title: [Jaundice and pancreatic mass: typical clinical presentation of a rare disease].
abstract: METHODS
  An 81-year-old man presented with jaundice and a pancreatic tumor. 6 years ago transperitoneal nephrectomy had been performed because of a clear cell renal cancer (pT3b pN0 pM0).
  
  
  METHODS
  Laboratory tests showed normocytic anemia and signs of cholestasis. Abdominal ultrasonography revealed a well-defined mass of the head of the pancreas with a diameter of about 4 cm, and a previously diagnosed adrenal mass which had slightly increased in size. Contrast-enhanced ultrasound demonstrated a hyperenhancing of the pancreatic mass, untypical for primary adenocarcinoma of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration disclosed a metastasis of the previously resected renal cancer.
  
  
  METHODS
  Bilary spincterotomy and stent insertion were performed. Because of proven pancreatic metastasis and suspected adrenal metastasis of renal cancer palliative treatment with multi-targeted receptor tyrosine kinase inhibitor sunitinib was initiated.
  
  
  CONCLUSIONS
  Renal cell carcinomas are the most common primary tumors leading to pancreatic metastasis. In contrast to ductal adenocarcinoma pancreatic metastasis shows hyperenhancement when examined by using contrast-enhanced ultrasonography. Endoscopic ultrasound-guided fine-needle aspiration helps to confirm the suspected diagnosis.
authors.affiliation: Abteilung für Innere Medizin, Paracelsus-Klinik Karlsruhe. dr.peter.matheiowetz@pk-mx.de
authors.forename: P
authors.initials: P
authors.lastname: Matheiowetz
authors.forename: E
authors.initials: E
authors.lastname: Siegel
authors.forename: G
authors.initials: G
authors.lastname: Faller
mesh_terms: D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000556:secondary*; D003937:Diagnosis, Differential; D006801:Humans; D007565:Jaundice / Q000175:diagnosis* / Q000209:etiology; D007674:Kidney Diseases / Q000175:diagnosis*; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000556:secondary*; D035583:Rare Diseases