Female 79 years old with abdominal pain. A 1.5 cm cystic lesion in the uncinate process of the pancreas was seen on EUS done in August of 2016. Patient was also noted to have multiple other cystic type lesions. Please evaluate for interval changes. Additional history from the electronic medical record indicates a right nephrectomy for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: There are multiple T1 isointense to muscle, T2 bright, enhancing lesions within the right lobe of the liver. Corresponding restricted diffusion suggested. The largest lesion is in segment 6 and measures 1 x 1 cm (series 4, image 24). The hepatic vasculature is patent. There is no ascites.SPLEEN: No significant abnormality noted.PANCREAS: A 2.2 x 1.0 cm cystic, ovoid lesion in the uncinate process is favored to represent a side branch IPMN (series 4, image 14). An additional subcentimeter cystic lesion at the pancreatic head/uncinate process junction is likely an additional sidebranch PMN. No definite associated wall thickening or enhancement seen.There are multiple additional solid, avidly enhancing lesions along involving the length of the pancreas, i.e., the head, body and tail, at least one lesion shows central necrosis. The largest measures 3.5 x 3.4 cm (series 11, image 37) and insinuates between the pancreatic tail and stomach (versus a separate metastatic deposit separate from pancreas).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is surgically absent. There is a subcentimeter T1 bright lesion within the left kidney which most likely represents a proteinaceous or hemorrhagic cyst, evaluation suboptimal due to small size and lesion is not well delineated on postcontrast sequences. Additional small foci within the left kidney are too small to reliably evaluate.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Solid enhancing lesions along the length of the pancreas are most suspicious for metastatic renal cell carcinoma given multiplicity and the patient's remote history of RCC. 2. Neuroendocrine tumor another differential consideration.3. Findings concerning for hepatic metastatic disease.4. Probable sidebranch IPMNs in uncinate process.5. Please refer to details above.