J Chinelli y col. Metástasis pancreáꢁca metacrónica de carcinoma renal. Rev Argent Cirug 2020;112(3):333-336
335
fue el caso analizado, no es un factor que contraindique co radica en la ausencia de respuesta a la quimio-
la resección quirúrgica pancreáꢀca. Esto se debe a las terapia, radioterapia y hormonoterapia, si bien hay
tasas relaꢀvamente altas de supervivencia informadas ensayos en fase III que estudian la eficacia de la in-
tras la resección (entre 29 y 88%), en contraposición al munoterapia con agentes como el suniꢀnib y el
mal pronósꢀco que ꢀenen las metástasis pancreáꢀcas bevacizumab.
de carcinomas disꢀntos del de cáncer renal. La resec-
La metástasis pancreáꢀca del carcinoma renal
ción debe ser radical, con márgenes libres de tumor mi- de células claras es excepcional. Sin embargo, la resec-
croscópico. Las lesiones suelen ser inmunorreacꢀvas al ción quirúrgica ‒de ser facꢀble‒ logra una alta tasa de
CD10 y vimenꢀna en la inmunohistoquímica, compro- curación, por lo que siempre deberá intentarse. En el
bándose en este caso la posiꢀvidad al PAX-8 y el marca- presente caso se pudo llevar a cabo una exéresis onco-
dor RCC (renal cell carcinoma).
lógicamente saꢀsfactoria a través de un abordaje míni-
La importancia del tratamiento quirúrgi- mamente invasivo.
■
ENGLISH VERSION
Pancreaꢀc metastases are rare (2-5% of both hypochondriac regions. A leꢃ subcostal transverse
pancreaꢀc cancers) and the most frequent primary mini-incision was performed to remove the surgical
locaꢀons of tumor are lung cancer (40%) and specimen and a drain was placed close to the pancreaꢀc
gastrointesꢀnal cancer (25%), among others. However, stump (Figure 2). Operaꢀve ꢀme was 150 minutes.
pancreaꢀc metastases from renal cell carcinoma are
The surgical specimen contained a yellowish-
very rare, accounꢀng for only 1-2.8% of pancreaꢀc brown nodular tumor measuring 25 × 25 × 20 mm
1
metastases .
(Figure 3). The microscopic examinaꢀon showed a clear
They usually present as metachronous cell carcinoma with a compact and alveolar paꢁern
metastases during the follow-up of paꢀents who with necrosis and hemorrhage, histological grade 2,
underwent surgery, even several years aꢃer surgery, scarce mitosis, and immunohistochemical staining
2
and up to 50% are asymptomaꢀc .
paꢁern posiꢀve for PAX8 (Figure 4.A) and RCC (renal
Surgery is the treatment of choice as the lesions cell carcinoma) (Figure 4.B).
do not respond to other treatments as chemotherapy.
The paꢀent was discharged on postoperaꢀve
We report the case of a paꢀent treated with day 6 without complicaꢀons. At the present ꢀme he
distal pancreatectomy and splenectomy through has been operated on for three months, with no clinical
laparoscopy.
signs of recurrence, waiꢀng for the esꢀmaꢀon of tumor
We report the case of a 61-year-old male markers.
paꢀent with a history of right nephrectomy 10
Pancreaꢀc metastases from clear cell renal
years before consultaꢀon due to clear cell renal cell carcinoma (which accounts for 80% of renal cancer
carcinoma. Nine years later, he underwent resecꢀon during the 6th decade of life) are very rare. Although
of metastases of the nasal cavity and paroꢀd gland. many autopsy series reported that the most frequent
An abdominal ultrasound performed during follow-up primary locaꢀons of tumors with pancreaꢀc metastasis
revealed the presence of a 27-mm solid nodule adjacent are lung and gastrointesꢀnal tumors (42 and 24.7%,
to the splenic hilum. A computed tomography (CT) scan respecꢀvely), in surgical cases metastases of renal cell
3
showed a hypodense mass at the level of the tail of the carcinoma are more common .
pancreaswithperipheralenhancement(Figure1.A). The
Metastases occur by hematogenous or
contrast-enhanced magneꢀc resonance imaging (MRI) lymphaꢀc spread, and tumor cells of renal cell
evidenced intense enhancement in the arterial phase carcinoma apparently have a high affinity for the
without thrombosis of the splenic vessels (Figure 1.B). parenchyma of the pancreas, which would explain
A somatostaꢀn receptor-targeted positron emission pancreaꢀc metastases and the absence of metastases
tomography (PET)-CT scan did not show higher uptake to other organs. However, an addiꢀonal feature of
at the level of the tumor or abnormal expression of clear cell carcinoma is its ability to metastasize to any
somatostaꢀn receptors. The tumor markers (CEA, CA organ at any ꢀme. In fact, pancreaꢀc metastases have
1
9-9, 5HHIA) were within normal ranges.
been described up to 27 years aꢃer the primary tumor
4
The paꢀent underwent laparoscopic leꢃ was resected . In this case, the pancreaꢀc metastases
antegrade distal pancreatectomy and splenectomy developed at long-term follow-up (metachronous
with favorable postoperaꢀve outcome. The laꢁer was disease), 10 years aꢃer the nephrectomy, while a year
performed to facilitate the technique. The paꢀent was earlier metastasis had also been resected in distant
placed in reverse Trendelenburg posiꢀon, the surgeon sites (nasopharynx and paroꢀd gland).
stood between the legs and the assistant on the sides
The clinical presentaꢀon is asymptomaꢀc in up
of the paꢀent. A 10-mm trocar was inserted above the to 50% of the cases, as in our paꢀent in whom pancreaꢀc
umbilicus, a 5-mm trocar between the 10-mm trocar metastases were an incidental finding during follow-up
and the subxiphoid area and two 12-mm trocars in with imaging tests, an expected situaꢀon in the case of