ArticleFrontiers in oncology2026
Case Report: Cardiac metastasis of sarcomatoid urothelial carcinoma.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sarcomatoid urothelial carcinoma (SUC) is a rare, highly aggressive subtype of urothelial carcinoma (UC) accounting for fewer than 1%-2% of all urothelial malignancies. It is characterized by biphasic histology, a dismal prognosis, resistance to conventional chemotherapy, and a propensity for distant metastasis. Clinically confirmed cardiac metastasis from UC is exceedingly rare, with only sporadic cases documented worldwide. Case summary: We report a 55-year-old woman who presented with right-sided flank pain and gross hematuria. Percutaneous renal biopsy confirmed right renal pelvis SUC with approximately 85% sarcomatoid component. The patient underwent palliative robot-assisted laparoscopic nephroureterectomy; final pathological staging was pT3N1M1 (Stage IV). Approximately two months postoperatively, imaging confirmed multifocal metastases involving the lungs, pleura, liver, and lymph nodes, and first-line chemo-immunotherapy was initiated with gemcitabine plus carboplatin plus nivolumab. Carboplatin was substituted for cisplatin because the patient was deemed cisplatin-ineligible owing to renal insufficiency, following a modified CheckMate 901 framework. After one cycle, grade IV myelosuppression (platelet nadir 28 × 10 Conclusion: To our knowledge, this is the first documented case of isolated RV metastasis from right renal pelvis SUC achieving an objective response to anti-PD-1 immunotherapy. The sustained imaging regression under tislelizumab monotherapy strongly suggests-but does not definitively confirm-a metastatic etiology. For patients with high PD-L1-expressing SUC and cardiac metastasis who are intolerant of combined chemo-immunotherapy regimens, immune checkpoint inhibitor monotherapy may represent a feasible and well-tolerated treatment strategy.
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