• breast cancer
• gastroenterology
• lobular carcinoma
• metastasis
• pancreatic
• pathology

• Humans
• Female
• Pancreatic Neoplasms/secondary
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/diagnosis
• Adult
• Breast Neoplasms/pathology
• Breast Neoplasms/diagnosis
• Tomography, X-Ray Computed
• Neoplasm Recurrence, Local
• Diagnosis, Differential
• Carcinoma, Lobular/secondary
• Carcinoma, Lobular/diagnosis
• Pancreas/pathology

• pancreatic metastasis
• renal cell carcinoma
• risk-factors
• seed and soil mechanism

• Humans
• Middle Aged
• Melanoma
• Pancreas/surgery
• Pancreatectomy/adverse effects
• Pancreatic Neoplasms
• Survival Rate

• chemotherapy
• colon cancer
• folfox
• iodine-125
• metastasis
• pancreas

• Adenocarcinoma/pathology
• Adenocarcinoma/therapy
• Colonic Neoplasms/pathology
• Colonic Neoplasms/therapy
• Female
• Humans
• Iodine Radioisotopes
• Middle Aged
• Pancreatic Neoplasms/drug therapy
• Quality of Life

• Adenocarcinoma/diagnosis
• Adenocarcinoma/pathology
• Humans
• Lung Neoplasms/diagnosis
• Lung Neoplasms/pathology
• Pancreatic Neoplasms/pathology

• isolated pancreatic metastasis
• organotropism
• prognosis
• renal cell carcinoma
• seed and soil mechanism

• isolated pancreatic metastases
• renal cell carcinoma metastases
• risk factors
• seed and soil mechanism
• tumour evolution

• duodenum
• metastases
• pancreas
• renal cell carcinoma
• surgery

• no external funding in support of our work

Previously documented arguments, in favor of the suspected impact of a seed and soil mechanism, in the development and progression of isolated pancreatic metastasis of renal cell carcinomas (isPM) are: (1) uniform and independent from the side of the primary tumor distribution of isPM within the pancreas and, (2) the similar survival rates for singular and multiple isPM. In addition, the present study adds new arguments that further confirm the importance of an seed and soil mechanism in isPM: (1) Within the singular isPM, the size of the metastasis does not affect the overall survival; (2) Within the group of multiple isPMs, the overall survival does not depend on the number of metastases; (3) For synchronous and metachronous isPM, survival rates are also not different, and (4) Within the group of metachronous isPM there is also no correlation between the overall survival and interval until metastases occurs. This unusual ineffectiveness of otherwise known risk factors of solid cancers can be explained plausibly by the hypothesis of a very selective seed and soil mechanism in isPM. It only allows embolized renal carcinoma cells in the pancreas to complete all steps required to grow into clinically manifest metastases. In all other organs, on the other hand, the body is able to eliminate the embolized tumor cells or at least put them into a dormant state for many years. This minimizes the risk of occult micrometastases in distant organs, which could later—after isPM treatment—grow into clinically manifest metastases, so that the prognosis of the isPM is only determined by an adequate therapy of the pancreatic foci, and prognostic factors, such as total tumor burden or interval until the occurrence of the isPM remain ineffective.

• isolated pancreatic metastases
• renal cell carcinoma
• renal cell carcinoma metastasis
• seed and soil mechanism
• treatment results

• Case report
• Endoscopic retrograde cholangiopancreatogram (ERCP)
• Endoscopic ultrasound (EUS)
• Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)
• Malignant melanoma

• Aged
• Cholangiopancreatography, Endoscopic Retrograde
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Fatal Outcome
• Female
• Humans
• Magnetic Resonance Imaging
• Melanoma/diagnosis
• Melanoma/secondary
• Melanoma/surgery
• Multimodal Imaging
• Nose Neoplasms
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/secondary
• Pancreatic Neoplasms/surgery
• Positron Emission Tomography Computed Tomography
• Skin Neoplasms/diagnosis
• Skin Neoplasms/secondary
• Skin Neoplasms/surgery
• Tomography, X-Ray Computed
• Melanoma, Cutaneous Malignant

• pancreatic metastasis
• renal cell carcinoma
• seed and soil mechanism

• Humans
• Metastasectomy/mortality
• Neoplasm Metastasis
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Prognosis
• Survival Rate

• 81625016 National Science Fund for Distinguished Young Scholars

• Endoscopic ultrasonography
• Endoscopic ultrasonography-guided fine needle aspiration
• Neuroendocrine neoplasm
• Pancreatic cancer
• Pancreatic juice cytology
• Pancreatic tumor

The management of metastatic Renal Cell Carcinoma (RCC) has changed dramatically in the last 20 years, and the role of surgery in the immunotherapy’s era is under debate. Metastatic lesions interesting pancreas are infrequent, but those harbouring from RCC have an high incidence. If metachronous resections are not rare, synchronous resection of primary RCC and its pancreatic metastasis is uncommonly reported, and accounts for a bad prognosis.

We report the case of a 68 years old woman, who presented hematuria at hospital incoming, with radiological appearance of a 13 cm left renal mass, with a 2.5 cm single pancreatic tail metastasis. Work-up of staging ruled out other distant metastases, urothelial cancer and there was no evidence of inferior vena cava thrombosis. We choose a 5-port trans-peritoneal robotic approach using lazy right lateral decubitus. Synchronous robotic radical nephrectomy and spleen-sparing pancreatic resection was performed. The pancreatic mass was completely enucleated from pancreatic parenchyma using a latero-medial dissection. Peri-operative hemoglobine loss was 2.4 g/dL. Total operative time was 213 min. No post-operative complications were recorded and patient was discharged in 7th post-operative day. Histopathological examination showed a pT2b N0 M1 RCC, Fuhrman grade II, with pancreatic tail metastasis; both, primary and metastatic lesions had the same histological characteristics with negative surgical margins. After 9 months patient had no evidence of disease recurrence at radiological studies.

The rationale for surgical removal of disseminated tumor, followed by immunotherapy, includes improving prognosis and enhancing the potential of an immune-mediated response to systemic treatment. A spleen-sparing procedure can adequately preserve post-operative immunologic capabilities. In our experience, the correct assessment of pre-operative imaging data and surgeon skills in robotic surgery seem to play a key role in the success of these procedures. Robotic surgery seems to enhance the possibility to control multiple vessels encountered during dissection. Such a conservative approach may be helpful in future research aimed at uncovering biological features, and also leading to better targeted preventive interventions and more individualized and effective treatments.

The online version of this article (10.1186/s12893-018-0371-x) contains supplementary material, which is available to authorized users.

• Distal atypical pancreasectomy
• Kidney cancer
• Metastasectomy
• Robot-assisted surgery
• Spleen-preservation

• Metastatic pathway
• Pancreatic metastases
• Renal cell carcinoma
• Seed and soil theory

• Acinar tumors
• CT
• MRI
• Pancreas
• Pancreas cancer
• Pancreatic ductal adenocarcinoma

• Contrast Media
• Diagnosis, Differential
• Humans
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Rare Diseases/diagnostic imaging
• Rare Diseases/pathology

• Liver
• Metastasis
• Pancreas
• Renal cell carcinoma
• Surgery

• G1002543 Medical Research Council

The possible benefits of the surgical resection of multiple metastases in rare sites from colorectal cancer (CRC) are still unclear. Therefore, more cases are needed to investigate the surgical outcomes of these diseases. A very rare case in which the simultaneous resection of both the metachronous retroperitoneal lymph node and pancreatic metastases from rectal cancer was successfully performed is reported.

A 68-year-old man had undergone low anterior resection for rectal cancer. Eight months later, computed tomography showed an enlarged lymph node located below the aortic bifurcation and a pancreatic head tumor. Positron emission tomography showed increased focal uptake in these two lesions. With a diagnosis of retroperitoneal lymph node metastasis from rectal cancer and primary pancreatic cancer or pancreatic metastasis from rectal cancer, resection of the enlarged retroperitoneal lymph node and pancreaticoduodenectomy were performed. The pathological examination showed that both resected lesions were metastases from the primary rectal cancer. After the metastasectomy, the patient was given systemic chemotherapy, which was discontinued due to an adverse event. He was then followed up routinely without any medication. Sixty-nine months after the metastasectomy, he is alive without any indication of recurrence.

Thus, even with metastases from CRC located in rare sites, an acceptable outcome can be expected following curative surgical resection in carefully selected patients. Whenever possible, an aggressive surgical approach should be included in the multimodality treatment of metastatic CRC.

• Pancreatic metastasis
• Rectal cancer
• Recurrence
• Retroperitoneal lymph node metastasis
• Surgery

Metastases to the pancreas are rare, accounting for less then 2 % of all pancreatic malignancies. However, both the benefit of extended tumor resection and the ideal oncological approach have not been established for such cases; therefore, we evaluated patients with metastasis to the pancreas who underwent pancreatic resection.

Between 1994 and 2012, 676 patients underwent pancreatic surgery in our institution. We retrospectively reviewed patients’ medical records according to survival, and surgical and non-surgical complications. Student’s t-test and the log-rank test were used for statistical analysis.

Eighteen patients (2.7 %) received resection for pancreatic metastases (12 multivisceral resections and 6 standard resections). The pancreatic metastases originated from renal cell carcinoma (n = 10), malignant melanoma (n = 2), neuroendocrine tumor of the ileum (n = 1), sarcoma (n = 1), colon cancer (n = 1), gallbladder cancer (n = 1), gastrointestinal stromal tumor (n = 1), and non-small cell lung cancer (n = 1). The median time between primary malignancy resection to metastasectomy was 83 months (range, 0–228 months). Minor surgical complications (Grade I-IIIa) occurred in six patients (33.3 %) whereas major surgical complications (Grade IIIb-V) occurred in three patients (16.6 %). No patients died during hospitalization. The median follow-up was 76 months (range, 10–165 months). One-year, 3-year and 5-year survival for standard resection versus multivisceral resection was 83, 50, and 56 % versus 83, 66, and 50, respectively. Twelve patients died after a median of 26 months (range, 5–55 months).

A surgical approach with curative intent is justified in select patients suffering from metastases to the pancreas and offers good long-term survival. The resection of pancreatic metastases of different tumor types was associated with favorable morbidity and mortality when compared with resection of the primary pancreatic malignancies. Our findings also demonstrated that multivisceral resection was feasible, with acceptable long term outcomes, even though morbidity rates tended to be higher after multivisceral resection than after standard resection.

Solitary metastases to the pancreas are rare. Therefore the value of resection in curative intention remains unclear. In the literature there are several promising reports about resection of solitary metastasis to the pancreas mainly of renal origin.

Here we report for the first time on the surgical therapy of a 1.5 cm solitary pancreatic metastasis of an adrenocortical carcinoma. The metastasis occurred almost 6 years after resection of the primary tumor. A partial pancreatoduodenectomy was performed and postoperatively adjuvant mitotane treatment was initiated. During the follow-up of 3 years after surgery no evidence of tumor recurrence occurred.

Resection of pancreatic tumors should be considered, even if the mass is suspicious for metastatic disease including recurrence of adrenocortical cancer.

• Pancreatic metastases
• Surgical resection
• Urogenital tract

• carcinoma
• endoscopic ultrasound (EUS)
• mesenchymal chondrosarcoma
• pancreaticobiliary
• rapid onsite evaluation

• Colonic neoplasm
• Distal pancreatectomy
• Pancreatic metastasis
• Pancreatic neoplasm

• Adenocarcinoma/diagnosis
• Adenocarcinoma/secondary
• Adenocarcinoma/surgery
• Aged
• Colonic Neoplasms/diagnosis
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Humans
• Male
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/secondary
• Pancreatic Neoplasms/surgery

Pancreatic metastases (PMs) are rare and lack of guidelines for diagnosis and treatments .The aim of this study is to explore the diagnosis, treatment, and prognosis of pancreatic metastases.

Twenty-two patients with pancreatic metastases who had been hospitalized at the First Affiliated Hospital of China Medical University from October 1980 to October 2012 were included in the present retrospective study. Seven patients had gastric cancer, five had colon cancer, two each had lung and liver cancer, and one each had bladder cancer, gallbladder cancer, breast cancer, nasopharyngeal cancer, renal cell carcinoma, and carcinoid.

No specific syndrome or imageological change was found for the pancreatic metastases. The most common symptoms were abdominal pain and jaundice. Hypo-echoic lesions with well-defined margins were found on ultrasonic examinations, and low-density lesions with heterogeneous enhancement were identified in CT images. Nineteen of the 22 received treatment. Three of the 8 patients (34.1%) that had undergone operation experienced complications, but all patients recovered after conventional treatment. Follow-up studies were performed for 17 patients (77.3%), and the median survival time from the diagnosis of pancreatic metastases was 13.2 months (range, 2 to 68 months). Of the five patients who underwent radical resection, one was lost to follow-up, one died at fifteen months postoperation, and the other three are still alive and free from disease (disease-free survival ranging from five to thirty-three months from the diagnosis of the pancreatic metastases).

Pancreatic metastases are rare lesions with no specific symptoms. Radical resection should be performed if possible; however, aggressive treatment should be performed for unresectable pancreatic metastases.

• Metastasectomy
• Metastatic renal cell cancer
• Pancreatectomy
• Pancreatic metastasis

Malignant melanomas rarely develop isolated pancreatic metastases. We describe a unique patient who is still alive 22 years following an isolated pancreatic melanoma metastasis, and we review the sparse literature in the field.

• endoscopic ultrasound-guided fine needle aspiration
• renal cell carcinoma
• solitary pancreatic metastasis

• Endoscopic ultrasonography-guided fine needle aspiration
• Middle pancreatectomy
• Pancreatic metastasis
• Uterine cervical mixed adenoneuroendocrine carcinoma

• Adenocarcinoma, Mucinous/diagnosis
• Adenocarcinoma, Mucinous/pathology
• Adenocarcinoma, Mucinous/surgery
• Biopsy, Fine-Needle
• Cystadenocarcinoma/diagnosis
• Cystadenocarcinoma/pathology
• Cystadenocarcinoma/surgery
• Cystadenoma/diagnosis
• Cystadenoma/pathology
• Cystadenoma/surgery
• Cystadenoma, Serous/diagnosis
• Cystadenoma, Serous/pathology
• Cystadenoma, Serous/surgery
• Diagnosis, Differential
• Female
• Humans
• Magnetic Resonance Imaging/methods
• Middle Aged
• Neoplasms, Cystic, Mucinous, and Serous/diagnosis
• Neoplasms, Cystic, Mucinous, and Serous/pathology
• Neoplasms, Cystic, Mucinous, and Serous/surgery
• Pancreas/diagnostic imaging
• Pancreas/pathology
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Tomography, X-Ray Computed/methods
• Ultrasonography

• Humans
• Lung Neoplasms/secondary
• Lung Neoplasms/surgery
• Male
• Melanoma/secondary
• Melanoma/surgery
• Middle Aged
• Neoplasms, Unknown Primary/pathology
• Neoplasms, Unknown Primary/surgery
• Pancreatic Neoplasms/secondary
• Pancreatic Neoplasms/surgery
• Prognosis

• Pancreatic metastases
• Pancreatic surgery
• Prognostic factors
• Radiological findings
• Renal cell carcinoma
• Therapeutic approach

• Abdominal Pain/etiology
• Adult
• Aged
• Carcinoma, Renal Cell/diagnosis
• Carcinoma, Renal Cell/mortality
• Carcinoma, Renal Cell/secondary
• Carcinoma, Renal Cell/surgery
• Colonic Neoplasms/pathology
• Female
• Humans
• Interdisciplinary Communication
• Kidney Neoplasms/pathology
• Male
• Melanoma/secondary
• Middle Aged
• Ovarian Neoplasms/pathology
• Pancreatectomy
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/secondary
• Pancreatic Neoplasms/surgery
• Prognosis
• Risk Factors
• Sarcoma/secondary
• Treatment Outcome

• K08 DK071329 NIDDK NIH HHS
• P01 CA117969 NCI NIH HHS
• P50 CA127003 NCI NIH HHS

Isolated metastatic melanoma of the pancreas is very rare. Currently, there is very limited experience with surgical resection of pancreatic metastasis. The potential benefit of metastasectomy can improve the quality of life and survival time of patients. We present a case of a 39-year-old Chinese male with a solitary pancreatic tumor which was considered a cystic benign lesion for years. Pathology and immunohistochemistry showed that the tumor in pancreatic tail was a metastasis from a malignant melanoma of the eyeball. No other metastastic foci were found in abdomen. The tumor was completely resected with combined distal pancreatectomy and splenectomy. The patient has survived 25 mo without any signs of local recurrence or other metastatic lesions after operation, indicating that complete surgical resection of a solitary metastatic melanoma of the pancreas can prolong the survival time of patients.

• Melanoma
• Metastasis
• Pancreas
• Solitary tumor
• Resection

• Adenocarcinoma/secondary
• Adenocarcinoma/therapy
• Aged
• Antineoplastic Agents/therapeutic use
• Chemotherapy, Adjuvant
• Combined Modality Therapy
• Female
• Humans
• Pancreatic Neoplasms/secondary
• Pancreatic Neoplasms/therapy
• Radiotherapy, Adjuvant
• Rectal Neoplasms/pathology
• Rectal Neoplasms/therapy
• Treatment Outcome