Pancreatic metastases from urothelial cancer

Background: Urothelial carcinoma (UC) is a common malignancy that rarely metastasizes to the pancreas. Pancreatic masses in patients with UC present significant diagnostic challenges. Case report: An elderly man with a history of nephroureterectomy for UC of the renal pelvis presented with lower back pain, nausea, and constipation. Imaging revealed local relapse and a solitary pancreatic mass. Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) confirmed the diagnosis of metastatic UC. The patient was treated with carboplatin and gemcitabine and subsequently with pembrolizumab but experienced rapid progression and succumbed to his disease. Conclusion: Pancreatic metastases from UC are extremely rare. Accurate diagnosis requires histological confirmation, and EUS-FNB provides a minimally invasive and effective method. Management should be individualized, and the role of multidisciplinary team involvement is critical. LEARNING POINTS: In patients with a history of advanced urothelial carcinoma, the possibility of a pancreatic mass being metastatic, though uncommon, should always be considered in the differential diagnosis.Multidisciplinary team involvement is crucial for optimal diagnostic and management decisions.Histological confirmation is mandatory, and endoscopic ultrasound-guided fine needle biopsy is the most accurate and minimally invasive approach for obtaining tissue.