Uncommon site of metastasis from renal cell carcinoma: Case report

Metastatic Renal Cell Carcinoma to Pancreas: Case Series and Review of the Literature

Metastasis to the pancreas represents a small proportion of all pancreatic malignancies. Among primary tumors that metastasize to the pancreas, renal cell carcinoma (RCC) is one of the most common causes of metastatic pancreatic lesions. We herein report a case series of three patients with pancreatic metastasis from RCC. The first is a 54-year-old male with a history of left nephrectomy for RCC, in whom an isthmic pancreatic mass suggestive of a neuroendocrine lesion was found during oncological follow-up. Endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) identified pancreatic metastasis of RCC and the patient was referred for surgery. The second case is a 61-year-old male, hypertensive, diabetic, with left nephrectomy for RCC six years previously, who complained of weight loss and was found with a hyperenhancing mass in the head of the pancreas and a lesion with a similar pattern in the gallbladder. EUS-FNB from the pancreas proved to be a metastatic pancreatic lesion. Cholecystectomy and treatment with tyrosine kinase inhibitors were recommended. The third case is a 68-year-old dialysis patient referred for evaluation of a pancreatic mass, also confirmed by EUS-FNB, who was started on sunitinib treatment. We report a literature summary on epidemiology and clinical features, diagnosis and differential diagnosis and treatment and outcomes in pancreatic metastasis of RCC.

Metastatic Renal Cell Carcinoma to Pancreas: Case Series and Review of the Literature

Metastasis to the pancreas represents a small proportion of all pancreatic malignancies. Among primary tumors that metastasize to the pancreas, renal cell carcinoma (RCC) is one of the most common causes of metastatic pancreatic lesions. We herein report a case series of three patients with pancreatic metastasis from RCC. The first is a 54-year-old male with a history of left nephrectomy for RCC, in whom an isthmic pancreatic mass suggestive of a neuroendocrine lesion was found during oncological follow-up. Endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) identified pancreatic metastasis of RCC and the patient was referred for surgery. The second case is a 61-year-old male, hypertensive, diabetic, with left nephrectomy for RCC six years previously, who complained of weight loss and was found with a hyperenhancing mass in the head of the pancreas and a lesion with a similar pattern in the gallbladder. EUS-FNB from the pancreas proved to be a metastatic pancreatic lesion. Cholecystectomy and treatment with tyrosine kinase inhibitors were recommended. The third case is a 68-year-old dialysis patient referred for evaluation of a pancreatic mass, also confirmed by EUS-FNB, who was started on sunitinib treatment. We report a literature summary on epidemiology and clinical features, diagnosis and differential diagnosis and treatment and outcomes in pancreatic metastasis of RCC.

Late Onset of Pancreatic Metastases from Renal Cell Carcinoma. A Case Report

Metastasis of renal cell carcinoma (RCC) to the pancreas is a rare entity accounting only 0.25-3% of all pancreatic tumors. We present a rare case of isolated three focal pancreatic metastases from RCC, occurring 15 years after the left nephrectomy. The majority of the pancreatic metastases are asymptomatic, as it was in case of our patient excluding the weight loss for the last three months. We demonstrate the importance of the medical history, radiological examinations, histological and immunohistochemical analysis in making a definitive diagnosis.

Metastatic renal cell carcinoma involving colon with unusual histologic features and diagnostic challenges: A case report

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Metastatic RCC in the colon, although very rare, should be kept in the differential diagnosis of patients with lower GI bleeding, particularly patients with a prior history of kidney mass or nephrectomy

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Most common type of primary or metastatic RCC is Clear-cell-type.

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We reported the first case of rhabdoid-RCC metastasizing to colon.

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In the absence of IHC-stains, rhabdoid-RCC may be misdiagnosed as soft-tissue-sarcoma or other poorly differentiated carcinomas.

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Our case exclusively occurred in a woman while colonic metastasis of RCC commonly occurring in males.

Introduction and importance

Renal cell carcinoma (RCC) accounts for 3% of all malignancies in adults, on its own being the 3rd most common urologic malignancy. Commonly RCC metastasizes to lung, bone, liver, brain but rarely to colorectum. Here we present the metastasis of RCC to colon with unusual histologic features.

Case presentation

A 40-year-old woman presented with abdominal pain and constipation. Colonoscopy showed an ulcerative mass 30 cm from anal verge. Subsequently, she underwent abdominoperineal resection of the involved portion of colon and the biopsy was sent to us for histopathological analysis. Grossly, it was a large fungating mass. Microscopic examination revealed a malignant neoplasm with polygonal cells, abundant eosinophilic cytoplasm, eccentric nuclei and prominent nucleoli. Immunohistochemistry confirmed the diagnosis of RCC.

Clinical discussion

Colon rarely infiltrated by metastasis from RCC and so far, around 25 of such cases have been reported in the literature. Most common metastatic type of RCC to gastrointestinal tract is clear cell type. In our patient, the type of the metastatic RCC to colon was RCC with rhabdoid features. RCC with rhabdoid features is rare (3–5% of all RCC), but it is highly aggressive with higher chance of metastasis, extra renal invasion and poorer prognosis.

Conclusion

RCC should be considered as one of the differential diagnosis of colorectal cancers. Appropriate immunohistochemical workup would then reveal the correct diagnosis.

Late onset metastasis from renal cell carcinoma masquerading as a gallbladder polyp

Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies. A third of people with RCC have metastatic lesions when diagnosed, and another third develop metachronous metastasis during follow-up or after surgical treatment. We report a case of gallbladder metastasis from clear-cell RCC in a 71-year-old woman 13 years after RCC of her right kidney. Preoperative imaging studies showed a suspicious, progressively enlarged gallbladder polyp. The patient underwent open cholecystectomy and lymph node dissection along the hepatoduodenal ligament. The pathology report was compatible with metastatic disease from the kidney that was previously resected. Gallbladder metastasis can occur from RCC several years after initial management. Physicians should be aware of this rare pathology, and intensive follow-up is essential after surgery for RCC.