Renal cell carcinoma metastases to the pancreas and the thyroid gland 19 years after the primary tumour

Renal cell carcinoma (RCC) is a relatively rare solid tumour: it comprises ca. 3% of all malignant neoplasms among adults. The most common histological RCC type (70–80% of renal neoplasms) is clear cell cancer. At diagnosis 30% of patients with this tumour have distant metastases, and in 20% of cases it is considerably advanced locally [1, 2]. Moreover, following nephrectomy, 20% to 30% of RCC patients in whom the tumour only affects the kidneys, on average will have a local recurrence and/or distant metastases after 15 to 18 months, while in 85% the disease will recur within 3 years [3]. Metastases may also appear more than 10 years after surgical treatment. The most common metastatic sites for bloodstream-spread are the lungs, liver, brain, and bones [3, 4]. The second way in which the tumour can spread is via the lymphatic vessels. Renal cell carcinoma patients may have distant metastases in atypical locations, i.e. the skin, thyroid, and pancreas. Resectable RCC metastases found in post-nephrectomy follow-ups should be removed surgically since metastasectomy sometimes enables long-term survival [2].
A 61-year-old woman was admitted to the Department of Endocrinology and Internal Medicine in February 2013 because of multiple pancreatic tumours. Nineteen years earlier she underwent left nephrectomy due to RCC, after which she was not followed-up, either urologically or oncologically. In October 2012 there was a single episode of haematuria; the patient had an abdominal ultrasound performed (8 January 2013), which revealed a 19-mm mass on the border of the body and neck of the pancreas. In an abdominal computed tomography (CT) scan (10 January 2013) multiple (at least 6) masses were found in the pancreas, the largest of them was located in the head and measured 35 mm in diameter, and had central necrosis. The character of the masses was suggestive of multiple pancreatic neuroendocrine tumours. In a magnetic resonance imaging (MRI) scan (31 January 2013) the masses were described as ambiguous, i.e. “their characteristics could match those of neuroendocrine tumours; however, the biggest of masses, with necrosis, might have a different aetiology; on account of the patient’s oncological history, metastatic tumours cannot be excluded (…)”.
Moreover, since at least 2004, two masses in the thyroid gland had been observed in this patient. Cytology result of the right-lobe mass fine needle aspiration biopsy (FNAB) material suggested normal follicular...


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