Sarcomatoid Renal Cell Carcinoma With Cardiac Metastasis Causing Right Ventricular Outflow Tract Obstruction
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Updated: Nov 6, 2026

Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Vall Vinaithirthan1, Aaron Levit1, Molly Feller2
1Department of Internal Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
Background:
Renal cell carcinoma (RCC) rarely metastasizes to the heart, and an aggressive histologic transformation known as sarcomatoid dedifferentiation confers a poor prognosis.
Case Summary:
A patient presented with progressive exertional dyspnea. Initial laboratory studies revealed elevated troponin and elevated D-dimer. Computed tomography pulmonary angiography showed a right ventricle (RV) filling defect. Cardiac magnetic resonance imaging demonstrated a large lobulated mass extending from the RV free wall into the outflow tract, encroaching on the pulmonic valve with an ejection fraction of <20%. Abdominal magnetic resonance imaging revealed a right renal mass. The patient suffered a fatal arrest because of obstructive shock from severe RV outflow tract obstruction.
Discussion:
Postmortem examination confirmed metastatic sarcomatoid RCC. Patients typically present with advanced disease, and survival is <1 year. Combination immunotherapy is approved for metastatic RCC. Initiating immunotherapy would not have addressed the patient's acute hemodynamic compromise.
Take-Home Message:
Early recognition of metastatic RCC is crucial for potential therapeutic intervention, though prognosis remains poor in advanced cases.
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