title: Relapsed metachronous pancreatic metastasis from renal cell carcinoma (RCC): report of a case and review of literature.
abstract: OBJECTIVE
  The pancreas is a preferred site of metastasis from renal cell carcinoma (RCC), that may occur even after many years from a radical nephrectomy. Surgical R0 resection remains the only potentially curative treatment for solitary tumor. The possibility of a multifocality of the lesions (20-45%) must be considered.
  
  
  METHODS
  We report a case of metachronous pancreatic metastasis from RCC that occurred twice. After five years from a right polar inferior nephrectomy for a RCC, two nodular lesions were identified in the body-tail of the pancreas and were treated with distal pancreatectomy and splenectomy. After six months the CT imaging revealed a nodular lesion of few millimeters in the residual pancreatic body; we followed the slow growth and in October 2012, when the size reached 2 cm, the patient was operated to remove the residual portion of pancreatic body. After 16 months of follow-up the patient is well and there isn't relapse of disease.
  
  
  CONCLUSIONS
  Patients with metachronous pancreatic lesions represent a particular group with a more indolent course of RCC, the appearance of metastases after a prolonged interval from nephrectomy is related to a more favorable prognosis. Radical lymph-node dissection is not necessary for the uncommon involvement of peripancreatic nodes, condition that explains the positive outcomes achieved with surgery.
  
  
  CONCLUSIONS
  Patients with resected metastasis present an 88% survival rate at 5 years versus 47% observed in nonoperated patients; studies provide encouraging results in survival and quality of life of surgically treated patients.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macrì
authors.forename: Francesco
authors.initials: F
authors.lastname: Fleres
authors.forename: Antonella
authors.initials: A
authors.lastname: Putortì
authors.forename: Maria
authors.initials: M
authors.lastname: Lentini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ascenti
authors.forename: Claudio
authors.initials: C
authors.lastname: Mastrojeni
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000601:surgery*; D009392:Nephrectomy; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000556:secondary* / Q000601:surgery*