J Cardiovasc Ultrasound.  2016 Dec;24(4):329-333. 10.4250/jcu.2016.24.4.329.

Rapidly Growing Right Ventricular Outflow Tract Mass in Patient with Sarcomatoid Renal Cell Carcinoma

• Hwang J
• Park YH
• Choi KU
• Kim JS
• Hwang KW
• Lee SH
• Chon MK
• Lee SY
• Lee DS

• KMID: 2364652
• DOI: http://doi.org/10.4250/jcu.2016.24.4.329

Abstract

Cardiac metastasis from renal cell carcinoma (RCC) without inferior vena cava (IVC) involvements is extremely rare with few reported cases. Sarcomatoid RCC with rhabdoid feature is a rare pathologic type of RCC having aggressive behavior due to great metastatic potential. Here, we report a case of rapidly growing cardiac metastasis of RCC which brought on right ventricular outflow tract (RVOT) obstruction without IVC and right atrial involvement in a 61-year-old woman. Cardiac arrest occurred during radical nephrectomy and echocardiography revealed mass nearly obstructing the RVOT which was not recognized by preoperative echocardiography 1 month ago. Postoperative immunohistochemical evaluation of renal mass revealed sarcomatoid RCC with rhabdoid feature.

Keyword

Renal cell carcinoma; Sarcomatoid variant; Cardiac metastasis; Right ventricular outflow obstruction

MeSH Terms

Carcinoma, Renal Cell*
Echocardiography
Female
Heart Arrest
Humans
Middle Aged
Neoplasm Metastasis
Nephrectomy
Vena Cava, Inferior
Ventricular Outflow Obstruction

Figure

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  Fig. 1 Abdominal computed tomography (CT) revealed 9-cm sized left renal mass (arrow) (A). Chest CT showed scanty amount of pericardial effusion (arrowheads) (B).

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  Fig. 2 Parasternal long axis view on transthoracic echocardiography showed normal left ventricle (LV) size and no evidence of right ventricular outflow tract mass (A). Modified four chamber view also showed normal LV and RV size with no evidence of intracardiac mass (B). In parasternal short axis view, no gross abnormality was observed (C and D). RV: right ventricle.

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  Fig. 3 Parasternal long axis view (A) and modified 4 chamber view (B) on transthoracic echocardiography revealed markedly dilated RV with moderate amount of pericardial effusion (asterisk). Parasternal short axis view showed D-shaped left ventricle (C). Parasternal short axis view of aortic valve level. In this view, right ventricular outflow tract (RVOT) mass (arrowhead) was hardly seen (D). Parasternal short axis view of RVOT level demonstrated 5.5 × 3 cm sized mass (arrowhead) nearly obstructing the RVOT (E). In this view, obstruction of blood flow by this RVOT mass (arrowhead) was well visualized under color Doppler image (F). RV: right ventricle, PA: pulmonary artery.

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  Fig. 4 The tumor showed an ill-defined, whitish, infiltrating mass with necrosis.

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  Fig. 5 The tumor composed of epithelioid tumor cells with rhabdoid feature. A: Hematoxylin and eosin staining (× 400). B: CD10 staining (× 400). C: Vimentin staining (× 400). D: Pan-cytokeratin staining (× 400). E: EMA staining (× 400). F: Desmin staining (× 400).

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