Late recurrent renal cell carcinoma presenting as a solitary gallium-68 DOTATATE-avid pancreatic mass with polycythemia

Pancreatic metastasis of renal cell carcinoma (RCC) is rare and can present many years after nephrectomy. It can exhibit radiological characteristics very similar to those of a pancreatic neuroendocrine tumor (pNET). Here, we present a case of an 81-year-old female who presented with an incidentally discovered solitary hypervascular pancreatic head mass with intense gallium-68-DOTA-OCTREOTATE positron emission tomography/computed tomography (Ga-68 DT-PET/CT) uptake 15 years after her initial nephrectomy for an RCC. The mass continued to grow despite somatostatin analog (SSA) therapy, prompting endoscopic ultrasound (EUS)-guided biopsy, which revealed metastatic RCC.