Answer

From question on page 122

At explorative laparotomy, the pancreatic tumour involving the head and proximal body of the pancreas was judged to be resectable. Pylorus preserving proximal pancreaticoduodenectomy was performed. Histology of the tumour was consistent with a diagnosis of renal cell cancer (RCC) metastasis to the pancreas (fig 2). Metastases were not detected in peripancreatic lymph nodes. The patient did not receive any further adjuvant therapy and was discharged from hospital without any serious perioperative morbidity.

The vast majority of pancreatic carcinomas are primary, and among these, more than 90% are of ductal origin. Solitary pancreatic masses can be classified as secondary tumours to the pancreas in only 2% of all cases.¹ In the latter group, RCC seems to be the most common cancer. Within the last three years, 43 new cases of RCC metastases to the pancreas have been reported (Medline review). Median interval from nephrectomy to diagnosis of pancreatic metastases is 83 months, but time intervals as long as 10–20 years were also reported.² Complete resection of pancreatic metastases from RCC are associated with long term survival, particularly in cases of single tumours and/or a long disease free interval.³

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Figure 1

 Histomorphological appearance of the pancreatic tumour (haematoxylin-eosin, ×40). From the lower left to the upper right corner, normal pancreatic glandular tissue, desmoplastic capsule, and clear cell carcinoma are visible.