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• W2127189637 abstract "Metastatic cardiac tumors are considered a terminal state of primary malignancy. Therefore, the condition of patients, local recurrence, and other metastases should be considered regarding indications for surgery, which should aim to improve the prognosis of patients in good condition with malignancies and prevent concomitant critical events. A 61-year-old woman was referred to the Graduate School of Medicine with an incidentally discovered right atrial tumor. She had undergone radiotherapy and chemotherapy to treat bone metastasis after left nephrectomy for renal cell carcinoma and radical hysterectomy for uterine endometrial adenocarcinoma 1 year previously and was free of symptoms originating from the heart. A computed tomography examination for femoral pain revealed a cardiac tumor (Figure 1, A) without findings in the femur. Subsequent echocardiography revealed a solitary right atrial tumor that arose from the right atrial appendage and entered the right ventricle during the diastolic phase and returned into the right atrium during the systolic phase (Figure 1, B). A physical examination and diagnostic imaging did not reveal any local recurrence or other metastases. The right atrial tumor was surgically resected to prevent sudden death caused by pulmonary embolism resulting from tumor separation. The ascending aorta, superior vena cava, and inferior vena cava from the right atrium were cannulated via a median sternotomy, and then a cardiopulmonary bypass was established. Tumor tissue occupied the entire right atrial appendage and proceeded into the cardiac cavity (Figure 2, A). The cylindric tumor appeared cracked and likely to imminently detach (Figure 2, B). The tumor was completely resected with the right atrial appendage, and the defect was reconstructed using an equine pericardial patch under cardiac arrest with cardiopulmonary bypass (Figure 2, C). The margin of the resection was cryoablated to confirm complete resection. A pathologic assessment of the tumor revealed clear cell carcinoma that was diagnosed as kidney metastasis. The surgical margin and pericardiac effusion remained free of malignancy. The patient tolerated all procedures and was discharged without complications. She has remained well without recurrence or metastasis for 12 months since the procedure. Surgery for cardiac metastasis from renal cell carcinoma with inferior vena cava involvement is often described as complete resection with the inferior vena cava. Martínez-Salamanca and colleagues1Martínez-Salamanca J.I. Huang W.C. Millán I. Bertini R. Bianco F.J. Carballido J.A. et al.Prognostic impact of the 2009 UICC/AJCC TNM Staging System for Renal Cell Carcinoma with Venous Extension.Eur Urol. 2011; 59: 120-127Abstract Full Text Full Text PDF PubMed Scopus (154) Google Scholar described tumors extending into the atrium in 77 of 1122 patients with renal cancer who underwent radical nephrectomy and complete tumor thrombectomy between 1970 and 2006 at 11 US and European institutions. On the other hand, cardiac metastasis from a renal cell carcinoma without inferior vena cava extension is rare, and thus surgical treatment for this condition is also rare. One study of 11,432 autopsies found only 266 (2.33%) cardiac tumors, and almost all of them were metastases originating from the lung, bone marrow, lymph node, and kidneys (3/266, 1.1%).2Butany J. Leong S.W. Carmichael K. Komeda M. A 30-year analysis of cardiac neoplasms at autopsy.Can J Cardiol. 2005; 21: 675-680PubMed Google Scholar Another study of 114 autopsies found metastatic cardiac tumors originating from melanoma, germ cell, leukemia, and the kidneys (12/114, 11%).3Roberts W.C. Primary and secondary neoplasms of the heart.Am J Cardiol. 1997; 80: 671-682Abstract Full Text Full Text PDF PubMed Scopus (260) Google Scholar Zustovich and colleagues4Zustovich F. Gottardo F. De Zorzi L. Cecchetto A. Dal Bianco M. Mauro E. et al.Cardiac metastasis from renal cell carcinoma without inferior vena involvement: a review of the literature based on a case report. Two different patterns of spread?.Int J Clin Oncol. 2008; 13: 271-274Crossref PubMed Scopus (23) Google Scholar reviewed 15 patients who were surgically treated for cardiac metastasis from renal cell carcinoma without inferior vena cava involvement. Their review considered the following as pathologic routes of metastatic spread: a venous hematogenous pathway mainly to the right side of the heart and a lymphatic pathway to the lymph nodes, lungs, pericardium, and left side of the heart.4Zustovich F. Gottardo F. De Zorzi L. Cecchetto A. Dal Bianco M. Mauro E. et al.Cardiac metastasis from renal cell carcinoma without inferior vena involvement: a review of the literature based on a case report. Two different patterns of spread?.Int J Clin Oncol. 2008; 13: 271-274Crossref PubMed Scopus (23) Google Scholar Metastasis to the right side seemed relatively more frequent, especially to the right ventricle. Among the 15 patients in that review, the right ventricle was involved in 10 of 11 with metastasis to the right side.4Zustovich F. Gottardo F. De Zorzi L. Cecchetto A. Dal Bianco M. Mauro E. et al.Cardiac metastasis from renal cell carcinoma without inferior vena involvement: a review of the literature based on a case report. Two different patterns of spread?.Int J Clin Oncol. 2008; 13: 271-274Crossref PubMed Scopus (23) Google Scholar We found only 1 report of a solitary right atrial metastasis from renal cell carcinoma without inferior vena cava involvement, and this symptomatic patient died shortly after surgery.5Pala S. Erkol A. Kahveci G. Massive right atrial metastasis from renal cell carcinoma without inferior vena cava involvement.Turk Kardiyol Dern Ars. 2009; 37: 358PubMed Google Scholar Because right atrial tumors generally elicit few symptoms during the early phase, complete surgical resection is likely to be difficult. However, an asymptomatic right atrial tumor that was incidentally detected in our patient was metastasis that could be resected. This is the first report of a favorable outcome after complete surgical resection of a right atrial metastasis from renal cell carcinoma. Progress in diagnostic imaging allows early diagnosis of not only symptomatic but also asymptomatic metastatic cardiac tumors. Surgery should be considered to improve the prognosis of patients in good condition with such malignancies and to prevent the occurrence of concomitant critical events." @default.
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• W2127189637 date "2011-09-01" @default.
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• W2127189637 title "Complete resection of asymptomatic solitary right atrial metastasis from renal cell carcinoma without inferior vena cava involvement" @default.
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