83.6% and 32.3%, respectively. Median OS after pancreatic surgery was 134.8 months, independent of resection of previous extrapancreatic metastases. CONCLUSIONS Pancreatic resection for metastases from RCC offers favorable prognosis with a curative potential and should be considered a valuable treatment option even in the era of novel targeted treatment.
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Affiliation(s)
| | - Waqas Farooqui
- Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Henrik Storkholm
- Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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2
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Rojas-Holguín A, Fondevila-Campo C, Sanjuanbenito A, Fabregat-Prous J, Secanella-Medayo L, Rotellar-Sastre F, Pardo-Sánchez F, Prieto-Calvo M, Marín-Ortega H, Sánchez-Cabús S, Diez-Valladares L, Alonso-Casado Ó, González-Serrano C, Rodríguez-Sanjuan JC, García-Plaza G, Jaén-Torrejimeno I, Suárez-Muñoz MÁ, Becerra-Massare A, Rio PSD, Pando E, López-Andújar R, Muñoz-Forner E, Rodriguez-López M, Pereira F, Serrablo-Requejo A, Turrión VS, Garrido MJ, Burdío F, Martín-Pérez E, Estevan-Estevan R, López-Guerra D, Castell-Gómez J, Salinas-Gómez J, López-Baena JÁ, López-Ben S, Solar-García L, Pérez-Alonso AJ, Martínez-Insfran LA, Blas JL, Cornejo M, Gutierrez-Calvo A, Pozo CDD, Ochando-Cerdan F, Muñoz-Bellvís L, Rebollar-Saenz J, Sánchez B, Jover JM, Gómez-Bravo MÁ, Ramia JM, Blanco-Fernández G. Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID). Surg Oncol 2024; 52:102039. [PMID: 38301449 DOI: 10.1016/j.suronc.2024.102039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.
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Affiliation(s)
- Adela Rojas-Holguín
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Constantino Fondevila-Campo
- Department of Surgery, Hospital Clinic, Barcelona, Spain; Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Luís Secanella-Medayo
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | - Héctor Marín-Ortega
- Department of Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Elizabeth Pando
- Department of Hepato-pancreato-biliary and Transplant Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael López-Andújar
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Mario Rodriguez-López
- Department of Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Víctor Sánchez Turrión
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Jiménez Garrido
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Diego López-Guerra
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Lorena Solar-García
- Department of Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alejandro J Pérez-Alonso
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain; Department of Surgery, Complejo Hospitalario de Jaén, Jaén, Spain
| | | | - Juan Luis Blas
- Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain
| | - Marian Cornejo
- Department of Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Alberto Gutierrez-Calvo
- Department of Surgery Hospital Universitario Principe de Asturias. Alcalá de Henares, Madrid, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Belinda Sánchez
- Department of Surgery, Hospital Regional de Málaga, Málaga, Spain
| | - José María Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - José M Ramia
- Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain; Department of Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain.
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3
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Boubaddi M, Marichez A, Adam JP, Chiche L, Laurent C. Long-term outcomes after surgical resection of pancreatic metastases from renal Clear-cell carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107960. [PMID: 38219701 DOI: 10.1016/j.ejso.2024.107960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/12/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Clear-cell renal cell carcinoma frequently metastasizes to the pancreas (PMRCC). The management of such metastases remains controversial due to their frequent multifocality and indolent evolution. METHODS This study describes the surgical management of these lesions and their long-term oncological outcomes. The study included patients who underwent pancreatic resection of PMRCC at Bordeaux University Hospital between June 2005 and March 2022. Morbidity and mortality were assessed at 90 days. Overall survival (OS) and disease-free (DFS) survival were assessed at 5 years. RESULTS Forty-two patients underwent pancreatic resection for PMRCC, including 18 (42.8 %) total pancreatectomies. The median time from nephrectomy to the diagnosis of PMRCC was 121 (range: 6-400) months. Lesions were multiple in 19/42 (45.2 %) patients. Ten (23.8 %) patients suffered a severe complication (Dindo-Clavien classification ≥ IIIA by D90), including one patient who died postoperatively. The median follow-up was 76 months. The R0 rate was 100 %. The OS and DFS rates were 92.8 % and 29.6 %, respectively, at 5 years. CONCLUSION Pancreatic resection for PMRCC provides long-term oncological control despite a high recurrence rate.
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Affiliation(s)
- Mehdi Boubaddi
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
| | - Arthur Marichez
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Jean Philippe Adam
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Laurence Chiche
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Christophe Laurent
- Department of Digestive Surgery, Hepatobiliary and Pancreatic Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
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4
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Sellner F, Compérat E, Klimpfinger M. Genetic and Epigenetic Characteristics in Isolated Pancreatic Metastases of Clear-Cell Renal Cell Carcinoma. Int J Mol Sci 2023; 24:16292. [PMID: 38003482 PMCID: PMC10671160 DOI: 10.3390/ijms242216292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Isolated pancreatic metastases of renal cell carcinoma (IsPMRCC) are a rare manifestation of metastatic, clear-cell renal cell carcinoma (RCC) in which distant metastases occur exclusively in the pancreas. In addition to the main symptom of the isolated occurrence of pancreatic metastases, the entity surprises with additional clinical peculiarities: (a) the unusually long interval of about 9 years between the primary RCC and the onset of pancreatic metastases; (b) multiple pancreatic metastases occurring in 36% of cases; (c) favourable treatment outcomes with a 75% 5-year survival rate; and (d) volume and growth-rate dependent risk factors generally accepted to be relevant for overall survival in metastatic surgery are insignificant in isPMRCC. The genetic and epigenetic causes of exclusive pancreatic involvement have not yet been investigated and are currently unknown. Conversely, according to the few available data in the literature, the following genetic and epigenetic peculiarities can already be identified as the cause of the protracted course: 1. high genetic stability of the tumour cell clones in both the primary tumour and the pancreatic metastases; 2. a low frequency of copy number variants associated with aggressiveness, such as 9p, 14q and 4q loss; 3. in the chromatin-modifying genes, a decreased rate of PAB1 (3%) and an increased rate of PBRM1 (77%) defects are seen, a profile associated with a favourable course; 4. an increased incidence of KDM5C mutations, which, in common with increased PBRM1 alterations, is also associated with a favourable outcome; and 5. angiogenetic biomarkers are increased in tumour tissue, while inflammatory biomarkers are decreased, which explains the good response to TKI therapy and lack of sensitivity to IT.
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Affiliation(s)
- Franz Sellner
- Department of General, Visceral and Vascular Surgery, Clinic Favoriten Vienna, Kaiser Franz Josef Hospital, 1100 Vienna, Austria
| | - Eva Compérat
- Clinical Institute of Pathology, Medical University Vienna, 1090 Vienna, Austria
| | - Martin Klimpfinger
- Clinical Institute of Pathology, Medical University Vienna, 1090 Vienna, Austria
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5
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Aparicio-López D, Chóliz-Ezquerro J, Hörndler-Algárate C, Serradilla-Martín M. Pancreatic metastasis from sarcoma, an infrequent finding. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:376-377. [PMID: 35718016 DOI: 10.1016/j.gastrohep.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/09/2022] [Indexed: 05/09/2023]
Affiliation(s)
- Daniel Aparicio-López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Jorge Chóliz-Ezquerro
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
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Möller K, Jenssen C, Braden B, Hocke M, Yamashita Y, Arcidiacono PG, Ignee A, D'Onofrio M, Fusaroli P, Bhutani MS, Dong Y, Sun S, Faiss S, Dietrich CF. Comments on and Illustrations of the EFSUMB CEUS Guidelines: Transabdominal and Endoscopic Ultrasound Features of Intrapancreatic Metastases and the Role of Multiparametric Imaging and EUS-Guided Sampling in Rare Pancreatic Tumors. Cancers (Basel) 2023; 15:cancers15092546. [PMID: 37174015 PMCID: PMC10177255 DOI: 10.3390/cancers15092546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
A definite pathologic diagnosis of intrapancreatic metastasis is crucial for the management decision, i.e., curative or palliative surgery versus chemotherapy or conservative/palliative therapy. This review focuses on the appearance of intrapancreatic metastases on native and contrast-enhanced transabdominal ultrasound and endoscopic ultrasound. Differences and similarities in relation to the primary tumor, and the differential diagnosis from pancreatic carcinoma and neuroendocrine neoplasms are described. The frequency of intrapancreatic metastases in autopsy studies and surgical resection studies will be discussed. Further emphasis is placed on endoscopic ultrasound-guided sampling to confirm the diagnosis.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, OX3 9DU Oxford, UK
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, 98617 Meiningen, Germany
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama City 641-8509, Japan
| | - Paolo Giorgio Arcidiacono
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - André Ignee
- Medical Clinic-Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, 97070 Wuerzburg, Germany
| | - Mirko D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, 37129 Verona, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, 40126 Bologna, Italy
| | - Manoop S Bhutani
- Department of Gastroenterology Hepatology and Nutrition, UTMD Anderson Cancer Center, Houston, TX 77030-4009, USA
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland
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7
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Sellner F, Thalhammer S, Klimpfinger M. Isolated Pancreatic Metastases of Renal Cell Carcinoma-Clinical Particularities and Seed and Soil Hypothesis. Cancers (Basel) 2023; 15:cancers15020339. [PMID: 36672289 PMCID: PMC9857376 DOI: 10.3390/cancers15020339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
A meta-analysis of 1470 isolated pancreatic metastases of renal cell carcinoma revealed, that, in addition to the unusual exclusive occurrence of pancreatic metastases and the favourable treatment results, the isPMRCC is characterised by further peculiarities of the clinical course: The lack of prognostic significance of volume and growth rate dependent risk factors and the independence of treatment results from standard or local resections. As an explanation for all these peculiarities, according to today's knowledge, a strong acting seed and soil mechanism can serve, which allows embolized tumour cells to grow to metastases only in the pancreas, and prevents them definitively or for years in all other organs. The good prognosis affects not only isolated PM, but also multi-organ metastases of the RCC, in which the additional occurrence of PM is also associated with a better prognosis. Genetic studies revealed specific changes in cases of PM of RCC: Lack of loss of 9p21.3 and 14q31.2, which are otherwise specific gene mutations at the onset of generalization, a low weight genome instability index, i.e., high genetic stability, and a low rate of PAB1 and a high rate of BPRM1 alterations, which signal a more favourable course. The cause of pancreatic organotropism in isPMRCC is still unclear, so only those factors that have been identified as promoting organotropism in other, more frequent tumour entities can be presented: Formation of the pre-metastatic niche, chemokine receptor-ligand mechanism, ability to metabolic adaptation, and immune surveillance.
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Affiliation(s)
- Franz Sellner
- Department of General, Visceral and Vascular Surgery, Clinic Favoriten, Kaiser Franz Josef Hospital, 1100 Vienna, Austria
- Correspondence:
| | - Sabine Thalhammer
- Department of General, Visceral and Vascular Surgery, Clinic Favoriten, Kaiser Franz Josef Hospital, 1100 Vienna, Austria
| | - Martin Klimpfinger
- Clinical Institute of Pathology, Medical University, 1090 Vienna, Austria
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8
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Literature review of imaging, pathological diagnosis, and outcomes of metachronous lung and pancreatic metastasis of cecal cancer. World J Surg Oncol 2022; 20:341. [PMID: 36253824 PMCID: PMC9575218 DOI: 10.1186/s12957-022-02797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pancreatic metastasis from colorectal cancer is extremely rare. Here, we report a case of colorectal cancer with lung and pancreatic metastasis and analyze the histopathology, immunohistochemistry, and next-generation sequencing (NGS) to generate a differential diagnosis and treatment of metastatic colon cancer. Case presentation AC1 A 78-year-old man was admitted because of a recently elevated carcinoembryonic antigen. This patient had undergone laparoscopic right hemicolectomy for cecal cancer IIA (T3N0M0) 5 years before admission, and thoracoscopic left upper lung wedge resection for primary colon cancer lung metastasis 2 years before admission. At that time, the patient was thought to have pancreatic metastasis from colon cancer. He underwent laparoscopic distal pancreatectomy (combined with splenectomy). Postoperative pathology revealed colon cancer metastasis. We performed NGS on tumor samples at three loci and found colon cancer's most common oncogenic driver genes (KRAS, APC, and TP53). One month after surgery, the patient was given capecitabine for six cycles of chemotherapy. At present, no high adverse reactions have been reported. Discussion For patients with pancreatic space-occupying, such as a previous history of colorectal cancer, and recent carcinoembryonic antigen elevation, we should highly suspect pancreatic metastatic colorectal cancer. NGS is an essential auxiliary for identifying metastatic tumors. Surgery combined with postoperative chemotherapy is an effective treatment.
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9
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Itamoto S, Abe T, Oshita A, Hanada K, Nakahara M, Noriyuki T. Repeat pancreatic resection for metachronous pancreatic metastasis from renal cell carcinoma: A case report. Int J Surg Case Rep 2022; 94:107022. [PMID: 35398785 PMCID: PMC9006246 DOI: 10.1016/j.ijscr.2022.107022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pancreatic metastasis (PM) from renal cell carcinoma (RCC) is relatively rare. Surgical resection of PM from RCC is considered as the first choice treatment for achieving long-term prognosis. Herein, we report a case of secondary multiple metastases from RCC to the remnant pancreas following pancreatectomy, with a review of the relevant literature. Presentation of case A 69-year-old man who underwent left nephrectomy for RCC (T2N0M0, stage II) 12 years ago was referred to our hospital. Multiple metastases to the pancreatic head from RCC occurred 2 years after the primary surgery, for which pancreaticoduodenectomy was performed. Nine years after metastatic resection, multiple tumors of the remnant pancreas were detected on dynamic computed tomography (CT); all tumors showed strong enhancement in the early phase, which persisted into the late phase. The tumors were round, the maximum diameter of the tumor was 20 mm, and they were hyperintense on T2-weighted magnetic resonance imaging. Positron emission tomography-CT revealed slight fluorodeoxyglucose uptake in the tumor. Multiple PMs were diagnosed, and the remnant pancreas was completely resected. Two years later, the patient was alive and showed no recurrence. Conclusions Surgical resection could provide long-term prognosis, even if secondary PM from RCC occurs metachronously. Long-term follow-up is recommended after primary resection, and vigilance regarding the occurrence of PM is needed. Surgical resection for pancreatic metastasis from renal cell carcinoma is considered as the first choice treatment. We report a case of secondary multiple metastases from renal cell carcinoma to the remnant pancreas following pancreatectomy. Surgical resection could provide long-term prognosis even if secondary pancreatic metastasis is occurred metachronously.
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Affiliation(s)
- Shingo Itamoto
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Akihiko Oshita
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
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10
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Isolated Pancreatic Metastases of Renal Cell Cancer: Genetics and Epigenetics of an Unusual Tumour Entity. Cancers (Basel) 2022; 14:cancers14061539. [PMID: 35326690 PMCID: PMC8945920 DOI: 10.3390/cancers14061539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022] Open
Abstract
Isolated pancreatic metastases of renal cell carcinoma (isPMRCC) are a rare manifestation of metastatic renal cell carcinoma (mRCC) characterized by two peculiarities: (1). The definite or at least long-term exclusive occurrence of metastases in the pancreas and (2). an unusual low tumour aggressiveness with slow tumour progression and consecutive, good treatment results. According to current knowledge, the exclusive occurrence of pancreatic metastases is due to a highly specific and highly selective seed and soil mechanism, which does not allow metastases settlement outside the pancreas, and whose detailed genetic/epigenetic causes are not yet elucidated. Recent studies have shed light on some of the pathways involved for the protracted course of the disease and highlighted a special genetic profile (lack of loss of 9p, lower weight genome instability index, low frequency of BAP1 alterations, and a high frequency of PBRM1 loss), which deviates from the conventional mRCC profile. Finally, the question of the reasons for the long-term relative genetic stability of the involved cell clones, which is an essential prerequisite for a favourable prognosis, remains unanswered.
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