- Renal Cell Carcinoma Metastatic to the Pancreas: Facts
-Usually hypervascular metastases
-Multiple lesions are common and may be seen in half the cases
-Occurs with a median interval of 6.5 to 12 years from original diagnosis. Longest interval from original diagnosis is 32.7 years
-May or may be associated with other sites of disease - Pancreatic Metastases vs Primary Adenocarcinoma: CT Findings
-Most metastases have some enhancement compared to adenocarcinoma which is typically hypodense
-Vascular invasion usually less common with metastases
-Most cases of metastases are silent asymptomatic lesions - CT Appearance of Pancreatic Metastases
-Solitary, well defined tumor (80%)
-Multiple lesions in the pancreatic gland (15%)
-Diffuse tumor infiltration (5%) - “ This pictorial essay illustrates the imaging appearances of a wide variety of metastases to the pancreas as seen on computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT. Key clinical and radiologic features (lesion distribution, non-contrast imaging appearance, enhancement pattern and pattern of spread) that may aid in differentiation of primary from solitary secondary pancreatic malignancies are discussed.”
Imaging features of hematogenous metastases to the pancreas: pictorial essay
Tan CH et al.
Cancer Imaging 2011 March 1;11:9-15 - “ In 22 patients, a total of 29 metastasis were found on CT and MRI. These metastasis originated from renal cell carcinomas (22/29), colorectal carcinoma (3/29), and other malignancies (4/29). The metastasis differed not in size or location, but in their contrast enhancement characteristics.”
Metastasis to the Pancreas: Characterization by Morphology and Contrast Enhancement Features on CT and MRI
Palmowski M et al.
Pancreatology 2008;8:199-203 - Metastases to the Pancreas: Organ of Origin
-Renal cell carcinoma
-Lung cancer
-Breast cancer
-Colorectal cancer
-Malignant melanoma
-Leiomyosarcoma - Pancreatic Metastases: Facts
-Reported incidence of 1.6% -11% in autopsy series of patient with advanced malignancy
-In clinical series make up less than 5% of all pancreatic malignancies
-The diagnosis of metastases to the pancreas has important clinical implications compared to a primary pancreatic tumor from a treatment and survival prospective
-Metastases to the pancreas can be detected at initial staging or on follow-up studies - “ In difficult cases, at PET/CT the presence of diffuse uptake of FDG by the pancreas or concomitant extrapancreatic uptake by the salivary glands can be used to aid in differention of autoimmune pancreatitis and pancreatic cancer.”
Utility of 18F-FDG PET/CT for Differentiation of Autoimmune Pancreatitis with Atypical Pancreatic Imaging Findings from Pancreatic Cancer
Lee TY et al.
AJR 2009; 193:343-348 - “ The enhancement patterns of the metastatic deposits and the normal pancreas differed. Thirty-four lesions ranging in size from 6 to 110 mm were identified. All metastases showed rapid enhancement during the early (arterial and portal) phases, resulting in differential attenuations (compared with normal pancreatic parenchyma) of approximately 50-100 H. The differential attenuations were approximately 5-45 H on delayed-phase scans, resulting in poorer conspicuity of the lesions.”
- “The pancreas may be the presenting and perhaps sole locus for metastasis, typically years after treatment for certain extrapancreatic malignant neoplasms. Recognition and surgical treatment can provide worthwhile palliation and long-term survival.”
Metastases to the Pancreas and Their Surgical Extirpation
Z’graggen K, Warshaw AL et al.
Arch Surg 1008; 133:413-418 - “ The enhancement patterns of the metastatic deposits and the normal pancreas differed. Thirty-four lesions ranging in size from 6 to 110 mm were identified. All metastases showed rapid enhancement during the early (arterial and portal) phases, resulting in differential attenuations (compared with normal pancreatic parenchyma) of approximately 50-100 H.”
Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast enhanced helical CT
Ng CS et al
AJR 172, 1555-1559, 1999 - “Diagnostic radiologists performing body CT examinations on oncology patients will encounter pancreatic metastases in their practices. The diagnosis requires knowledge of the patient's primary neoplasm and familiarity with the spectrum of CT appearances we have illustrated and described. At times, pancreatic metastases may mimic primary pancreatic ductal carcinoma, islet cell tumors, and pancreatitis.”
Pancreatic Parenchymal Metastases: Observations on Helical CT
Scatarige JC, Horton KM, Sheth S, Fishman EK
AJR 2001; 176:695-699 - “Diagnostic radiologists performing body CT examinations on oncology patients will encounter pancreatic metastases in their practices. The diagnosis requires knowledge of the patient's primary neoplasm and familiarity with the spectrum of CT appearances we have illustrated and described. At times, pancreatic metastases may mimic primary pancreatic ductal carcinoma, islet cell tumors, and pancreatitis. Rarely, the metastases may be discovered before the primary site is known.”
Pancreatic Parenchymal Metastases: Observations on Helical CT
Scatarige JC, Horton KM, Sheth S, Fishman EK
AJR 2001; 176:695-699 - “ Disparity in prognosis and management between primary and secondary pancreatic tumors makes recognition of metastases to the pancreas on CT and MRI an important goal. Three different patterns of secondary pancreatic tumors may be seen; localized, multifocal, or diffuse enlargement.”
Metastases to the Pancreas
Merkle EM et al.
British J Radiol 71(1998), 1208-1214 - Metastatic Disease to the Pancreas: CT Findings
-Solitary mass most common
-Most commonly hypovascular similar to pancreatic adenocarcinoma
-Vascular metastases typical in renal cell carcinoma
-CBD or pancreatic duct obstruction may occur - Metastatic Disease to the Pancreas: Management
-Surgery in select cases
-Chemotherapy and radiation therapy may be used
-Mean survival is under 9 months - Metastatic Disease to the Pancreas: Presentation
-Incidental finding during staging/restaging of a known tumor
-Presentation with symptoms including abdominal pain, nausea, weight loss, GI bleeding or obstruction
-May present like a primary pancreatic adenocarcinoma
-Usually presents 1-3 years after initial diagnosis but may present 10-15 years later (i.e. Renal Cell Carcinoma) - Metastatic Disease to the Pancreas: Facts
May be seen in 3-12% of patients with advanced malignancy at autopsy
Most frequent site of metastases are;
-Lung cancer
-Breast cancer
-Renal cancer
-GI tract cancer
-Thyroid cancer
-Melanoma
-Hepatoma
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