Ignatavicius Povilas, Lizdenis Paulius, Pranys Darius, Gulbinas Antanas, Pundzius Juozas, Barauskas Giedrius
Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Pathology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Prague Med Rep. 2018;119(4):165-169. doi: 10.14712/23362936.2019.4.
Ampulla of Vater metastases from renal cell carcinoma are rare. The time between detection of the primary tumour and its metastasis may extend to years. Management should be aggressive, since the prognosis of renal cell carcinoma is unpredictable and curative surgery of metastases may extend patient survival and even lead to definite cure. Herein we report a case of long-term survival after successful surgical treatment of a renal cell carcinoma metastasis to the ampulla of Vater. A 62-year-old man with a history of renal cell carcinoma in the left kidney underwent a successful left nephrectomy. Eight months later duodenoscopy showed a tumour at the site of papilla of Vater. Biopsy confirmed the diagnosis of carcinoma. Contrast enhanced computer tomography scan verified the periampullary mass, dilatation of the pancreatic and the common bile duct. No radiological signs of either local advancement or distant metastases were present. Pylorus-preserving pancreatoduodenectomy with lymphadenectomy was performed. Pathology report disclosed metastatic lesions in the papilla of Vater from the clear cell carcinoma of the kidney. The postoperative course was uneventful, and the patient lived for 14 years after pancreatoduodenectomy and, following thorough investigations, was free from local and systemic recurrence. Pancreatoduodenectomy can provide long-term survival in selected cases with solitary papilla of Vater metastasis from renal cell carcinoma. Favourable long-term survival rates suggest that these patients should be considered candidates for pancreatoduodenectomy if experienced pancreatic surgeon is available and no other metastases are found.
肾细胞癌转移至 Vater 壶腹较为罕见。从原发肿瘤检测到其转移的时间可能长达数年。治疗应积极主动，因为肾细胞癌的预后难以预测，而对转移灶进行根治性手术可能延长患者生存期，甚至实现根治。在此，我们报告一例肾细胞癌转移至 Vater 壶腹经手术成功治疗后长期存活的病例。一名 62 岁男性，有左肾肾细胞癌病史，成功接受了左肾切除术。八个月后，十二指肠镜检查显示 Vater 乳头处有肿瘤。活检确诊为癌。增强计算机断层扫描证实了壶腹周围肿块、胰管和胆总管扩张。无局部进展或远处转移的影像学征象。行保留幽门的胰十二指肠切除术并清扫淋巴结。病理报告显示 Vater 乳头处有来自肾透明细胞癌的转移灶。术后过程顺利，患者在胰十二指肠切除术后存活了 14 年，经过全面检查，无局部和全身复发。对于肾细胞癌孤立性转移至 Vater 乳头的特定病例，胰十二指肠切除术可实现长期存活。良好的长期生存率表明，如果有经验丰富的胰腺外科医生且未发现其他转移灶，这些患者应被视为胰十二指肠切除术的候选对象。
