Safi Dokmak, Carmen Cabral, Anne Couvelard, Beatrice Aussilhou, Jacques Belghiti, Alain Sauvanet
Context Pancreatic metastasis from renal cell carcinoma is a well-known entity. When metastatic disease is limited to the pancreas, pancreatic resection is the optimal treatment. A nephroblastoma is a frequent childhood cancer but can also occur in adults. A metastatic nephroblastoma mainly affects the lung and the liver. Pancreatic metastases from a nephroblastoma are very rare. Case report We report an extremely rare case of pancreatic metastases in a 20-year-old man who had a right nephroblastoma resected at 9 years of age and liver metastases treated by right hepatectomy at 18 years of age. Pancreatic metastasis was revealed by acute pancreatitis. Imaging studies revealed one 2 cm nodule in the pancreatic head with upstream dilatation of the Wirsung duct. Imaging studies revealed no other localization except a 1.5 cm liver nodule. Surgical resection was performed without preoperative chemotherapy because the patient was symptomatic and had already received numerous chemotherapy protocols. The patient underwent pancreaticoduodenectomy and limited liver resection with an uneventful postoperative course. Pathological examination confirmed pancreatic and liver metastases from a nephroblastoma composed of blastematous cells mixed with embryonic tubular structures without lymph node metastases. After resection, the patient received adjuvant high dose chemotherapy with autologous hematopoietic stem-cell support. After a 21-month follow-up, the patient was in good general condition but had liver recurrence without intra-pancreatic recurrence. Conclusion This is probably the first case of pancreatic metastasis from a nephroblastoma reported in a living patient. A nephroblastoma, like clear cell renal carcinoma, can be considered a possible etiology of pancreatic metastasis from a primary renal tumor.
