Renal-Cell Carcinoma Extending into the Vena Cava and Right Side of the Heart

Abstract

An obese 82-year-old woman with a history of hypertension and type 2 diabetes mellitus had had dyspnea on exertion and swelling of her legs for three to four months. Transthoracic echocardiography revealed a right atrial mass with extension into the inferior vena cava. Computed tomography of the chest and abdomen showed that the mass originated in the left kidney. The results of coronary angiography, ventilation-perfusion scanning, and bone scanning were normal. A radical left nephrectomy and excision of the right atrial mass were performed with the use of cardiopulmonary bypass. Intraoperative two-dimensional transesophageal echocardiography with an omniplane probe (Panel A) revealed a mass (T) in the right atrium (RA) that prolapsed into the right ventricle (RV) during diastole, mild-to-moderate tricuspid regurgitation, and a normal aorta (A), pulmonic valve (PV), and pulmonary artery (PA). The patient tolerated the surgery well and was discharged home on the 10th postoperative day. The mass was a renal-cell carcinoma measuring 17 by 3 by 2 cm (Panel B).

Unusual sites of delayed metachronous metastases from renal cell carcinoma: a case series of five cases and review of literature

“…Micro dissemination via a venous haematogenous pathway is the most likely mechanism of metastasis in patients with a single metastatic lesion in the right heart and no involvement of the IVC. [15][16][17] The second route is via the lymphatic vessels of the thorax, followed by the nodes via the reversed lymphatic flow caused by metastasis. 17,18 Nkengurutse et al reported solitary metastatic lesion in left atrium developing 13 years after radical nephrectomy which was initially confused to be an atrial myxoma.…”

Left atrial extension of metastatic renal cell carcinoma via pulmonary vein: A case report

“…In majority of cases, the tumor reaches the right heart cavities through a neoplastic thrombus within IVC. RCC extends into the renal vein and IVC in about 5% to 15% patients and into the right atrium in about 1% of patients [7,9,10]. Other mechanisms are dissemination via hematogeous spread and direct extension from either mediastinal or lung lesions involving pulmonary veins.…”

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.…”