A80-3-06 An Intrusion of the Heart: Renal Cell Carcinoma’s Uncommon Journey

Introduction Renal Cell Carcinoma makes up about 90% of all renal tumors, which are malignant, and can potentially metastasize to lymph nodes, opposite kidney, liver, lungs, adrenal glands, bones, and brain. Of the diagnosed cancers of the kidneys, metastatic renal cancer constitutes 13.3%. The lungs are the most frequently involved organ, followed by bone, and less frequently by lymph nodes and liver. Case Discussion Patient in his 40s presented with complaints of nausea, vomiting, abdominal pain with epigastric tenderness for few days, with unintentional weight loss of 40 pounds in the past 8 months and reported nocturia. He had 1 pack per day smoking history for 34 years. On presentation had a mild temperature of 100F. Labs revealed anemia with hemoglobin of 9.1g/dl (13.7-17.5), leukocytosis of 27.91 K/uL (4.23-9.07), mild thrombocytosis with platelet around 600 K/uL (163-337). CT abdomen pelvis with IV contrast showed complex mixed cystic/solid mass in the left kidney with numerous internal enhancing septations, measuring approximately 10.1 cm, likely involving portions of the collecting system as well as the superior calyx and possibly extending into the renal hilum. There was noted to be numerous enlarged retroperitoneal lymph nodes, musculature, and numerous intrathoracic metastases. Additional imaging with CT scan of the chest showed a large left lower lobe pulmonary mass, moderate pericardial mass subjacent to the left ventricle, and multiple less than or equal to 1 cm pulmonary nodules, consistent with metastases. Biopsy of the left renal mass which revealed high grade renal cell carcinoma with rhabdoid features. Patient followed up with Oncology for Stage IV RCC with systemic therapy administered with palliative intent. Immunotherapy with Ipilimumab and Nivolumab was started given the relative lack of efficacy using VEGF directed therapy in this subtype of RCC. Discussion The presented case of renal cell carcinoma (RCC) with metastasis to the heart serves as a poignant reminder of the diverse and sometimes unexpected metastatic patterns of this malignancy. The mechanism of metastasis may be through direct tumor extension through inferior vena cava or hematogenous spread. The prompt identification of cardiac metastasis is crucial for appropriate treatment planning and to alleviate symptom burden. Conclusion The case highlights the importance of considering RCC as a possible primary when there is evidence of cancer metastasis in the heart. This abstract is funded by: NONE