Akinseye Oluwaseun A, Ardeshna Devarshi R, Teshome Meron K, Alsafwah Shadwan
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee, USA.
Caspian J Intern Med. 2019 Spring;10(2):235-238. doi: 10.22088/cjim.10.2.235.
Cardiac metastasis of unclassified renal cell carcinoma (RCC) subtype is very rare, and even more so is an isolated right ventricular (RV) metastasis without vena cava extension or right atrial involvement. To the best of our knowledge, this is the first report of a cardiac metastasis of an unclassified RCC (an aggressive RCC) without vena cava extension.
A 61-year-old African American male with past medical history of hypertension and schizophrenia presented to the emergency room following 2 episodes of syncope and 3-month history of progressive neck mass. CT scan of neck, abdomen and pelvis showed bulky left cervical, supraclavicular and axillary lymph node, mass in anterior aspect of heart, and multiple solid left renal masses and probable right renal mass. Echocardiogram revealed a large RV mass with deformation of the RV free wall suggesting malignant growth. Core biopsy of the right superficial gluteal mass revealed a metastatic poorly differentiated carcinoma of likely renal origin, with a possibility of an unclassified RCC. Due to the extent and burden of metastasis, patient and family members agreed to conservative management and evaluation for hospice care.
Cardiac metastasis of unclassified RCC is rare, and even more so is an isolated RV metastasis without vena cava extension or right atrial involvement, and the present case, to the best of knowledge is the first of such rare presentation.
未分类肾细胞癌（RCC）亚型的心脏转移非常罕见，而孤立的右心室（RV）转移且无腔静脉延伸或右心房受累则更为罕见。据我们所知，这是首例未分类RCC（侵袭性RCC）无腔静脉延伸的心脏转移报告。
一名61岁的非裔美国男性，有高血压和精神分裂症病史，在经历2次晕厥发作和3个月渐进性颈部肿块病史后就诊于急诊室。颈部、腹部和骨盆的CT扫描显示左侧颈部、锁骨上和腋窝有肿大淋巴结，心脏前方有肿块，左侧肾脏有多个实性肿块，右侧肾脏可能有肿块。超声心动图显示右心室有一个大肿块，右心室游离壁变形，提示恶性生长。右臀部浅表肿块的核心活检显示为转移性低分化癌，可能起源于肾脏，有可能是未分类的RCC。由于转移的范围和负担，患者和家属同意采取保守治疗并评估临终关怀。
未分类RCC的心脏转移罕见，孤立的无腔静脉延伸或右心房受累的右心室转移更是罕见，就目前所知，本病例是这种罕见表现的首例。
