title: Cardiac metastases of renal cell carcinoma revealed by syncope: diagnosis and treatment.
abstract: BACKGROUND
  Cardiac metastases from renal cell carcinoma are very rare. In this report, we describe a case of ventricular metastases in the absence of vena cava or right atrial involvement.
  
  
  METHODS
  We report the case of a 60-year-old man who had a past history of heavy tobacco intake and well-controlled arterial hypertension. He experienced sudden-onset palpitations, lost consciousness and, as a result, was involved in an accident on the public highway. Cardiac arrhythmia was suspected and, therefore, transthoracic echocardiography was suggested, which revealed a large right ventricular mass. Chest and abdominal computed tomography demonstrated a mass in the right ventricle, but without contiguous vena cava involvement, and a right renal mass related to the probable neoplasm. An ultrasound-guided renal biopsy showed a clear-cell renal cell carcinoma. A bone scan revealed a metastatic bone disease. The patient was started on sunitinib treatment, which was well tolerated. However, approximately 8 months later, reevaluation showed pulmonary metastases. The patient was subsequently started on treatment with everolimus, which, however, was poorly tolerated. Two months later, the patient died due to terminal respiratory insufficiency.
  
  
  CONCLUSIONS
  Based on the literature and our observations in this case, targeted antiangiogenic therapy should be considered as a viable therapeutic alternative to metastasectomy for patients with inoperable cardiac metastatic disease as long as there is no baseline systolic or diastolic dysfunction. The case also emphasizes the importance of a thorough history review and physical examination in the workup of patients with syncope.
authors.affiliation: Department of Medical Oncology, Military Hospital My Ismail, Meknès, Morocco.
authors.forename: Aziz
authors.initials: A
authors.lastname: Bazine
authors.affiliation: Department of Medical Oncology, Military Hospital My Ismail, Meknès, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fetohi
authors.affiliation: Department of Medical Oncology, Military Hospital Med V, Morocco.
authors.forename: Rachid
authors.initials: R
authors.lastname: Tanz
authors.affiliation: Department of Medical Oncology, Military Hospital Med V, Morocco.
authors.forename: Tarik
authors.initials: T
authors.lastname: Mahfoud
authors.affiliation: Department of Medical Oncology, Military Hospital Med V, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ichou
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Errihani
keywords: Cardiac metastases; Renal cell carcinoma; Target therapy