Cardiac Metastases of Renal Cell Carcinoma Revealed by Syncope: Diagnosis and Treatment

Abstract

Introduction: Cardiac metastases from renal cell carcinoma are very rare. In this report, we describe a case of ventricular metastases in the absence of vena cava or right atrial involvement. Case Report: We report the case of a 60-year-old man who had a past history of heavy tobacco intake and well-controlled arterial hypertension. He experienced sudden-onset palpitations, lost consciousness and, as a result, was involved in an accident on the public highway. Cardiac arrhythmia was suspected and, therefore, transthoracic echocardiography was suggested, which revealed a large right ventricular mass. Chest and abdominal computed tomography demonstrated a mass in the right ventricle, but without contiguous vena cava involvement, and a right renal mass related to the probable neoplasm. An ultrasound-guided renal biopsy showed a clear-cell renal cell carcinoma. A bone scan revealed a metastatic bone disease. The patient was started on sunitinib treatment, which was well tolerated. However, approximately 8 months later, reevaluation showed pulmonary metastases. The patient was subsequently started on treatment with everolimus, which, however, was poorly tolerated. Two months later, the patient died due to terminal respiratory insufficiency. Discussion: Based on the literature and our observations in this case, targeted antiangiogenic therapy should be considered as a viable therapeutic alternative to metastasectomy for patients with inoperable cardiac metastatic disease as long as there is no baseline systolic or diastolic dysfunction. The case also emphasizes the importance of a thorough history review and physical examination in the workup of patients with syncope.

Renal Cell Carcinoma With Cardiac Metastases

“…Since signs and symptoms of metastatic cardiac involvement can be non-specific, a high index of suspicion is required for diagnosis. It is frequently a post-mortem finding [ 2 ]. Also, cardiac metastases can be mistaken for thrombi, endocarditis, or primary tumors, therefore echocardiograms can be limiting.…”

“…For example, Schinzari et al showed a partial response with signs of metastatic devascularization with pazopanib [ 5 ]. Bazine et al showed stabilization of cardiac metastases with sunitinib [ 2 ]. Stellato et al showed partial regression of metastases with cabozantinib after a 3-month treatment period [ 8 ].…”

“…A high index of suspicion is required for diagnosing cardiac metastases, since signs and symptoms of metastatic cardiac involvement can be non-specific. It is most often a post-mortem finding [ 2 ]. Also, cardiac metastases can be easily mistaken for thrombus, endocarditis, myxoma, sarcoma or other primary tumors, so cardiac echocardiograms are not always reliable.…”

Open kidney cancer surgery and perioperative cardiac arrhythmias

“…Extremely rare are intramyocardial metastasis without venous involvement. They may be asymptomatic but can manifest as a cardiac arrhythmia or longer QTc interval [ 20 , 21 ].…”

Renal Cell Carcinoma with Cardiac Metastases: A Case Report and Review of the Literature

“…Treatment for metastatic RCC is challenging and may include systemic therapy with immunotherapy and/or molecularly targeted therapy, cytoreductive nephrectomy, metastasectomy, or clinical trial enrollment (6)(7)(8)(9). Typical sites of metastases include the lymph nodes, lung, bone, liver, and brain (10)(11)(12). Other rare sites of metastases include the head and neck, skin, skeletal muscle, and pelvis (13).…”