INVADING THE VENTRICLE: MASSIVE RIGHT VENTRICULAR METASTASIS FROM RENAL CELL CARCINOMA

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Cardiac tumors are rare, the majority of which are secondary metastatic tumors rather than primary cardiac tumors. Cardiac metastases confer a poor prognosis through mass-effect on vital cardiac structures and chambers. Case A 63-year-old woman with clear-cell renal cell carcinoma (RCC) treated with immunotherapy underwent cardiac risk stratification prior to a spinal debulking surgery. She had extensive tumor involvement of the renal vein and inferior vena cava with metastases to the lungs and spine. EKG showed a new RBBB. Echocardiogram was subsequently obtained and revealed significant right ventricular dysfunction with a homogenous hyperechoic echodensity in the mid-apical RV. Chest CT showed a 7 x 3 x 5 cm mass in the RV extending from the tricuspid valve to the apex. Cardiac MRI defined this mass as characteristic of cardiac metastasis with foci of tumor thrombi. [Formula presented] Decision-making Our patient's large metastatic tumor to the RV resulting in cardiac dysfunction necessitated urgent treatment. Evaluation by cardiac surgery deemed the tumor unresectable and she was deemed to have prohibitive risk to undergo surgery for her spinal metastases. Despite several lines of immunotherapy, no curative treatments available and she was recommended a palliative approach which she opted for. Conclusion Cardiac metastases confer a poor prognosis. Curative treatment is typically dependent on systemic therapy with chemotherapy and immunotherapy as surgical resection is often not possible.

Volume

83

Issue

13

First Page

3512

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