P1572 - Renal Cell Carcinoma Presenting Years Later With Gastrointestinal Metastases

Sakina Neemuchwala, BS, Manasa Narasimman, MD, Rozina Mithani, BA, MD
University of Texas Southwestern Medical Center Dallas, Dallas, TX

Introduction: Clear cell renal cell carcinoma (ccRCC) accounts for 85% of kidney malignancies and often metastasizes to lymph nodes, lung, and bone; however, GI metastases are rare. Among pancreatic malignancies, metastatic tumors occur in only 2-5% of cases, with ccRCC being the most common cause. Pancreatic metastases often arise asymptomatically over 10 years after resection of ccRCC and are detected incidentally, making detection and treatment difficult. We present a patient who developed isolated pancreatic metastasis of ccRCC 12 years after complete resection.

Case Description/Methods: An 82 y/o M with a history of ccRCC, s/p right radical nephrectomy in 2007, presented with abnormal imaging and no symptoms in 2019. CT Chest to investigate unrelated cardiac symptoms revealed two pancreatic lesions concerning for malignancy, one in the body of the pancreas that measured 2.6 x 2.3cm and one in the tail that measured 1.5cm. Following an abdominal CT that confirmed the initial findings, the differential diagnoses included a neuroendocrine tumor vs metastasis, suspected from ccRCC. Subsequent endoscopic ultrasound showed two hypoechoic masses with hyperechoic centers and well-defined borders in the body of the pancreas. Core biopsy via fine needle aspiration and immunohistochemical staining confirmed the presence of ccRCC metastases. The patient then underwent CTs of the pelvis, lungs, and lymph nodes and MRI of the brain, which showed no metastases elsewhere. His IMDC risk was then calculated as 0, which indicated a favorable prognosis, and he was put on Pazopanib. He continued this systemic therapy for two years, at which point a chest CT showed a slight increase in the size of the mass in the pancreatic body to 2.8 x 2.5cm. The patient then opted for definitive treatment with stereotactic radiation therapy in 2021. Since then, he is not on any systemic therapy and has been undergoing diligent radiologic surveillance. His disease has stabilized, and he has not experienced any progression in his pancreas.

Discussion: This case demonstrates incidental finding of pancreatic metastasis of ccRCC that was detected incidentally over a decade after nephrectomy. Ongoing, long term surveillance should occur to increase findings of metastases and recurrence and make early intervention possible. There may also be an indication for earlier radiation therapy and systemic therapy following surgical therapies to reduce incidents of recurrence.



Disclosures:


Sakina Neemuchwala, BS, Manasa Narasimman, MD, Rozina Mithani, BA, MD. P1572 - Renal Cell Carcinoma Presenting Years Later With Gastrointestinal Metastases, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.