Kassabian A, Stein J, Jabbour N, Parsa K, Skinner D, Parekh D, Cosenza C, Selby R
Department of Urology, LAC-University of Southern California Medical Center, Los Angeles, California 90033, USA.
Urology. 2000 Aug 1;56(2):211-5. doi: 10.1016/s0090-4295(00)00639-7.
To present a series of 5 patients with solitary metastatic renal cell carcinoma (RCC) to the pancreas after radical nephrectomy at our institution and review the published reports of this rare event.
A retrospective review of the records of 5 patients with histologically confirmed RCC metastatic to the pancreas after radical nephrectomy was performed. A total of 5 patients (4 men, 1 woman) with a median age of 56 years (range 54 to 68) underwent radical nephrectomy for primary RCC. The pathologic stage was Robson I (n = 3) or Robson III (n = 2), with a left-sided tumor occurring in 3 patients and a right-sided tumor in 2 patients. The median interval from nephrectomy to the diagnosis of the pancreatic metastasis was 12 years (range 4 to 15). All patients were symptomatic at presentation, including weight loss (n = 3), abdominal pain (n = 3), early satiety (n = 1), steatorrhea (n = 1), and/or hemosuccus pancreaticus (n = 1).
All pancreatic metastases were hypervascular on imaging studies, and surgical removal was accomplished by pancreaticoduodenectomy (n = 3), partial pancreatectomy (n = 1), or subtotal pancreatectomy (n = 1). One patient died of disseminated disease 12 months after pancreatic resection. Two other patients had recurrences in the lung (n = 1) at 5 months or the pancreas/liver (n = 1) at 48 months. Both of these patients underwent a second resection and were disease free at 2 and 12 months afterward. The two remaining patients were disease free at 7 and 24 months after pancreatic resection.
RCC is an unpredictable tumor that may demonstrate very late metastases even from early-stage lesions. Aggressive surgical management of isolated pancreatic lesions offers a chance of long-term survival.
介绍我院5例在根治性肾切除术后出现孤立性胰腺转移的肾细胞癌（RCC）患者，并回顾关于这一罕见事件的已发表报告。
对5例经组织学证实为根治性肾切除术后胰腺转移的RCC患者的病历进行回顾性分析。共有5例患者（4例男性，1例女性），中位年龄56岁（范围54至68岁），因原发性RCC接受了根治性肾切除术。病理分期为Robson I期（n = 3）或Robson III期（n = 2），左侧肿瘤3例，右侧肿瘤2例。从肾切除到诊断为胰腺转移的中位间隔时间为12年（范围4至15年）。所有患者就诊时均有症状，包括体重减轻（n = 3）、腹痛（n = 3）、早饱（n = 1）、脂肪泻（n = 1）和/或胰管出血（n = 1）。
所有胰腺转移灶在影像学检查中均为高血供，手术切除方式为胰十二指肠切除术（n = 3）、部分胰腺切除术（n = 1）或次全胰腺切除术（n = 1）。1例患者在胰腺切除术后12个月死于播散性疾病。另外2例患者分别在5个月时肺部复发（n = 1）或48个月时胰腺/肝脏复发（n = 1）。这2例患者均接受了二次切除，术后2个月和12个月时无疾病。其余2例患者在胰腺切除术后7个月和24个月时无疾病。
RCC是一种不可预测的肿瘤，即使是早期病变也可能出现很晚的转移。对孤立性胰腺病变进行积极的手术治疗可提供长期生存的机会。
