Cardiac metastasis from renal cell carcinoma without inferior vena involvement: a review of the literature based on a case report. Two different patterns of spread?

Abstract

We report the case of a 59-year-old man with advanced renal cell carcinoma (RCC), without inferior vena cava (IVC) involvement, treated with radical nephrectomy, palliative radiotherapy for bone metastasis, and medical therapy for bone and lung metastases. The patient died of cardiac arrest after evidence of massive malignant pericardial effusion. At autopsy, massive myocardial and pericardial neoplastic invasion was found. Heart involvement via the IVC is a well-known phenomenon during RCC progression, while in the absence of IVC involvement, clinically evident cardiac involvement is exceptional, with few cases reported in the worldwide literature. Analysis of prior reports and of the present case provides evidence on how the cardiac metastasis may have two distinct origins and clinical features. The first is hematogenous, via the IVC, even in the absence of renal vein involvement; it is generally circumscribed and has a good prognosis after surgery. The second is through the intrathoracic lymphatic system, in the presence of disseminated disease, especially pulmonary metastasis, and this type has a very poor prognosis.

Rare sites of delayed metastasis in renal cell carcinoma

“…The first employs a venous haematogenous pathway through the renal vein to the right heart. In patients with isolated disease and delayed disease progression to the right heart, with no involvement of the IVC, microdissemination through a venous haematogenous pathway remains the most probable mode of metastasis 13 – 15. The second is through the lymphatic vessels of the thorax, and then through the reversed lymphatic flow caused by metastasis to the nodes, metastatic RCC can spread to the pericardium and the left myocardium 15 – 17.…”

Sunitinib Malate, a Receptor Tyrosine Kinase Inhibitor, Is Effective in the Treatment of Restrictive Heart Failure due to Heart Metastases from Renal Cell Carcinoma

“…However, cases without vena cava involvement have also been described [8,9,10]. In these cases, it has been suggested that RCC metastasizes to the heart via the lymphatic system [10]. …”

“…The right atrium [7] and the right ventricle of the heart are common sites for RCC spread via the inferior vena cava [6]. However, cases without vena cava involvement have also been described [8,9,10]. In these cases, it has been suggested that RCC metastasizes to the heart via the lymphatic system [10].…”

Clinical Spectrum of Patients with Renal Cell Carcinoma

“…The tumor may involve the pericardium and less frequently, myoendocardium.So malignant pericardial effusion is a common finding in advanced cancer patients (Kim et al, 2010). Although uncommon, there are reports of malignant pericardial effusion secondary to RCC (Zustovich et al, 2008).…”