The CT-finding of a hypervascular pancreatic lesion in patients with past nephrectomy for renal clear cell cancer (RCC) or synchronous renal neoplasm is usually due to pancreatic metastasis from RCC. We reviewed our series (2005-2022) of pancreatic Neuroendocrine Tumors (pNET) to identify patients with past nephrectomy or synchronous kidney lesion.

Ten/277 cases (3.6%) of pNET were enrolled. Five patients with a past nephrectomy from 8 mo. up to 27 yrs. before detection of the pancreatic lesion(s). Five cases had a syncronous renal and pancreatic lesion; three of them had a pancreatic resection. Follow up to September 2023.

Five patients underwent distal pancreatectomy, 1 had a duodenum preserving pancreatic head resection, 1 underwent a pancreaticoduodenectomy and 1 had an enucleation of a head pNET. Among the eight patients who underwent pancreatic surgery, pathology found in one case both RCC metastases and a G1 pNET. In the other seven patients (all G1) four cases had a single (1.0 -2.0 cm.) pNET in the tail, and three had a (1.0-2.3 cm.) pNET in the head. Two cases had a pancreatic fistula (grade B and C). One patient died for RCC progression 52 mo. and one for unrelated disease 150 mo. after surgery. Six patients are alive without recurrence 3 to 104 mo. (median 50 mo).

CT -hypervascular pancreatic lesions in post- nephrectomy patient or in patient with synchronous renal tumor, are not always metastases of a kidney cancer. The occurrence of asymptomatic p-NET has to be taken in account.