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Isolated Left Ventricular Metastasis from Renal Cell Carcinoma: Diagnostic and Therapeutic Dilemma
Amirahwaty Abdullah1, Manidhar Lekkala1, Zachary Wolfe1
1Internal Medicine Residency, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA.
Background:
The treatment of metastatic renal cell carcinoma (RCC) has been radically changed by the advent of tyrosine kinase inhibitors (TKIs). However, few reports have described their role in cardiac metastases. We present a case of a left ventricular metastasis from RCC that was managed with pazopanib therapy.
Case Report:
A 74-year-old male with stage I RCC underwent right nephrectomy in 2004 and right lung metastasis resection in 2009. He was well till March 2016, when he presented with chest pain. Cardiac catheterization revealed a highly vascular mass in the apex. Cardiac magnetic resonance imaging revealed a left ventricular mass with full-thickness involvement of the myocardium, and the open cardiac biopsy was consistent with metastatic RCC. The patient was initially treated with pazopanib with response but later developed therapy-related side effects, and the dose was reduced. Due to tumor progression, he is currently on nivolumab instead and is stable.
Conclusion:
RCC with cardiac metastasis poses unique challenges with regard to diagnosis as well as treatment. The use of TKI therapy is associated with cardiotoxicity and has not been adequately studied in cardiac metastasis. Choosing the right treatment for this subgroup of patients continues to pose an ongoing dilemma.
Insights
Metastatic renal cell carcinoma (RCC) rarely affects the heart. This case study details managing a left ventricular RCC metastasis with pazopanib (a tyrosine kinase inhibitor), highlighting treatment challenges and potential cardiotoxicity.
Area of Science:
- Oncology
- Cardiology
- Medical Case Reports
Background:
- Metastatic renal cell carcinoma (RCC) treatment has advanced with tyrosine kinase inhibitors (TKIs).
- Cardiac metastases from RCC are rare, with limited data on TKI efficacy and safety.
- This report details a case of left ventricular metastasis from RCC managed with pazopanib.
Observation:
- A 74-year-old male with a history of RCC presented with chest pain and a left ventricular mass.
- Diagnostic imaging confirmed a myocardial metastasis consistent with RCC.
- Initial treatment with pazopanib showed a response but led to dose reduction due to side effects.
Findings:
- Pazopanib, a TKI, demonstrated initial efficacy in treating left ventricular RCC metastasis.
- The patient experienced therapy-related side effects necessitating dose adjustment.
- Tumor progression occurred despite initial response, leading to a switch in therapy.
Implications:
- Managing cardiac metastasis in RCC presents diagnostic and therapeutic challenges.
- The cardiotoxicity associated with TKI therapy requires careful consideration in these patients.
- Optimal treatment strategies for RCC cardiac metastases remain an area of ongoing clinical dilemma.
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