Misdiagnosis of pancreatic metastasis from renal cell carcinoma: A case report

Table 1 Differential diagnosis of isolated pancreatic metastasis from renal cell cancer and similar diseases[3,12]

	Symptoms	Number, location, and size	Unenhanced CT	Enhanced CT	Indirect sign	Histology
isPM-RCC	Asymptomatic, non-specific	Solitary/ multiple; No special location; 37.0 ± 21.4 mm	Lower or equal density; Clear boundary; Homogeneous	Hypervascular; Fast in fast out; Homogeneous; Rim enhancement	Rare Infringement of bile duct or main pancreatic duct; No parenchymal atrophy, clear retroperitoneal structure	Similar to the primary RCC, nests of polygonal cells with a rich vascular network. Pseudocapasule. CD10+, PAX8+, c-kit/CD117+, CK7-
pNET	Hormone-related symptoms in functional tumor	Solitary; More in tail; Small in Functional tumor (< 20 mm); Large in nonfunctional tumor (> 50 mm)	Lower density; Clear boundary; Heterogeneous; Calcification	Hypervascular; Obvious and continuous; Heterogeneous	Main pancreatic duct dilation; No parenchymal atrophy, clear retroperitoneal structure	Reveals cords, gyriform patterns of tumor cell arrangement, central hemorrhage, CgA+, Synaptophysin+, PAX8-
Clear cell carcinoma of the pancreas	Subxiphoid abdominal pain, jaundice, athrepsy	Solitary; More in head; 10 mm to 100 mm	Lower density; Unclear boundary; Heterogeneous;	Hypovascular; Mild in arterial phase but delayed in venous phase	Parenchymal atrophy and pancreatic and bile duct cutoff and dilatation; early metastasis	Virtue of tubular/glandular structures lined by clear cells with varying degrees of nuclear atypia; areas of conventional pancreatic ductal adenocarcinoma are present; CD10-, PAX8-

CT: Computed tomography; isPM-RCC: Isolated pancreatic metastasis from renal cell cancer; pNET: Pancreatic neuroendocrine tumor.