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doi:10.1111/jgh.12816
E D U C AT I O N A N D I M A G I N G
Gastrointestinal: Pancreatic metastatic renal cell carcinoma diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology
Figure 1 (a) Computed tomography and (b) endoscopic ultrasonography (EUS) appearance a mass arising from the body of the pancreas.
A 73-year-old lady was found to have a pancreatic mass on a computed tomography (CT) performed after radiotherapy for nasopharyngeal carcinoma (Fig. 1a). She has a history of renal cell carcinoma treated with a radical right nephrectomy 20 years ago. The CT did not show any suspicious residual or recurrence of the renal cell carcinoma. Endoscopic ultrasonography (EUS) revealed a 6.5 × 4.0 cm well-circumscribed, heterogeneous lesion arising from the pancreatic body closely related to the posterior wall of the stomach (Fig. 1b). Central necrosis and increased vascularity with perilesional varices were noted. There was also a hypoechoic portal hepatis lymph node measuring 1.6 × 1.8 cm, but no other lymph nodes were detected. No renal tumor was seen during EUS. EUSguided fine needle aspiration cytology (22 G, 2 passes) of the pancreatic mass revealed metastatic renal cell carcinoma. In view of a solitary metastasis with relatively good prognosis, distal pancreatectomy and splenectomy were performed. Intraoperatively, a 6-cm pancreatic tail tumor and a 1.5-cm lymph node were noted at the pancreatic body. Histological examination of the two lesions confirmed metastatic renal cell carcinoma with clear resection margins (Fig. 2). The tumor was compressing onto the pancreas but separated from its parenchyma by fibrous tissue without invasion. Metastatic carcinoma of the pancreas contributes to 2–5% of pancreatic malignancies. Differential diagnoses include pancreatic
436
Figure 2 (a) Low-power magnification HE staining showing the boundary between the metastatic renal cell carcinoma and the pancreatic capsule (arrow). The tumor was compressing on the pancreatic capsule without definite invasion. (b) High-power magnification HE staining showing metastatic renal cell carcinoma, clear cell type, growing in nests and tubular formation and of Furhman grade 1.
adenocarcinoma, neuroendocrine tumor, and focal chronic pancreatitis, all potentially difficult to distinguish without performing a biopsy. Accurate diagnosis is important to guide further management and to avoid unnecessary surgery. Pancreatic metastasis from renal cell carcinoma, whether solitary or multiple, is one with a high 5-year survival rate of 70% after radical resection of the metastasis. EUS is highly accurate and has become the preferred method for tissue sampling of pancreatic masses. It is as accurate as CT/US-guided sampling and surgical biopsies. Contributed by BKW Cho,* K Al-YahYaee,† AYB Teoh,* CCN Chong* and EKW Ng* Departments of *Surgery and †Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal of Gastroenterology and Hepatology 30 (2015) 436 © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Copyright of Journal of Gastroenterology & Hepatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
doi:10.1111/jgh.12816
E D U C AT I O N A N D I M A G I N G
Gastrointestinal: Pancreatic metastatic renal cell carcinoma diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology
Figure 1 (a) Computed tomography and (b) endoscopic ultrasonography (EUS) appearance a mass arising from the body of the pancreas.
A 73-year-old lady was found to have a pancreatic mass on a computed tomography (CT) performed after radiotherapy for nasopharyngeal carcinoma (Fig. 1a). She has a history of renal cell carcinoma treated with a radical right nephrectomy 20 years ago. The CT did not show any suspicious residual or recurrence of the renal cell carcinoma. Endoscopic ultrasonography (EUS) revealed a 6.5 × 4.0 cm well-circumscribed, heterogeneous lesion arising from the pancreatic body closely related to the posterior wall of the stomach (Fig. 1b). Central necrosis and increased vascularity with perilesional varices were noted. There was also a hypoechoic portal hepatis lymph node measuring 1.6 × 1.8 cm, but no other lymph nodes were detected. No renal tumor was seen during EUS. EUSguided fine needle aspiration cytology (22 G, 2 passes) of the pancreatic mass revealed metastatic renal cell carcinoma. In view of a solitary metastasis with relatively good prognosis, distal pancreatectomy and splenectomy were performed. Intraoperatively, a 6-cm pancreatic tail tumor and a 1.5-cm lymph node were noted at the pancreatic body. Histological examination of the two lesions confirmed metastatic renal cell carcinoma with clear resection margins (Fig. 2). The tumor was compressing onto the pancreas but separated from its parenchyma by fibrous tissue without invasion. Metastatic carcinoma of the pancreas contributes to 2–5% of pancreatic malignancies. Differential diagnoses include pancreatic
436
Figure 2 (a) Low-power magnification HE staining showing the boundary between the metastatic renal cell carcinoma and the pancreatic capsule (arrow). The tumor was compressing on the pancreatic capsule without definite invasion. (b) High-power magnification HE staining showing metastatic renal cell carcinoma, clear cell type, growing in nests and tubular formation and of Furhman grade 1.
adenocarcinoma, neuroendocrine tumor, and focal chronic pancreatitis, all potentially difficult to distinguish without performing a biopsy. Accurate diagnosis is important to guide further management and to avoid unnecessary surgery. Pancreatic metastasis from renal cell carcinoma, whether solitary or multiple, is one with a high 5-year survival rate of 70% after radical resection of the metastasis. EUS is highly accurate and has become the preferred method for tissue sampling of pancreatic masses. It is as accurate as CT/US-guided sampling and surgical biopsies. Contributed by BKW Cho,* K Al-YahYaee,† AYB Teoh,* CCN Chong* and EKW Ng* Departments of *Surgery and †Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal of Gastroenterology and Hepatology 30 (2015) 436 © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Copyright of Journal of Gastroenterology & Hepatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
