The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Renal Cell Carcinoma Metastasis to the Left Atrium 
Aizaz Ali, MD 1*, Neha Patel, MD1 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614

*Corresponding author: Aizaz.Ali@utoledo.edu

Published: 05 May 2023 

Only 13 cases of renal cell carcinoma metastasis to the left atrium (LA) of the heart have been described 
in literature. Our patient presented with LA metastasis 14 years after a nephrectomy for RCC. Because 
RCC rarely metastasizes to the heart, its diagnosis is difficult. In addition, affected patients are mostly 
asymptomatic and can present variably. Our patient had purely neurologic symptoms and none 
indicating cardiac involvement. 

Although unlikely, it is possible that a mass found incidentally in a patient with RCC and metastasis is 
instead, an atrial myxoma. Our patient’s mass had some features of an atrial myxoma (clear definition 
and pedunculation with a stalk); however, we were unable to confirm this histologically because surgical 
excision was not performed. 

Given the risk of sudden cardiac death, most cardiac masses are removed surgically as soon as possible. 
For inoperable metastases, molecular targeted therapy is used. Our cardiologists had advised against 
surgical resection because of a poor prognosis. We prescribed the patient a 10-session regimen of 3-
dimensional conformal radiation therapy, axitinib and pembrolizumab. At the 4-month visit, there was 
substantial improvement in memory recall and the radiotherapy had brought 70% to 75% subjective 
improvement.  

Atrial masses can be detected in patients' years after nephrectomy and may not produce obvious 
symptoms, so patients with RCC should undergo regular cardiovascular evaluation and investigation of 
any cardiac mass. If surgery is inadvisable, the patient should be started on immunotherapy, and the 
cardiac mass should be monitored regularly for structural changes. Given that there is no established 
algorithm for managing cardiac metastases from RCC, a surgical approach seems most feasible. For 
inoperable metastases, molecular therapy is an alternative, although further studies are needed to 
determine efficacy and safety profiles. 

https://dx.doi.org/10.46570/utjms.vol11-2023-690 

https://dx.doi.org/10.46570/utjms.vol11-2023-690
mailto:Aizaz.Ali@utoledo.edu