Ultra-late pancreatic metastases from renal cell carcinoma after nephrectomy: two case reports and a literature review.

Pancreatic metastases of renal cell carcinoma (PM-RCC) are relatively rare. However, they exhibit unique biological behavior, often presenting as late-onset metastases with a relatively favorable prognosis. This report presents two cases of pancreatic masses detected 16 and 20 years, respectively, after radical nephrectomy for renal cell carcinoma (RCC). Both patients were asymptomatic, with the masses identified during routine health examinations. Each patient successfully underwent robot-assisted distal pancreatectomy with splenectomy. Pathological examination confirmed the diagnosis of PM-RCC in both cases, illustrating the characteristic of ultra-late metastasis in RCC. This underscores the necessity for lifelong follow-up in RCC patients and maintaining a high index of suspicion for metastasis when new pancreatic lesions are identified. Carbonic anhydrase-IX-targeted PET/CT may be helpful as an adjunct for preoperative differential diagnosis. Our findings suggest that an aggressive surgical approach may be considered for patients in whom complete resection appears feasible.