Pancreatic metastasis from clear-cell renal cell carcinoma causing extrinsic left ventricular compression: A rare case report

Renal cell carcinoma is the most common renal malignancy in elderly people. It is well known for its unpredictable metastatic potential in different sites of the body, even many years after curative nephrectomy. Metastatic spread to the pancreas, accompanied by extrinsic compression of the left ventricle, is extremely rare and a late presentation. We report the case of a 68-year-old man who presented with progressively worsening shortness of breath on exertion, early satiety, and occasional abdominal discomfort. He had a history of left-sided radical nephrectomy for clear cell RCC performed 5 years earlier. An initial transthoracic echocardiogram revealed normal cardiac chambers, but there was an extrinsic compression on the LV wall. A contrast-enhanced computed tomography of the chest and abdomen was conducted, which showed a hyperenhancing mass at the head of the pancreas, and the lesion extended superiorly, exerting pressure on the inferior wall of the LV. The diagnosis of metastatic clear cell RCC was confirmed using endoscopic ultrasound-guided fine needle aspiration of the pancreatic lesion. Metastatic RCC is still challenging due to its late recurrence and atypical metastatic site. Further research and extended surveillance should be considered in long-term survivors to optimize early detection of metastasis.