Pancreatic metastases from extra-pancreatic solid tumors are rare, accounting for approximately 3–15% of solid pancreatic masses in the absence of other detectable distant metastases. The pancreas is an uncommon metastatic site for renal cell carcinoma, breast and lung cancers, melanoma, colorectal cancer, sarcomas and gastrointestinal stromal tumors. These secondary lesions are often incidentally discovered during oncologic follow-up or may mimic primary pancreatic ductal adenocarcinoma. Endoscopic ultrasound (EUS) plays a key role in their detection and characterization. We aimed to evaluate the prevalence and characteristics of pancreatic metastases diagnosed by EUS in our center.

We conducted a retrospective single-center study including all consecutive patients who underwent pancreatic EUS with tissue acquisition between 2018 and 2025. The diagnosis of pancreatic metastasis was based on histological examination of EUS-guided biopsy samples, complemented by immunohistochemical staining. Diagnostic criteria relied on correlation of morphological and immunohistochemical findings with the patient’s oncologic history and cross-sectional imaging. Lesions were classified according to primary tumor origin, pancreatic location and histological features.

Among 380 patients who underwent pancreatic EUS with biopsy (236 men, 144 women; male-to-female ratio 1.63; mean age 62 years [29–88]), ten pancreatic metastases were identified, corresponding to a prevalence of 2.6%. Primary tumors were: four clear cell renal cell carcinomas (36%), two small-cell lung cancers (18%), one colonic adenocarcinoma (9%), one breast carcinoma (9%), one gastric stromal tumor recurring in the pancreas (9%) and  one shoulder chondrosarcoma recurring in the pancreas (9%).Pancreatic involvement was located in the head/uncinate process in sIX cases (60%), the body in three (30%) and the tail in one (10%). Lesions were solitary in eight patients (80%) and multiple in two (20%). Immunohistochemistry was systematic and decisive, showing PAX8 expression in renal metastases and GATA3 in breast cancer metastasis , thereby excluding a primary pancreatic ductal adenocarcinoma.

In our series, pancreatic metastases accounted for 2.6% of solid pancreatic masses. EUS with guided tissue acquisition represents the reference diagnostic tool, allowing precise histological and immunohistochemical characterization. Pancreatic metastases should be systematically considered in any pancreatic mass occurring in patients with a history of malignancy, even remote, as prognosis and management differ fundamentally from primary pancreatic ductal adenocarcinoma.