Left atrial extension of metastatic renal cell carcinoma via pulmonary vein: A case report

Abstract

Cardiac involvement from renal cell carcinoma is rare but well-recognized entity with several cases reported in literature. In majority of cases, the tumor reaches the right heart cavities through a neoplastic thrombus within inferior vena cava.  Other mechanisms are dissemination via hematogeous spread and direct extension from either mediastinal or lung lesions involving pulmonary veins. Left heart involvement from renal cell carcinoma with normal inferior vena cava is extremely rare. Direct extension of metastatic pulmonary mass to left atrium from renal cell carcinoma via pulmonary veins is even rarer.

We report a case of left atrial extension via pulmonary vein from metastatic renal cell carcinoma who presented with left cerebellar and right thalamic acute ischemic lesions along with multiple metastatic lesions.

Keywords

• Renal cell carcinoma,pulmonary vein,tumor embolus,left atrium

Metastatik renal hücreli karsinomun pulmoner ven yoluyla sol atriyuma uzanımı: Bir olgu sunumu

Öz

Renal hücreli karsinomun kardiyak tutulumu nadir ancak iyi bilinen bir olgudur ve literatürde bir çok vaka bildirilmiştir. Tümör çoğu durumda, sağ kalp boşluklarına vena kava inferiyor içinde neoplastik trombüs yoluyla ulaşır.  Bu mekanizma dışında, kardiyak tutulum, hematojen yolla olabileceği gibi, mediyastinal veya akciğer lezyonlarının pulmoner venler yoluyla direk yayılımı ile de ortaya çıkabilir. Ancak vena kava inferiyor tutulumu olmaksızın tümörün sol kalbe ulaşması son derece nadirdir.  Renal hücreli karsinomun akciğer metastazlarının, pulmoner venler yoluyla sol atriyuma direk uzanımı daha da nadirdir.

Bu makalede, çok sayıda metastatik lezyonu olan ve sol serebellar ve sağ talamik akut iskemik lezyonlara bağlı belirtileri ortaya çıkan,  pulmoner ven yoluyla sol atriyuma direk uzanımı olan metastatik renal hücreli karsinom olgusunu sunuyoruz.

Anahtar Kelimeler

• Renal hücreli karsinom,pulmoner ven,tümör embolisi,sol atrium

Kaynakça

1. 1. Schreffler SM, Paolo WF, Kloss BT. Spontaneous showering of tumor emboli in a patient with advanced primary lung cancer: a case report. Int J Emerg Med. 2012;5:27.
2. 2. Lin M, Ku S, Wu M, Yu CJ. Intracardiac extension of lung cancer via the pulmonary vein. Thorax. 2008;63:1122.
3. 3. Funakoshi Y, Mukohara T, Kataoka T, Tomioka H, Chayahara N, Fujiwara Y, et al. Left atrial extension of metastatic lung tumor via pulmonary vein: report on the first case of Ewing sarcoma. Rare Tumors. 2010;2:53.
4. 4. Kojiro O, Yasuyoshi M, Kensuke M, Matsuo T, Mochizuki Y, Sakai H. Left atrial metastasis of renal cell carcinoma: a case report and review of the literature. BMC Res Notes. 2014; 7:520.
5. 5. Frederic C, Agathe S, Marc R, Kuntze T, Czesla M, Walther T, et al. Intracardiac renal cell carcinoma metastasis. Eur J Cardiothorac Surg. 2008;34:697-9.
6. 6. Fogel R, Balady G.J, Klein M.D, Rajaii-Khorasani A. Metastatic Renal Cell Carcinoma An Unusual Cause of Syncope. Chest. 1990;98:481-2.
7. 7. Aburto J, Bruckner BA, Blackmon SH, Beyer EA, Reardon MJ. Renal cell carcinoma, metastatic to the left ventricle. Tex Heart Inst J. 2009;36:48-9.
8. 8. Zhang B, Malouf J, Young P, Kohli M, Dronca R. Cardiac metastasis in renal cell carcinoma without vena cava or atrial involvement: an unusual presentation of metastatic disease. Rare Tumors. 2013;5:29.

9. 9. Atik FA, Navia JL, Krishnamurthi V, Singh G, Shiota T, Pitas G, et al. Solitary massive right ventricular metastasis of renal cell carcinoma without inferior vena cava or right atrium involvement. J Card Surg. 2006;21:304-6.
10. 10. Hunsaker RP, Stone JR. Images in clinical medicine. Renal cell carcinoma extending into the vena cava and side of the heart. New Eng J Med. 2001;345:1676.
11. 11. Motwani M, Kidambi A, Herzog BA, Uddin A, Greenwood JP, Plein S. MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 2013;268:26-43.
12. 12. Hoffmann U, Globits S, Schima W, Loewe C, Puig S, Oberhuber G, et al. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol. 2003;92:890-5.
13. 13. Fussen S, De Boeck BW, Zellweger MJ, Bremerich J, Goetschalckx K, Zuber M, et al. Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. Eur Heart J. 2011;32:1551-60.