Final Diagnosis
Metastatic Clear Cell Renal Cell Carcinoma
Discussion
Clear cell renal cell carcinoma is the main subtype of kidney epithelial tumors, which accounts for approximately 2% of total cancers. It typically occurs in men with a peak age incidence of 60-70. Grossly these tumors have a classic golden yellow cut surface, typically arising from the renal cortex. Microscopically, the tumor cells have clear/eosinophilic granular cytoplasm with a readily apparent vascular network and grow in a solid and nested pattern. Inactivation of the VHL gene on chromosome 3p25 is a genetic hallmark of this tumor (1). PAX8 shows nuclear positivity in ~95% of cases (1). The incidence of metastatic disease to pancreas is rare (2%). The most common reported tumor origins are kidney, followed by melanoma, colorectal, breast, sarcoma and lastly lung origin. Clear cell renal cell carcinoma most commonly metastasizes hematogenously (2). The lung is the most common metastatic site, followed by bone, liver, retroperitoneum, pleura, CNS, and head and neck (2). Isolated metastatic renal cell carcinoma to the pancreas is very rare (2).
Conclusion
This case highlights an isolated metastasis to the pancreas consistent with the patient’s known history of clear cell renal cell carcinoma.
References
- Nezami BG, MacLennan GT. Clear Cell Renal Cell Carcinoma: A Comprehensive Review of its Histopathology, Genetics, and Differential Diagnosis. Int J Surg Pathol. 2024 Jul 25:10668969241256111. doi: 10.1177/10668969241256111. Epub ahead of print. PMID: 39051572.
- Sellner F, Thalhammer S, Klimpfinger M. Isolated Pancreatic Metastases of Renal Cell Cancer: Genetics and Epigenetics of an Unusual Tumour Entity. Cancers (Basel). 2022 Mar 17;14(6):1539. doi: 10.3390/cancers14061539. PMID: 35326690; PMCID: PMC8945920.