Abdullah Amirahwaty, Lekkala Manidhar, Wolfe Zachary, Raghu Charumathi, Khan Safi Ullah, Krishnan Mrinalini, Winnicka Lydia, Lash Bradley
Internal Medicine Residency, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA.
Case Rep Oncol. 2018 Jun 7;11(2):365-371. doi: 10.1159/000489770. eCollection 2018 May-Aug.
The treatment of metastatic renal cell carcinoma (RCC) has been radically changed by the advent of tyrosine kinase inhibitors (TKIs). However, few reports have described their role in cardiac metastases. We present a case of a left ventricular metastasis from RCC that was managed with pazopanib therapy.
A 74-year-old male with stage I RCC underwent right nephrectomy in 2004 and right lung metastasis resection in 2009. He was well till March 2016, when he presented with chest pain. Cardiac catheterization revealed a highly vascular mass in the apex. Cardiac magnetic resonance imaging revealed a left ventricular mass with full-thickness involvement of the myocardium, and the open cardiac biopsy was consistent with metastatic RCC. The patient was initially treated with pazopanib with response but later developed therapy-related side effects, and the dose was reduced. Due to tumor progression, he is currently on nivolumab instead and is stable.
RCC with cardiac metastasis poses unique challenges with regard to diagnosis as well as treatment. The use of TKI therapy is associated with cardiotoxicity and has not been adequately studied in cardiac metastasis. Choosing the right treatment for this subgroup of patients continues to pose an ongoing dilemma.
酪氨酸激酶抑制剂（TKIs）的出现彻底改变了转移性肾细胞癌（RCC）的治疗方法。然而，很少有报告描述它们在心脏转移中的作用。我们报告一例接受帕唑帕尼治疗的肾细胞癌左心室转移病例。
一名74岁男性，2004年接受I期肾细胞癌右肾切除术，2009年接受右肺转移灶切除术。直到2016年3月他一直情况良好，之后出现胸痛。心脏导管检查显示心尖部有一个血管丰富的肿块。心脏磁共振成像显示左心室肿块，心肌全层受累，心脏开放活检结果与转移性肾细胞癌一致。患者最初接受帕唑帕尼治疗有效，但后来出现与治疗相关的副作用，剂量减少。由于肿瘤进展，他目前改用纳武单抗治疗，病情稳定。
肾细胞癌伴心脏转移在诊断和治疗方面都带来了独特的挑战。TKI治疗与心脏毒性有关，在心脏转移方面尚未得到充分研究。为这一亚组患者选择合适的治疗方法仍然是一个持续存在的难题。
