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Cases
Woman With a Pancreatic Mass
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Background
This 62-year old woman was referred for a neck swelling. Her surgical history includes cholecystectomy performed 32 years ago for gallbladder disease. She also underwent subtotal thyroidectomy 15 years ago to treat a multinodular goiter. Histologic analysis of the specimen at that time had shown a microscopic focus of follicular thyroid carcinoma. The patient also underwent right nephrectomy for renal cell carcinoma 10 years ago, when she presented with hematuria.
Physical examination reveals a 5 X 3-cm swelling in the right supraclavicular fossa. Fine-needle aspiration of the swollen area is attempted, but the sample is deemed insufficient for cytologic diagnosis. CT scans of the abdomen (shown here) show a 7.5-cm pancreatic mass and a 7-cm left renal mass.
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down for Hint and Answer
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***** HINT *****
Metastases
***** ANSWER *****
Renal cell carcinoma with a pancreatic metastatic deposit: CT-guided core-needle biopsy of the pancreatic mass reveals histologic findings characteristic of a metastatic deposit from a renal cell carcinoma. Pancreatic metastases are rare, representing 2% of pancreatic cancers, and are usually part of diffuse carcinomatosis.
Solitary metastatic tumors are also rare. Known primary cancers include renal cell, bronchial, colon, breast, stomach, and endometrial carcinomas. Renal cell carcinoma is the most common primary tumor leading to solitary metastasis in the pancreas.
The median time between radical nephrectomy and pancreatic metastases is 8 years. Spread may be hematogenous or lymphatic. Gastrointestinal bleeding is the most common presentation, although weight loss, obstructive jaundice, duodenal obstruction, pancreatitis, and exocrine and/or endocrine pancreatic disturbances may also occur. Pancreatic metastases may be asymptomatic, though the exact incidence of silent lesions is not known. Five-year survival rates after pancreatic resection of metastatic renal cell carcinoma are 29-35% and better than those of primary pancreatic carcinoma.
For more information on renal cell carcinoma, see the eMedicine articles Renal Cell Carcinoma (within the Internal Medicine specialty) and Renal Cell Carcinoma (within the Radiology specialty).
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Author:
Ali Nawaz Khan, MBBS, FRCP, FRCS, FRCR, Lecturer, Department of Diagnostic Radiology, Faculty of Medicine, University of Manchester, and Basil Issa, MBChB, FRCP, Consulting Staff, North Manchester Heath Care NHS Trust
eMedicine Editor:
Sat Sharma, MD, Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
Source
http://emedicine.com
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