Pancreatic metastases

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.

Although essentially any primary may eventually deposit in the panaceas the most common primaries encountered include 1-2:

Demographics will match those of the primary tumour, 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:

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:

  • localised mass: 50-75%
  • diffuse involvement: 5-45%
  • multiple nodules: 5-15%

In general they tend to be small lesions (0.5-2.0cm) 5.

Ultrasound

Metastases appear as solid hypoechogenic masses located within the pancreatic parenchyma 5. Cysts are generally not a feature.

CT

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 heterogeneous, but tends to be present, homogeneously for smaller lesions, and peripheral in larger lesions, presumably due to central necrosis 1,4. In general, the enhancement pattern resembles that of the primary tumour. 

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 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.

Pancreatic pathology
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Article Information

rID: 6987
Section: Pathology
Synonyms or Alternate Spellings:
  • Metastases to pancreas

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