Abstract
Purpose
To describe the clinical and MDCT findings of metastatic pancreatic tumors (MPTs) from various primary malignancies and to determine whether there are characteristic imaging features of MPTs according to the various histologies of primary tumors.
Materials and methods
Thirty-six patients with pathologically proven MPTs who underwent MDCT were retrospectively enrolled. Mean survival and factors associated with prolonged survival were analyzed using multivariate Cox regression analysis. MDCT was analyzed for the location, number, margin, and pattern and degree of enhancements of MPTs and main pancreatic duct (MPD) dilatations. Significant differences in CT features among the various histologies of MPTs were determined using the χ 2 or Fisher’s exact test.
Results
The most common primary tumors metastasized to the pancreas were renal cell carcinomas (RCC) (n = 17), gastric cancers (n = 7), and colorectal cancers (n = 5). Mean survival was significantly different between RCC (106.7 months) and non-RCC (25.1 months) metastases (P < 0.001). A primary tumor of RCC was the only factor associated with prolonged survival (hazard ratio: 0.106, P = 0.003). On MDCT, pancreatic metastases from RCC were frequently multifocal, located at the center of the pancreas, usually homogeneous and well-defined with early wash-in and persistent enhancement; non-RCC metastases tended to be solitary, located off-center (P < 0.05), and appeared as heterogeneous, ill-defined nodules with persistent low attenuation (P < 0.05).
Conclusion
Various non-RCC tumors as well as RCCs metastasize to the pancreas but a primary tumor of RCC is the only factor associated with prolonged survival. MDCT features of MPTs are significantly different between the RCC and non-RCC metastases, potentially aiding in their differentiation and selection of the most appropriate management options for these patients.
Similar content being viewed by others
References
Roland CF, van Heerden JA (1989) Nonpancreatic primary tumors with metastasis to the pancreas. Surg Gynecol Obstet 168(4):345–347
Adsay NV, Andea A, Basturk O, et al. (2004) Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature. Virchows Archiv 444(6):527–535
Crippa S, Angelini C, Mussi C, et al. (2006) Surgical treatment of metastatic tumors to the pancreas: a single center experience and review of the literature. World J Surg 30(8):1536–1542
Sperti C, Pasquali C, Liessi G, et al. (2003) Pancreatic resection for metastatic tumors to the pancreas. J Surg Oncol 83(3):161–166
Yoon WJ, Ryu JK, Kim YT, et al. (2011) Clinical features of metastatic tumors of the pancreas in Korea: a single-center study. Gut Liver 5(1):61–64
Minni F, Casadei R, Perenze B, et al. (2004) Pancreatic metastases: observations of three cases and review of the literature. Pancreatology 4(6):509–520
Klein KA, Stephens DH, Welch TJ (1998) CT characteristics of metastatic disease of the pancreas. Radiographics 18(2):369–378
Cubilla AL, Fitzgerald PJ (1980) Surgical pathology of tumors of the exocrine pancreas. In: Moosa AR, ed. Tumors of the pancreas. Williams & Wilkins, Baltimore. pp159–193
Ng CS, Loyer EM, Iyer RB, et al. (1999) Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. Am J Roentgenol 172(6):1555–1559
Moussa A, Mitry E, Hammel P, et al. (2004) Pancreatic metastases: a multicentric study of 22 patients. Gastroenterol Clin Biol 28(10 Pt 1):872–876
Reddy S, Wolfgang CL (2009) The role of surgery in the management of isolated metastases to the pancreas. Lancet Oncol 10(3):287–293
Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223(3):603–613
Bollen TL, Singh VK, Maurer R, et al. (2011) Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. Am J Roentgenol 197(2):386–392
Sheth S, Scatarige JC, Horton KM, et al. (2001) Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics 21:S237–254
Sahani DV, Shah ZK, Catalano OA, et al. (2008) Radiology of pancreatic adenocarcinoma: current status of imaging. J Gastroenterol Hepatol 23(1):23–33
Tamm EP, Balachandran A, Bhosale PR, et al. (2012) Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin N Am 50(3):407–428
Yoon SH, Lee JM, Cho JY, et al. (2011) Small (<20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology 259(2):442–452
Kim SY, Park SH, Hong N, et al. (2013) Primary solid pancreatic tumors: recent imaging findings updates with pathology correlation. Abdom Imaging 38(5):1091–1105
Paulson AS, Tran Cao HS, Tempero MA, et al. (2013) Therapeutic advances in pancreatic cancer. Gastroenterology 144(6):1316–1326
Saif MW (2011) Pancreatic neoplasm in 2011: an update. JOP 12(4):316–321
Moch H (2013) An overview of renal cell cancer: pathology and genetics. Semin Cancer Biol 23(1):3–9
Jung KW, Park S, Won YJ, et al. (2012) Prediction of cancer incidence and mortality in Korea. Cancer Res Treat 44(1):25–31
Reddy S, Edil BH, Cameron JL, et al. (2008) Pancreatic resection of isolated metastases from nonpancreatic primary cancers. Ann Surg Oncol 15(11):3199–3206
Acknowledgments
This study was supported by a grant from the Seoul National University Hospital Research Fund No. 03-2013-390.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Choi, T.W., Kim, S.H., Shin, CI. et al. MDCT findings of pancreatic metastases according to primary tumors. Abdom Imaging 40, 1595–1607 (2015). https://doi.org/10.1007/s00261-014-0299-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-014-0299-2