Sarcomatoid Renal Cell Carcinoma With Cardiac Metastasis Causing Right Ventricular Outflow Tract Obstruction

Q: What are the key findings of this study?

Metastatic sarcomatoid renal cell carcinoma invading the right ventricular outflow tract caused severe obstruction (ejection fraction <20%) and fatal obstructive shock in 1 patient.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Sarcomatoid renal cell carcinoma with cardiac metastasis and right ventricular outflow tract obstruction (n=1). Intervention: Metastatic sarcomatoid renal cell carcinoma. Primary outcome: Fatal cardiac arrest due to obstructive shock from right ventricular outflow tract obstruction.

Q: What does this research mean for the field?

Sarcomatoid renal cell carcinoma can metastasize to the right ventricular outflow tract, leading to acute obstructive shock and fatal hemodynamic compromise. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Vall Vinaithirthan; Aaron Levit; Molly Feller; John C. DeWitt; Steven Ades; Tanush Gupta

doi:10.1016/j.jaccas.2026.110982

November 1, 2026JACC Case ReportsOpen Access

Sarcomatoid Renal Cell Carcinoma With Cardiac Metastasis Causing Right Ventricular Outflow Tract Obstruction

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Key result

Metastatic sarcomatoid renal cell carcinoma invading the RVOT causes fatal obstructive shock.

n=1

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND 4.0

Why the study?

Renal cell carcinoma rarely metastasizes to the heart, and sarcomatoid dedifferentiation is an aggressive histologic transformation that confers a poor prognosis.

Key Points

To report a rare and aggressive presentation of sarcomatoid renal cell carcinoma metastasizing to the heart and causing fatal right ventricular outflow tract obstruction.
Clinical, diagnostic, and postmortem evaluation of a patient presenting with progressive exertional dyspnea.
Diagnostic workup included serum troponin and D-dimer testing, CT pulmonary angiography, cardiac MRI, and abdominal MRI.
Histopathologic confirmation was obtained via postmortem examination.
Cardiac MRI demonstrated a large lobulated right ventricular mass extending into the outflow tract and encroaching on the pulmonic valve, with a right ventricular ejection fraction under 20%.
The patient developed fatal obstructive shock due to acute right ventricular outflow tract obstruction, with autopsy confirming metastatic sarcomatoid renal cell carcinoma.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

1 patient with metastatic sarcomatoid renal cell carcinoma presenting with progressive exertional dyspnea and a large right ventricular outflow tract mass (ejection fraction <20%).

O

Outcome

Fatal arrest due to obstructive shock from severe right ventricular outflow tract obstruction.hard clinical

This case report highlights that sarcomatoid renal cell carcinoma can metastasize to the right ventricle and cause fatal obstructive shock via right ventricular outflow tract obstruction, underscoring the need for early recognition.

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Implication

Alerts clinicians to rare cardiac metastasis in sarcomatoid RCC; leaves open optimal diagnostic and therapeutic strategies.

Abstract

BACKGROUND: Renal cell carcinoma (RCC) rarely metastasizes to the heart, and an aggressive histologic transformation known as sarcomatoid dedifferentiation confers a poor prognosis. CASE SUMMARY: A patient presented with progressive exertional dyspnea. Initial laboratory studies revealed elevated troponin and elevated D-dimer. Computed tomography pulmonary angiography showed a right ventricle (RV) filling defect. Cardiac magnetic resonance imaging demonstrated a large lobulated mass extending from the RV free wall into the outflow tract, encroaching on the pulmonic valve with an ejection fraction of <20%. Abdominal magnetic resonance imaging revealed a right renal mass. The patient suffered a fatal arrest because of obstructive shock from severe RV outflow tract obstruction. DISCUSSION: Postmortem examination confirmed metastatic sarcomatoid RCC. Patients typically present with advanced disease, and survival is <1 year. Combination immunotherapy is approved for metastatic RCC. Initiating immunotherapy would not have addressed the patient's acute hemodynamic compromise. TAKE-HOME MESSAGE: Early recognition of metastatic RCC is crucial for potential therapeutic intervention, though prognosis remains poor in advanced cases.

Discussion

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Cite This Study

Vinaithirthan et al. (2026) conducted a case report in Sarcomatoid renal cell carcinoma with cardiac metastasis and right ventricular outflow tract obstruction (n=1). Metastatic sarcomatoid renal cell carcinoma was evaluated on Fatal cardiac arrest due to obstructive shock from right ventricular outflow tract obstruction. Metastatic sarcomatoid renal cell carcinoma invading the right ventricular outflow tract caused severe obstruction (ejection fraction <20%) and fatal obstructive shock in 1 patient.

synapsesocial.com/papers/6aee6be671a7594806220cd2 https://doi.org/10.1016/j.jaccas.2026.110982

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Sarcomatoid Renal Cell Carcinoma With Cardiac Metastasis Causing Right Ventricular Outflow Tract Obstruction

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sarcomatoid Renal Cell Carcinoma With Cardiac Metastasis Causing Right Ventricular Outflow Tract Obstruction

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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