Intracardiac Metastasis From a Testicular Yolk Sac Tumor With Brain and Pulmonary Involvement: A Multimodality...

Cardiac metastasis from non-seminomatous germ cell tumors (NSGCTs) is exceedingly rare and represents an aggressive disease course. We report a 37-year-old man with a testicular yolk sac tumor who initially declined adjuvant therapy after orchiectomy. He later developed pulmonary metastases treated with BEP chemotherapy, followed by progressive disease with brain involvement requiring emergent decompressive craniectomy and whole-brain radiotherapy. Salvage TIP chemotherapy was administered. Persistent pulmonary disease led to thoracotomy, during which a discrete metastatic deposit in the right atrium was identified and surgically resected. Histopathology confirmed metastatic yolk sac tumor in all sites. The patient subsequently received maintenance therapy with oxaliplatin and bevacizumab. Follow-up has been based on clinical assessment and serial tumor marker monitoring, demonstrating ongoing biochemical and clinical stability for approximately 6 months following initiation of maintenance therapy, with the patient remaining on treatment at the time of this report. This case highlights the unpredictable metastatic behavior of NSGCTs and underscores the importance of multidisciplinary management in achieving disease control in rare and life-threatening metastatic presentations.