[Cardiac metastasis of renal cell carcinoma, a rare location]

Detection of muscle metastases on 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan in 13 cases

Muscular metastases (MMs) form an infrequent entity, and their physiopathology is still not well-defined. In this study, we estimated the incidence of MMs that were detected by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography and also specified their metabolic characteristics. This study includes 13 patients with MMs from a remotely located primary tumor. The results of this study showed an incidence of MMs at about 1%, with the most frequently involved muscles being iliopsoas and paraspinal. Lung cancer seems to be the most common tumor that causes MMs. Furthermore, these MMs vary in size and physiological uptake; they seem to be out of the ordinary and easily detected. They are often associated with other extra muscular locations and frequently involve the trunk muscles. Their detection in the course of the evolution of a specific neoplasia testifies to their aggressiveness and portends an unfavorable prognosis. The data in our series confirm that in the literature regarding the underlying primary tumors and anatomical sites involved by MMs.

Cardiac metastases of renal cell carcinoma revealed by syncope: diagnosis and treatment

INTRODUCTION

Cardiac metastases from renal cell carcinoma are very rare. In this report, we describe a case of ventricular metastases in the absence of vena cava or right atrial involvement.

CASE REPORT

We report the case of a 60-year-old man who had a past history of heavy tobacco intake and well-controlled arterial hypertension. He experienced sudden-onset palpitations, lost consciousness and, as a result, was involved in an accident on the public highway. Cardiac arrhythmia was suspected and, therefore, transthoracic echocardiography was suggested, which revealed a large right ventricular mass. Chest and abdominal computed tomography demonstrated a mass in the right ventricle, but without contiguous vena cava involvement, and a right renal mass related to the probable neoplasm. An ultrasound-guided renal biopsy showed a clear-cell renal cell carcinoma. A bone scan revealed a metastatic bone disease. The patient was started on sunitinib treatment, which was well tolerated. However, approximately 8 months later, reevaluation showed pulmonary metastases. The patient was subsequently started on treatment with everolimus, which, however, was poorly tolerated. Two months later, the patient died due to terminal respiratory insufficiency.

DISCUSSION

Based on the literature and our observations in this case, targeted antiangiogenic therapy should be considered as a viable therapeutic alternative to metastasectomy for patients with inoperable cardiac metastatic disease as long as there is no baseline systolic or diastolic dysfunction. The case also emphasizes the importance of a thorough history review and physical examination in the workup of patients with syncope.