Background: Metastatic cancer infrequently involves the pancreas. When the pancreas hosts a metastatic tumor, cytopathological evaluation of fine-needle aspirate material is a crucial part of the diagnostic process. In this study, we show two institutions' experience with cytopathological diagnosis of pancreatic metastasis. Methods: Databases of institutional experience at The Johns Hopkins Hospital and Ohio State University Medical Center were queried for cases of metastatic tumors in the pancreas that underwent fine-needle aspiration. Demographic and pathological features were compiled and the cytomorphology was reviewed. Results: Forty-two cases of tumor metastasis to the pancreas were found. Over the time of this review, 5,495 aspirates were performed, and 43% (2,389/5,495) had malignant cytological findings. Thus, the 42 cases of metastatic disease to the pancreas comprised 0.8% of all pancreas aspirates and 1.8% of the malignant ones. Renal cell carcinoma was the most common metastasis, followed by melanoma and non-small cell lung carcinoma. Among the other tumors in this series, 2 cases each of rare metastases such as the fibrolamellar variant of hepatocellular carcinoma and solitary fibrous tumor were also seen. Conclusion: The pancreas is rarely involved with metastatic disease, but when it is involved the most common tumor is renal cell carcinoma followed by melanoma and non-small cell lung cancer. Clinical history and awareness of the primary pancreatic mimickers are necessary for arriving at the correct diagnosis. As conventional pancreatic adenocarcinoma is uncommon in children and young adults, history of other tumors - even ones that usually follow an indolent course - is essential.

Keywords:
Pancreas metastasis, Fine-needle aspiration, Renal cell carcinoma, Fibrolamellar hepatocellular carcinoma, Pediatric pancreas cancer
1.
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.
2.
Adsay NV, Andea A, Basturk O, Kilinc N, Nassar H, Cheng JD: Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature. Virchows Archiv 2004;444:527-535.
3.
Wiersema M, Hawes R, Tao L, Wiersema L, Kopecky K, Rex D, Kumar S, Lehman G: Endoscopic ultrasonography as an adjunct to fine needle aspiration cytology of the upper and lower gastrointestinal tract. Gastrointest Endosc 1992;38:35-39.
4.
Benning TL, Silverman JF, Berns LA, Geisinger KR: Fine needle aspiration of metastatic and hematologic malignancies clinically mimicking pancreatic carcinoma. Acta Cytol 1992;36:471-476.
5.
Reddy S, Edil BH, Cameron JL, Pawlik TM, Herman JM, Gilson MM, Campbell KA, Schulick RD, Ahuja N, Wolfgang CL: Pancreatic resection of isolated metastases from nonpancreatic primary cancers. Ann Surg Oncol 2008;15:3199-3206.
6.
Olson MT, Ali SZ: Cytotechnologist on-site evaluation of pancreas fine needle aspiration adequacy: comparison with cytopathologists and correlation with the final interpretation. Acta Cytol 2012;56:340-346.
7.
Olson MT, Siddiqui MT, Ali SZ: The differential diagnosis of squamous cells in pancreatic aspirates: from contamination to adenosquamous carcinoma. Acta Cytol 2013;57:139-146.
8.
Hiotis SP, Klimstra DS, Conlon KC, Brennan MF: Results after pancreatic resection for metastatic lesions. Ann Surg Oncol 2002;9:675-679.
9.
Kassabian A, Stein J, Jabbour N, Parsa K, Skinner D, Parekh D, Cosenza C, Selby R: Renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. Urology 2000;56:211-215.
10.
Medina-Franco H, Halpern NB, Aldrete JS: Pancreaticoduodenectomy for metastatic tumors to the periampullary region. J Gastrointest Surg 1999;3:119-122.
11.
Boudghène FP, Deslandes PM, LeBlanche AF, Bigot JM: US and CT imaging features of intrapancreatic metastases. J Comput Assist Tomogr 1994;18:905-910.
12.
Whittington R, Moylan DJ, Dobelbower RR, Kramer S: Pancreatic tumours in patients with previous malignancy. Clin Radiol 1982;33:297-299.
13.
Gessi M, Gielen GH, Roeder-Geyer E-D, Sommer C, Vieth M, Braun V, Kuchelmeister K, Pietsch T: Extracranial metastasizing solitary fibrous tumors (SFT) of meninges: histopathological features of a case with long-term follow-up. Neuropathology 2013;33:68-74.
14.
Kim KA, Gonzalez I, McComb JG, Giannotta SL: Unusual presentations of cerebral solitary fibrous tumors: report of four cases. Neurosurgery 2004;54:1004-1009.
15.
Muñoz E, Prat A, Adamo B, Peralta S, Ramón y Cajal S, Valverde C: A rare case of malignant solitary fibrous tumor of the spinal cord. Spine 2008;33:E397-E399.
16.
Ng HK, Choi PC, Wong CW, To KF, Poon WS: Metastatic solitary fibrous tumor of the meninges: case report. J Neurosurg 2000;93:490-493.
17.
Ogawa K, Tada T, Takahashi S, Sugiyama N, Inaguma S, Takahashi SS, Shirai T: Malignant solitary fibrous tumor of the meninges. Virchows Archiv 2004;444:459-464.
18.
Metellus P, Bouvier C, Guyotat J, Fuentes SP, Jouvet A, Vasiljevic A, Giorgi R, Dufour H, Grisoli FO, Figarella-Branger D: Solitary fibrous tumors of the central nervous system. Neurosurgery 2007;60:715-722.
19.
Sasaki H, Kurihara T, Katsuoka Y, Nakano T, Yoshioka M, Miyano S, Sato Y, Uejima I, Hoshikawa M, Takagi M, Chikaraishi T: Distant metastasis from benign solitary fibrous tumor of the kidney. Case Rep Nephrol Urol 2013;3:1-8.
20.
Guo G, Zhang X, Zhou Z-H: Clinical characteristics of malignant solitary fibrous tumors of the kidney with thoracic vertebral metastasis. Int J Urol 2011;19:177-178.
21.
Mavros MN, Mayo SC, Hyder O, Pawlik TM: A systematic review: treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma. J Am Coll Surg 2012;215:820-830.
22.
Stipa F, Yoon SS, Liau KH, Fong Y, Jarnagin WR, D'Angelica M, Abou-Alfa G, Blumgart LH, DeMatteo RP: Outcome of patients with fibrolamellar hepatocellular carcinoma. Cancer 2006;106:1331-1338.
23.
Epstein BE, Pajak TF, Haulk TL, Herpst JM, Order SE, Abrams RA: Metastatic nonresectable fibrolamellar hepatoma: prognostic features and natural history. Am J Clin Oncol 1999;22:22-28.
24.
Thirabanjasak D, Sosothikul D, Mahayosnond A, Thorner PS: Fibrolamellar carcinoma presenting as a pancreatic mass: case report and review of the literature. J Pediatr Hematol Oncol 2009;31:370-372.
25.
Wojcicki M, Lubikowski J, Post M, Chmurowicz T, Wiechowska-Kozlowska A, Krawczyk M: Aggressive surgical management of recurrent lymph node and pancreatic head metastases of resected fibrolamellar hepatocellular carcinoma: a case report. JOP 2012;13:529-532.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.