Late solitary pancreatic metastasis from clear-cell renal cell carcinoma: A case report

Solitary pancreatic metastasis from renal cell carcinoma (RCC) is uncommon and may present decades after nephrectomy. We report an unusually late (17-year) solitary pancreatic metastasis from clear-cell RCC treated with curative resection. A 66-year-old man with a prior right nephrectomy 17 years earlier presented with 3 months of unintentional weight loss. Contrast-enhanced computed tomography (CECT) demonstrated an 8.0 × 5.0 cm hypervascular exophytic mass in the pancreatic neck body. Tumor markers (CEA, CA19-9) were within normal limits. Because of lesion vascularity, preoperative percutaneous biopsy was deferred. The patient underwent distal pancreatectomy with splenectomy. Gross and histology showed sheets of polygonal clear cells with prominent vasculature; immunohistochemistry was positive for CD10 and PAX8 and negative for synaptophysin and chromogranin, confirming metastatic clear-cell RCC. Resection margins were negative (R0). The patient declined adjuvant systemic therapy and remains disease-free at 36 months post-surgery. This case illustrates the potential for extremely late solitary pancreatic metastasis from RCC and underscores the importance of lifelong surveillance in RCC survivors. In selected patients, complete surgical resection can achieve durable disease control, even in the absence of adjuvant therapy.