Letter to the Editor Asian Cardiovascular & Thoracic Annals 2014, Vol. 22(8) 1013–1014 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314548433 aan.sagepub.com
Management of cardiac metastasis from renal carcinoma 11 years after radical nephrectomy We read with great interest the report by Kasama and colleagues,1 which highlighted the late outcome of cardiac metastasis from colorectal carcinoma. Similarly, we report the unusual clinical case of a 48-year-old woman hospitalized for thoracic pain, who had developed renal cell carcinoma (RCC), Furhman grade 2, with no renal vein or lymph node invasion, treated 11 years previously by radical nephrectomy. No coronary artery lesion was found on angiography, however a vascular mass from the left distal anterior descending artery was observed (Figure 1). Magnetic resonance imaging revealed a 31-mm lesion involving the apex of the right ventricle with extensive neovascularization (Figure 2). Surgical management of unique metastasis has been reported to improve overall survival by 60% over 5 years in cystic RCC.2 Therefore, we decided to perform radical surgical resection by sternotomy using extracorporeal circulation (Figure 3). Histological analysis confirmed cystic RCC metastasis with positive surgical margins. In 43% of patients, metastasis appears during the first year after radical nephrectomy, particularly in cases of renal vein invasion.3 Cardiac cystic RCC metastasis is rarely reported in the literature, and is synchronous in the majority of cases.4,5 Recently, a clinical benefit of antiangiogenic treatment in metastatic cystic RCC has been demonstrated, with an improvement in progression-free survival of 12 months.6 However, in the presence of positive margins, as observed in our patient, currently, the adjuvant use of this type of treatment still remains under clinical trial evaluation. In conclusion, our case is of particular interest, not only due to the localization and unusual delay of the cardiac metastasis, but also for the surgical and medical oncological management.
Figure 1. Coronary angiography showing a vascular mass originating from the left distal anterior descending artery.
Figure 2. Cardiac magnetic resonance imaging of a 31-mm lesion involving the apex of the right ventricle, with a low-signal intensity mass.
Downloaded from aan.sagepub.com at GEORGETOWN UNIV MED CTR on May 21, 2015
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Asian Cardiovascular & Thoracic Annals 22(8)
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Figure 3. Removal of the lesion through a median sternotomy under extracorporeal circulation.
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Funding This research received no specific grant from any funding agency in the public, commerical, or not-for-profit sectors.
Ann 2014 Jun 9. pii: 0218492314539950. [Epub ahead of print]. Russo P. Multi-modal treatment for metastatic renal cancer: the role of surgery. World J Urol 2010; 28: 295–301. Eggener SE, Yossepowitch O, Pettus JA, Snyder ME, Motzer RJ, Russo P. Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol 2006; 24: 3101–3106. Takuleder MQ, Deo SV, Maleszewski JJ and Park SJ. Late isolated metastasis of renal carcinoma in the left ventricular myocardium. Interact Cardiovasc Thorac Surg 2010; 1: 814–816. Anis A, Maldjian P, Klapholz M and Saric M. Images in cardiology. Renal cell carcinoma with extension to the heart. Can J Cardiol 2008; 24: 860. Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007; 356: 115–124.
David Charbit, Franc¸ois-Xavier Nouhaud and Christian Pfister Department of Urology, Rouen University Hospital, Rouen, France
Conflict of interest statement None declared.
References 1. Kasama K, Ichikawa Y, Suwa Y, Okudera K, Suzuki S, Masuda M. Late cardiac metastasis from colorectal carcinoma 15 years after surgery. Asian Cardiovasc Thorac
Corresponding author: Email: [email protected]
Downloaded from aan.sagepub.com at GEORGETOWN UNIV MED CTR on May 21, 2015
Management of cardiac metastasis from renal carcinoma 11 years after radical nephrectomy We read with great interest the report by Kasama and colleagues,1 which highlighted the late outcome of cardiac metastasis from colorectal carcinoma. Similarly, we report the unusual clinical case of a 48-year-old woman hospitalized for thoracic pain, who had developed renal cell carcinoma (RCC), Furhman grade 2, with no renal vein or lymph node invasion, treated 11 years previously by radical nephrectomy. No coronary artery lesion was found on angiography, however a vascular mass from the left distal anterior descending artery was observed (Figure 1). Magnetic resonance imaging revealed a 31-mm lesion involving the apex of the right ventricle with extensive neovascularization (Figure 2). Surgical management of unique metastasis has been reported to improve overall survival by 60% over 5 years in cystic RCC.2 Therefore, we decided to perform radical surgical resection by sternotomy using extracorporeal circulation (Figure 3). Histological analysis confirmed cystic RCC metastasis with positive surgical margins. In 43% of patients, metastasis appears during the first year after radical nephrectomy, particularly in cases of renal vein invasion.3 Cardiac cystic RCC metastasis is rarely reported in the literature, and is synchronous in the majority of cases.4,5 Recently, a clinical benefit of antiangiogenic treatment in metastatic cystic RCC has been demonstrated, with an improvement in progression-free survival of 12 months.6 However, in the presence of positive margins, as observed in our patient, currently, the adjuvant use of this type of treatment still remains under clinical trial evaluation. In conclusion, our case is of particular interest, not only due to the localization and unusual delay of the cardiac metastasis, but also for the surgical and medical oncological management.
Figure 1. Coronary angiography showing a vascular mass originating from the left distal anterior descending artery.
Figure 2. Cardiac magnetic resonance imaging of a 31-mm lesion involving the apex of the right ventricle, with a low-signal intensity mass.
Downloaded from aan.sagepub.com at GEORGETOWN UNIV MED CTR on May 21, 2015
1014
Asian Cardiovascular & Thoracic Annals 22(8)
2.
3.
4.
Figure 3. Removal of the lesion through a median sternotomy under extracorporeal circulation.
5.
6.
Funding This research received no specific grant from any funding agency in the public, commerical, or not-for-profit sectors.
Ann 2014 Jun 9. pii: 0218492314539950. [Epub ahead of print]. Russo P. Multi-modal treatment for metastatic renal cancer: the role of surgery. World J Urol 2010; 28: 295–301. Eggener SE, Yossepowitch O, Pettus JA, Snyder ME, Motzer RJ, Russo P. Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol 2006; 24: 3101–3106. Takuleder MQ, Deo SV, Maleszewski JJ and Park SJ. Late isolated metastasis of renal carcinoma in the left ventricular myocardium. Interact Cardiovasc Thorac Surg 2010; 1: 814–816. Anis A, Maldjian P, Klapholz M and Saric M. Images in cardiology. Renal cell carcinoma with extension to the heart. Can J Cardiol 2008; 24: 860. Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007; 356: 115–124.
David Charbit, Franc¸ois-Xavier Nouhaud and Christian Pfister Department of Urology, Rouen University Hospital, Rouen, France
Conflict of interest statement None declared.
References 1. Kasama K, Ichikawa Y, Suwa Y, Okudera K, Suzuki S, Masuda M. Late cardiac metastasis from colorectal carcinoma 15 years after surgery. Asian Cardiovasc Thorac
Corresponding author: Email: [email protected]
Downloaded from aan.sagepub.com at GEORGETOWN UNIV MED CTR on May 21, 2015
