We report a case of post-irradiation pancreatic sarcoma occurring in a 53 year-old woman, forty-nine years after radical nephrectomy for Wilms tumor. Sarcomas comprise less than 1% of pancreatic tumors. They are aggressive neoplasms with poor prognosis. Second malignancies are an issue following treatment of childhood tumors. This is the first reported case of pancreatic sarcoma following radiotherapy for Wilms tumor. The article also highlights the increasing role of EUS as a primary modality for diagnosing unusual malignancies.