Percutaneous Biopsy under Simultaneous Ultrasound and Computer Tomography Guidance in Diagnosis of Isolated Pancreatic Metastasis of Clear Cell Renal Cell Carcinoma

Abstract

Cancers of the kidney are a various group of tumors, most of which are of epithelial origin and malignant. Renal cell carcinoma (RCC) classically referred to as clear cell carcinoma is the most common kidney cancer (70- 80% of all kidney cancers). The most common primary cancer site resulting in pancreatic metastases is liver, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. 65 year old man six years after nephrectomy due to clear cell renal cell carcinoma (ccRCC), attended regular abdominal CT examination, which revealed 28.9 mm focal lesion located in pancreatic tail. No other pathological lesions were detected. Patient underwent US guided biopsy preceded by CT pre-biopsy planning. Histopathological analysis of the obtained material confirmed clear cell carcinoma. The authors being aware of other than renal possible sites of clear cell carcinoma origin, additional tests such as membranous immunoreactivity with renal cell carcinoma (RCC), and immunohistochemical staining applied to identify the cellular origin and confirm the renal origin of the metastasis. This innovative, combined method of US guided biopsy supported by CT pre-biopsy planning can be helpful in the diagnosis of atypically located metastases of RCC. Our described case shows that in contrast to other well-known biopsy methods, our assay enables to obtain material for complete histopathological diagnosis and consequently start treatment. Moreover, presented method is based on diagnostic tools that are routinely available in every hospital such as US and CT. The only required modification is the installation of programme that enables to upload CT images containing marked planned needle path to the biopsy room, and simultaneous display of both - static CT image and US image performed in real time.