Cardiac Metastases from Renal Cell Carcinoma
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and Giselle A. Suero-Abreu, MD, PhD
Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-06200-7 © Society of General Internal Medicine 2020
61-year-old man with clear cell renal cell carcinoma A with multiorgan metastases treated with axitinibpembrolizumab presented for follow-up. Restaging computed tomography (CT) with contrast showed disease progression to multiple organs, including new-onset cardiac metastases (Fig. 1). The patient reported no cardiac-related symptoms, although a transthoracic echocardiogram performed 1 month earlier had shown a pericardial effusion without cardiac metastases. Through shared decision-making, the patient opted to continue immunotherapy but died 1 month later secondary to complications of bowel perforation and brain metastases.
Cardiac metastases have an incidence of 0.7–3.5% in the general population (up to 9.1–18.3% in patients with known cancer) and are more frequent than primary cardiac tumors (incidence of 0.01–0.3%).1, 2 Most cardiac metastases originate from lung (36–39%), breast (10–12%), and hematologic malignancies (10–21%), which reflects the high prevalence of these malignancies in the general population.2 Other malignancies that have a proclivity to involve the heart include melanomas (as high as 28–56% of cases), pleural mesotheliomas, and renal, ovarian, gastric, and pancreatic cancers.1, 2 Manifestations of cardiac metastases depend on their location and may include dyspnea, chest pain, pericardial effusion, arrhythmias, heart failure, and embolic phenomena.2, 3 However, most patients are asymptomatic, and most cardiac metastases are diagnosed post-mortem. Imaging studies such as echocardiography, CT, magnetic resonance imaging, and positron emission tomography are essential to diagnose and characterize cardiac metastases.2, 4 Management of cardiac metas-
Figure 1 Contrast-enhanced computed tomography images. Panel a shows multiple myocardial left ventricular metastases (black arrowheads), a moderate-size pericardial effusion (white arrowheads), and the primary right renal cell carcinoma (black arrows). Axial images highlight the extent of the cardiac metastases (black arrowheads) below the level of the main bronchus (panel b) and close to the cardiac apex (panel c, arterial phase), as well as the pericardial effusion (white arrowheads). Received April 23, 2020 Accepted August 27, 2020
Barajas-Ochoa and Suero-Abreu: Cardiac Metastases from Renal Cell Carcinoma
tases is guided by the clinical presentation (e.g., cardiac tamponade or metastasis-induced arrhythmias). Since cardiac metastases often occur in patients with high metastatic burden, most treatments are systemic and palliative, with surgery reserved for the few cases where the prognosis is good.2, 4
REFERENCES 1. 2. 3.
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Corresponding Author: Aldo Barajas-Ochoa, MD; Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA (e-mail: [email protected]).
Compliance with Ethical Standards: Conflict of Interest: The au
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