Pancreatic metastases: An updated narrative review of epidemiology, diagnosis and management illustrated by a rare case of pulmonary artery intimal sarcoma
Background: Pancreatic metastases (PM) account for 2%–5% of pancreatic neoplasms diagnosed clinically, while autopsy series report a 3%–12% prevalence, reaching 43% in advanced malignancy. This statistic suggests underdiagnosis of silent lesions mimicking primary pancreatic tumors, representing a major diagnostic challenge. Aim: This study aims to summarize evidence on PM etiology, diagnosis, and management, as illustrated by an exceptional case of acute pancreatitis (AP) secondary to pulmonary artery intimal sarcoma (PAIS). Methods: A narrative review of the medical literature was conducted in June 2026 using PubMed/MEDLINE. Publications available up to January 2026 were reviewed, including electronic ahead-of-print publications. Relevant original studies, systematic reviews, pooled analyses, and clinical guidelines were reviewed, synthesized, and integrated with the case. Results: Renal cell carcinoma (RCC), which accounts for 30%–70% of reported PM in clinical and surgical series, is characterized by indolent biology and latency periods exceeding ten years. Sarcomas, which represent 4.3%–7.2% of reported PM, are biologically aggressive sources of PM. AP presentation is exceptionally uncommon and is a result of mechanical pancreatic duct obstruction. Endoscopic ultrasound-guided fine-needle biopsy is considered the diagnostic standard, with a 97.9% accuracy. Metastasectomy achieves a 76.6% five-year survival rate in RCC cases. In PAIS cases, AP has been reported to resolve following systemic chemotherapy; however, this temporal association should not be interpreted as evidence confirming the proposed pathogenic mechanism. Conclusion: PM should be considered in any pancreatic mass or AP of uncertain origin in patients with cancer. The oligometastatic disease model (≤5 lesions) supports curative-intent or prolonged systemic disease-control strategies. Relevance for patients: Accurate diagnosis prevents staging errors, preserves pancreatic function, and supports prolonged radiological surveillance in tumors with pancreatic tropism.
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