CT Appearance of Hypervascular Pancreatic Metastases from Renal Cell Carcinoma before and after Treatment with Sunitinib in One Case

1. Clinical Image
The pancreas is an unusual site for tumor metastases, accounting for only 2-5% of all cancers. The renal cell carcinoma as primitive tumour represent the most common pancreatic metastases.
Unlike other forms of non-renal malignancies affecting the pancreas secondarily, which are often associated with widespread systemic disease, renal cell carcinoma may spread to the pancreas as the only secondary site, causing an isolated involvement of the pancreas. Ppancreatic metastatic disease is often discovered during routine surveillance imaging for primary lesions or as an accidental finding on imaging performed for other reasons [1]. With advances in pancreatic surgery a resection , can now be performed safely and is associated with long-term survival in most cases [1, 2]. In fact, surgery is considered the gold standard therapy for the disease. However, the opportunity for surgical exploration is limited. Patients with multiple metastatic sites and widespread systemic disease at the time of diagnosis are not good candidates for resection. These patients usually undergo biological therapy with sunitib (tyrosine kinase inhibitors and molecular targeted therapy, which have been introduced into clinical practice for the treatment of metastatic RCC. 2 Vascular endothelial growth factor (VEGF) inhibitors and the mammalian target of rapamycin (mTOR) radically changed the outcome of patients with metastatic renal cell carcinoma, which was typically a chemoresistant disease [2]. For all these reasons, it is essential to reach an early radiological diagnosis of relapse in order to choose whether to perform a metastesectomy or continue with medical therapy [3].