Pancreatic metastases are uncommon and are only found in a minority (3-12%) of patients with widespread metastatic disease at autopsy. They account for only 2-5% of all pancreatic malignancies.
Demographics will match those of the primary tumor, but in general, will be in elderly patients.
Most pancreatic metastases are asymptomatic and are found incidentally on imaging or at autopsy 1. If particularly large, especially if at the head of the pancreas, then local symptoms may include:
- jaundice: from CBD obstruction
- malabsorption: pancreatic insufficiency
- duodenal/gastric outlet obstruction
- gastrointestinal bleeding
Although essentially any primary may eventually deposit in the pancreas, the most common primaries encountered include 1,2:
- renal cell carcinoma (RCC): one of the most common tumors that metastasize to the pancreas
- breast cancer
- lung cancer
- gastric cancer
- colorectal carcinoma (CRC)
- soft-tissue sarcoma 6
- prostatic cancer 7,8
- Merkel cell carcinoma (rare) 9
- hepatocellular carcinoma 10
- papillary thyroid carcinoma 11
- esophageal squamous cell carcinoma 12
- testicular seminoma 13
- rhabdomyoma 14
Metastases to the pancreas do not have a predilection for any one part of the gland, and can have a variety of appearances 1,4:
- localized mass: 50-75%
- diffuse involvement: 5-45%
- multiple nodules: 5-15%
In general, they tend to be small lesions (0.5-2.0 cm) 5.
Metastases appear as solid hypoechogenic masses located within the pancreatic parenchyma 5. Cysts are generally not a feature.
Findings are non-specific, typically demonstrating a well-circumscribed mass which is iso- to hypodense relative to normal pancreas on non-contrast scans 1,4. Enhancement is usually present and heterogeneous but tends to be homogeneous in smaller lesions, and peripheral in larger lesions, presumably due to central necrosis 1,4. In general, the enhancement pattern resembles that of the primary tumor.
Calcification is rare (again depends on the primary).
Pancreatic ductal obstruction is common for head and body lesions, seen in up to ~40% of cases, and may be associated with CBD obstruction and intrahepatic biliary dilatation 4.
Treatment and prognosis
Treatment is targeted at local symptomatic control, with biliary stents or gastroenteric bypass for obstruction. In general, patients are treated with palliative intent, due to widespread metastatic disease.
Resection is usually not an option, except occasionally in the setting of solitary RCC metastasis 1.
Prognosis is universally poor, matching that of the metastatic primary.
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- 2. Charnsangavej C, Whitley NO. Metastases to the pancreas and peripancreatic lymph nodes from carcinoma of the right side of the colon: CT findings in 12 patients. AJR Am J Roentgenol. 1993;160 (1): 49-52. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Ng CS, Loyer EM, Iyer RB et-al. Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. AJR Am J Roentgenol. 1999;172 (6): 1555-9. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Klein KA, Stephens DH, Welch TJ. CT characteristics of metastatic disease of the pancreas. Radiographics. 18 (2): 369-78. Radiographics (abstract) - Pubmed citation
- 5. Wernecke K, Peters PE, Galanski M. Pancreatic metastases: US evaluation. Radiology. 1986;160 (2): 399-402. Radiology (abstract) - Pubmed citation
- 6. Dähnert W. Radiology Review Manual. (2011) ISBN: 9781609139438
- 7. C Triantopoulou, E. Kolliakou, I. Karoumpalis, et al. Metastatic disease to the pancreas: an imaging challenge. (2012) Insights into Imaging. 3 (2): 165. doi:10.1007/s13244-011-0144-x - Pubmed
- 8. Jacob J, Chargari C, Bauduceau O, Fayolle M, Ceccaldi B, Prat F, Le Moulec S, Vedrine L. Pancreatic metastasis from prostate cancer. (2010) Case reports in medicine. 2010: 826273. doi:10.1155/2010/826273 - Pubmed
- 9. C Triantopoulou, E. Kolliakou, I. Karoumpalis, S. et al. Metastatic disease to the pancreas: an imaging challenge. (2012) Insights into Imaging. 3 (2): 165. doi:10.1007/s13244-011-0144-x - Pubmed
- 10. Scatarige JC, Horton KM, Sheth S, Fishman EK. Pancreatic parenchymal metastases: observations on helical CT. (2001) AJR. American journal of roentgenology. 176 (3): 695-9. doi:10.2214/ajr.176.3.1760695 - Pubmed
- 11. Davidson M, Olsen RJ, Ewton AA, Robbins RJ. PANCREAS METASTASES FROM PAPILLARY THYROID CARCINOMA: A REVIEW OF THE LITERATURE. (2017) Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 23 (12): 1425-1429. doi:10.4158/EP-2017-0001 - Pubmed
- 12. Esfehani MH, Mahmoodzadeh H, Alibakhshi A, Safavi F. Esophageal squamous cell carcinoma with pancreatic metastasis: a case report. (2011) Acta medica Iranica. 49 (11): 760-2. Pubmed
- 13. M. Wehrschütz, H. Stöger, F. Ploner, et al. Seminoma Metastases Mimicking Primary Pancreatic Cancer. (2019) Oncology Research and Treatment. 25 (4): 371. doi:10.1159/000066057 - Pubmed
- 14. Priyanka Jha, Andreas M. J. Frölich, Beth McCarville, Oscar M. Navarro, Paul Babyn, Robert Goldsby, Heike Daldrup-Link. Unusual association of alveolar rhabdomyosarcoma with pancreatic metastasis: emerging role of PET-CT in tumor staging. Pediatric Radiology. 40 (8): 1380. doi:10.1007/s00247-010-1572-3
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