Luciano Emmanuel, Kamel Mohamed K, Kaakeh Bakri
Department of Surgery, Central Michigan University College of Medicine, United States of America.
Department of Surgery, Central Michigan University College of Medicine, United States of America.
Int J Surg Case Rep. 2022 Oct;99:107692. doi: 10.1016/j.ijscr.2022.107692. Epub 2022 Sep 20.
Cardiac tumors are uncommon with an estimated incidence of 0.002-0.3 % in autopsy series. Most cardiac tumors are metastatic in nature. Renal cell carcinoma (RCC) metastatic to the heart without inferior vena cava (IVC) contiguous involvement is extremely rare with about 31 cases reported in the literature and only one case with bilateral atrial metastases.
In this report, the surgical management of metachronous RCC involving the right and left atrium is described in a 41-year-old male patient three years after initial diagnosis who presented with worsening episodes of cough, dyspnea, chest pain and hemoptysis. Transesophageal echocardiogram revealed significant inflow obstruction. The patient underwent bilateral atrial mass excision via median sternotomy. The postoperative period was unremarkable, and the patient was referred to medical oncology to pursue further treatment.
Among the reported cases of cardiac RCC metastases without contiguous IVC involvement, bilateral atrial metastases are exceedingly rare. To our knowledge, this is the first case with bilateral atrial involvement to undergo surgical resection reported in the literature.
Isolated biatrial cardiac metastases from RCC can be successfully resected with good outcomes in selected patients.
心脏肿瘤并不常见，尸检系列研究估计其发病率为0.002 - 0.3%。大多数心脏肿瘤本质上是转移性的。肾细胞癌（RCC）转移至心脏且不伴有下腔静脉（IVC）连续受累极为罕见，文献报道约31例，仅有1例为双侧心房转移。
本报告描述了一名41岁男性患者在初次诊断三年后出现咳嗽、呼吸困难、胸痛和咯血症状加重，其先后出现的肾细胞癌累及右心房和左心房的手术治疗情况。经食管超声心动图显示存在明显的流入道梗阻。患者通过正中胸骨切开术接受了双侧心房肿物切除术。术后恢复顺利，患者被转至医学肿瘤学科室进行进一步治疗。
在已报道的无IVC连续受累的心脏肾细胞癌转移病例中，双侧心房转移极为罕见。据我们所知，这是文献中首例接受手术切除的双侧心房受累病例。
在部分患者中，孤立性肾细胞癌双侧心房心脏转移可成功切除且预后良好。
