P0090 - Pancreatic Metastasis of Renal Cell Carcinoma: A Case Report and Literature Review

Dhruvkumar Patel, MBBS¹, Fevilkumar Patel, MD², Hassaan A. Zia, MD^1
1LSU Health Sciences Center, Shreveport, LA; ²Ross University School of Medicine, Nashville, GA

Introduction: Metastasis to the pancreas is uncommon, accounting for less than 5% of pancreatic malignancies; lung, colon, and breast cancer being the most common tumors of origin. Renal cell carcinoma (RCC) has a propensity to metastasize to rare sites like the thyroid gland and pancreas, often occurring after a long interval following nephrectomy. Pancreatic metastasis of RCC carries a more favorable prognosis compared to other pancreatic malignancies. The diagnosis of pancreatic metastases can be challenging due to its rarity and the need for knowledge of the patient's medical history.

Case Description/Methods: A 76-year-old male with a history of hypertension, hyperlipidemia, COPD, OSA, BPH, and previous right nephrectomy (2015) for renal clear cell carcinoma (RCC) presented with a newly diagnosed pancreatic mass which was incidentally found on a CT scan done while being worked up for melena at an outside hospital. He reported a 40-pound weight loss. His family history included colon cancer in his mother and prostate cancer in his father. He had a history of former smoking, quit in 1991, and denied alcohol or drug use. Upper and lower endoscopies for melena showed reflux esophagitis and a benign colon polyp. Further workup included laboratory tests, MRI, and endoscopic ultrasound (EUS). All laboratory findings, including LFTs, were unremarkable, and tumor markers (CA 19-9 and CEA) were within normal limits. MRI revealed three masses in the pancreas body and tail, with the largest measuring 7 x 6 cm and exhibiting scar tissue features. EUS-guided biopsy initially yielded atypical cells. A repeat biopsy confirmed the suspicion of metastatic renal carcinoma. Multidisciplinary discussions determined surgical intervention unsuitable due to comorbidities and palliative chemotherapy with Axitinib and Pembrolizumab was initiated.

Discussion: Pancreatic metastasis from RCC is a rare occurrence that can occur after a long interval following nephrectomy. Diagnostic modalities, including EUS, plays a crucial role in distinguishing metastases from primary pancreatic malignancies. Surgical resection is recommended for selected patients, while chemotherapy has shown promising results. The prognosis for pancreatic metastasis from RCC is generally more favorable compared to primary pancreatic tumors. This case emphasizes the importance of considering pancreatic metastasis in patients with a pancreatic mass and a history of RCC, and the need for multidisciplinary approaches in determining the most appropriate treatment.


Disclosures:


Dhruvkumar Patel, MBBS¹, Fevilkumar Patel, MD², Hassaan A. Zia, MD¹. P0090 - Pancreatic Metastasis of Renal Cell Carcinoma: A Case Report and Literature Review, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.