Background: Renal cell carcinoma rarely metastasizes to the pancreas. Diagnosing a neoplasm that is metastatic to the pancreas by fine-needle aspiration (FNA) cytology is often challenging. A detailed clinical history may prove to be beneficial. Case Reports: A total of 729 pancreatic FNAs were performed from January 2005 through August 2012 at our institution. Among these, we found 3 patients with a prior history of a malignant renal neoplasm who presented with a pancreatic mass: 2 in the tail and 1 in the head. Radiographically, they ranged in size from 2.5 to 7.0 cm. Microscopic evaluation of cytologic material obtained during endoscopic ultrasound-guided FNA (EUS-FNA) revealed cohesive clusters of atypical cells with clear cytoplasm and prominent nucleoli surrounded by a thin capillary network. The neoplastic cells were immunoreactive with CD10 (cases 2 and 3). A diagnosis of metastatic clear cell renal cell carcinoma was rendered for each case based on the morphologic features and immunohistochemical staining pattern of the neoplastic cells. Histologic comparison with the available slides of the corresponding primary renal neoplasm confirmed the diagnosis. Conclusion: We conclude that EUS-FNA of pancreatic masses is an important, effective, and accurate diagnostic modality for early diagnosis of both primary and metastatic neoplasms of the pancreas.

1.
Thadani A, Pais S, Savino J: Metastasis of renal cell carcinoma to the pancreas 13 years postnephrectomy. Gastroenterol Hepatol (NY) 2011;7:697-699.
2.
Sohn TA, Yeo CJ, Cameron JL, Nakeeb A, Lillemoe KD: Renal cell carcinoma metastatic to the pancreas: results of surgical management. J Gastrointest Surg 2001;5:346-351.
3.
Ballarin R, Spaggiari M, Cautero N, De Ruvo N, Montalti R, Longo C, Pecchi A, Giacobazzi P, De Marco G, D'Amico G, Gerunda GE, Di Benedetto F: Pancreatic metastases from renal cell carcinoma: the state of the art. World J Gastroenterol 2011;17:4747-4756.
4.
Hiotis SP, Klimstra DS, Conlon KC, Brennan MF: Results after pancreatic resection for metastatic lesions. Ann Surg Oncol 2002;9:675-679.
5.
Layfield LJ, Hirschowitz SL, Adler DG: Metastatic disease to the pancreas documented by endoscopic ultrasound guided fine-needle aspiration: a seven-year experience. Diagn Cytopathol 2012;40:228-233.
6.
El Hajj II, LeBlanc JK, Sherman S, Al-Haddad MA, Cote GA, McHenry L, DeWitt JM: Endoscopic ultrasound-guided biopsy of pancreatic metastases: a large single-center experience. Pancreas 2013;42:524-530.
7.
Gilbert CM, Monaco SE, Cooper ST, Khalbuss WE: Endoscopic ultrasound-guided fine-needle aspiration of metastases to the pancreas: a study of 25 cases. Cytojournal 2011;8:7.
8.
Ray S, Lu Z, Rajendiran S: Clear cell ductal adenocarcinoma of pancreas: a case report and review of the literature. Arch Pathol Lab Med 2004;128:693-696.
9.
Tanino M, Kohsaka S, Kimura T, Tabu K, Nishihara H, Sawa H, Kawami H, Kamada H, Shimizu M, Tanaka S: A case of clear cell variant of solid-pseudopapillary tumor of the pancreas in an adult male patient. Ann Diagn Pathol 2012;16:134-140.
10.
Albores-Saavedra J, Simpson KW, Bilello SJ: The clear cell variant of solid pseudopapillary tumor of the pancreas: a previously unrecognized pancreatic neoplasm. Am J Surg Pathol 2006;30:1237-1242.
11.
Jungbluth AA, Iversen K, Coplan K, Williamson B, Chen YT, Stockert E, Old LJ, Busam KJ: Expression of melanocyte-associated markers gp-100 and Melan-A/MART-1 in angiomyolipomas. An immunohistochemical and rt-PCR analysis. Virchows Arch 1999;434:429-435.
12.
Fryer E, Serra S, Chetty R: Lipid-rich (‘clear cell') neuroendocrine tumors of the pancreas in MEN I patients. Endocr Pathol 2012;23:243-246.
13.
Hoang MP, Hruban RH, Albores-Saavedra J: Clear cell endocrine pancreatic tumor mimicking renal cell carcinoma: a distinctive neoplasm of von Hippel-Lindau disease. Am J Surg Pathol 2001;25:602-609.
14.
Blandamura S, Parenti A, Famengo B, Canesso A, Moschino P, Pasquali C, Pizzi S, Guzzardo V, Ninfo V: Three cases of pancreatic serous cystadenoma and endocrine tumour. J Clin Pathol 2007;60:278-282.
15.
Lyle PL, Amato CM, Fitzpatrick JE, Robinson WA: Gastrointestinal melanoma or clear cell sarcoma? Molecular evaluation of 7 cases previously diagnosed as malignant melanoma. Am J Surg Pathol 2008;32:858-866.
16.
Baehner FL, Ng B, Sudilovsky D: Metastatic balloon cell melanoma: a case report. Acta Cytologica 2005;49:543-548.
17.
Law CH, Wei AC, Hanna SS, Al-Zahrani M, Taylor BR, Greig PD, Langer B, Gallinger S: Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment, and outcome. Ann Surg Oncol 2003;10:922-926.
18.
Konstantinidis IT, Dursun A, Zheng H, Wargo JA, Thayer SP, Fernandez-del Castillo C, Warshaw AL, Ferrone CR: Metastatic tumors in the pancreas in the modern era. J Am Coll Surg 2010;211:749-753.
19.
Chara L, Rodríguez B, Holgado E, Ramírez N, Fernández-Rañada I, Mohedano N, Arcediano A, García I, Cassinello J: An unusual metastatic renal cell carcinoma with maintained complete response to sunitinib treatment. Case Rep Oncol 2011;4:583-586.
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