Quinton D. Palmer, MD, Salman Ali Khan, MD, Abhilash Perisetti, MD, Nazish Khan, MBBS, Kemmian D. Johnson, MD, MPH, Sumant Inamdar, MD, MPH
University of Arkansas for Medical Sciences, Little Rock, AR
Introduction: Renal cell carcinoma (RCC) is the most common malignancy of the kidney. RCC is curative with nephrectomy followed with post-operative surveillance with computed tomography (CT) or magnetic resonance imaging (MRI). RCC recurrence rarely occurs beyond 5 years. We present a 57-year-old woman 8 years post left nephrectomy due to RCC, who presented with an incidental pancreatic head mass on MRI subsequently confirmed as RCC.
Case Description/Methods: A 57- year old Caucasian woman with a past medical history of recently diagnosed T1a N0M0 colorectal carcinoma (CRC) status post right hemicolectomy and Grade 2 RCC status post left nephrectomy 8 years prior to presentation, underwent post-surgical surveillance for CRC two months post hemicolectomy. She reported no clinical symptoms. Incidental findings on outside hospital MRI of the abdomen and pelvis with contrast demonstrated a 2.5 cm hypodense mass at the pancreatic head (Figure 1). Metastatic work up for CRC including whole body positron emission tomography was negative. She was referred to our institution for endoscopic ultrasonography with find needle aspiration (EUS-FNA) of the pancreatic mass. Blood test showed normal liver function test and CA 19-9. The EUS showed a 2 cm x 2 cm ill-defined hypoechoic and heterogenous in echotexture mass in the head and neck of the pancreas (Figure 2). A 22-gauge needle with a stylet was used to perform FNA. Immunostains showed neoplastic cells positive for PAX-8 and RCC; immunophenotype consistent with clear cell RCC (Figure 3). She underwent successful central pancreatomy with pancreato-gastrostomy without complications.
Discussion: This case is extraordinary as RCC recurred after 8 years following nephrectomy as an isolated pancreatic mass following 5-year surveillance without evidence of recurrence. Up to 93% of recurrence occurs within 5 years post nephrectomy and current guidelines recommend RCC surveillance up to 5 years post nephrectomy. EUS-FNA provided a minimally invasive method of accurately diagnosing metastatic RCC and is an excellent tool for evaluating pancreatic lesions. Reporting such a case should raise the awareness among physicians for delayed recurrence of RCC in sites such as the pancreas and further longitudinal studies should be sought to assess the prolonged surveillance strategies to identify such recurrences.
Citation: Quinton D. Palmer, MD, Salman Ali Khan, MD, Abhilash Perisetti, MD, Nazish Khan, MBBS, Kemmian D. Johnson, MD, MPH, Sumant Inamdar, MD, MPH. P0094 - AN EXTRAORDINARY CASE OF DELAYED AND ISOLATED RECURRENCE OF RENAL CELL CARCINOMA IN THE PANCREAS. Program No. P0094. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.