Hidden in Plain Sight: Pancreatic and Gastric Metastases of Renal Cell Carcinoma Undetectable on Imaging

Renal cell carcinoma (RCC) is one of the most common origins of pancreatic metastases. Pancreatic spread of RCC is often found incidentally on surveillance imaging in asymptomatic patients. We present the case of a 49-year-old male with a history of RCC who presented with acute pancreatitis. Multiple imaging studies showed no pancreatic masses, but endoscopic ultrasound with fine needle biopsy and endoscopy showed RCC metastases to the pancreas and stomach, respectively. Pancreatic metastases should be suspected in patients with RCC who present with progressive abdominal pain and biliary obstruction despite negative imaging. Endoscopy is useful for their detection.