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This case report describes a rare cardiac metastasis in a 62-year-old man with a complex history of recurrent urothelial carcinoma, initially diagnosed as bladder cancer in 1999 and treated with multiple resections and intravesical therapies, followed by cystectomy in 2012 for refractory anaplastic tumors. After a decade, right hydronephrosis and hematuria led to nephroureterectomy, revealing papillary urothelial carcinoma with squamous differentiation (pT3pNxMx). In 2023, cardiac metastasis involving the right ventricular myocardium was identified, and systemic chemotherapy produced minimal response. Despite aggressive management, the patient died of progressive cardiac failure. Squamous differentiation is linked to aggressive, treatment-resistant disease, and delayed post-cystectomy recurrence supports field cancerization and the need for lifelong surveillance.",{"@graph":69,"@context":127},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cardiac-metastasis-in-upper-tract-urothelial-carcinoma-with-squamous-differentiation/365878/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cardiac-metastasis-in-upper-tract-urothelial-carcinoma-with-squamous-differentiation/365878.png","ImageObject",300,407,{"name":92,"@type":93},"Sarah ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-28","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119,123],{"name":110,"@type":111,"acceptedAnswer":112},"How common is cardiac metastasis in upper tract urothelial carcinoma (UTUC)?","Question",{"text":113,"@type":114},"UTUC accounts for about 5–10% of urothelial malignancies, but cardiac metastases are exceedingly uncommon compared with other metastatic patterns.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What treatment history preceded the detection of cardiac metastasis?",{"text":118,"@type":114},"The patient had recurrent anaplastic bladder tumors treated with multiple transurethral resections and intravesical therapies, followed by cystectomy in 2012, then later nephroureterectomy for right-sided hydronephrosis and hematuria.",{"name":120,"@type":111,"acceptedAnswer":121},"What was found on the nephroureterectomy pathology?",{"text":122,"@type":114},"It showed papillary urothelial carcinoma with squamous differentiation, with staging reported as pT3pNxMx.",{"name":124,"@type":111,"acceptedAnswer":125},"What was the clinical outcome after systemic chemotherapy for cardiac metastasis?",{"text":126,"@type":114},"Systemic chemotherapy produced minimal response, and the patient ultimately succumbed to progressive cardiac failure.","https://schema.org",{"og:url":83,"og:type":129,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":131,"canonical":83},"index,follow",{"doc_id":133,"site_id":62},365878,1790211168,{"code":4,"msg":5,"data":136},{"doc_id":133,"user_id":137,"nickname":92,"user_avatar":138,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":139,"file_id":140,"file_url":141,"file_type":142,"file_size":143,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":144,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":145,"faqs":146,"seo_title":147,"seo_description":67,"update_tm":148,"read_time":149},962085320529,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Case Reports in Oncology  \n\n| Case Rep Oncol 2025;18:763–772 |  |\n| --- | --- |\n| DOI: 10.1159/000546330\u003Cbr>Received: March 11, 2025\u003Cbr>Accepted: May 2, 2025\u003Cbr>Published online: May 8, 2025 | © 2025 The Author(s) .\u003Cbr>Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) |\n\nThis article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([http://www.karger.com/Services/OpenAccessLicense](http://www.karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission.  \nCase Report  \nCardiac Metastasis in Upper Tract Urothelial Carcinoma with Squamous Differentiation  \nAhmad Al-Bitar Ayla Kouli Joudi Talaba Mariah Azarpayk Muhamad Al Tawil  \nFaculty of Medicine, Damascus University, Damascus, Syrian Arab Republic  \nKeywords  \nUpper tract urothelial carcinoma · Cardiac metastasis · Heart metastasis · Bladder cancer · Case report  \nAbstract  \nIntroduction: Upper tract urothelial carcinoma, accounting for 5–10% of urothelial malignancies, rarely metastasizes to distant sites such as the heart. Case Presentation: This report describes a rare case of cardiac metastasis in a 62-year-old male with a complex history of recurrent urothelial carcinoma. Initially diagnosed with bladder cancer in 1999, the patient underwent multiple resections and intravesical therapies, followed by cystectomy in 2012 due to refractory anaplastic tumors. A decade later, he developed right-sided hydronephrosis and hematuria, prompting a nephroureterectomy, which revealed papillary urothelial carcinoma with squamous differentiation (pT3pNxMx). Despite aggressive local management, cardiac metastasis involving the right ventricular myocardium was identified in 2023. Systemic chemotherapy yielded minimal response, and the patient eventually succumbed to progressive cardiac failure. Conclusion: Squamous differentiation in urothelial carcinoma predicts aggressive, treatment-resistant behavior. Delayed post-cystectomy recurrence supports the concept of field cancerization and necessitates lifelong surveillance. A rare cardiac metastasis confirms the hematogenous spread potential and underscores the need for improved adjuvant therapies.  \n© 2025 The Author(s) .  \nPublished by S. KargerAG, Basel  \nIntroduction  \nUpper tract urothelial carcinoma (UTUC) represents 5–10% of urothelial malignancies and approximately 10% of kidney cancers [1] . It is more prevalent in males than in females [2] . Common symptoms include hematuria, flank pain, clot colic, palpable mass, systemic manifestations, or incidental discovery through imaging [3] . While the exact etiology of UTUC  \nCorrespondence to:  \nAhmad Al-Bitar, [dr.ahmad.al.bitar](dr.ahmad.al.bitar@ gmail.com)[@](dr.ahmad.al.bitar@ gmail.com)[ gmail.com](dr.ahmad.al.bitar@ gmail.com)  \nCase Reports in Oncology  \nCase Rep Oncol 2025;18:763–772 764  \n\n| DOI: 10.1159/000546330 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) |\n| --- | --- |\n\nAl-Bitar et al.: Cardiac Metastasis in Upper Tract Urothelial Carcinoma  \nFig. 1. Dynamic renal scintigraphy showing right-sided parenchymal uptake and excretion. Sequential frames demonstrate preserved perfusion and excretion function of the right kidney over a 20-min acquisition period. The left renal unit is absent, consistent with history of left nephroureterectomy.  \nis unclear, several risk factors have been identified, including chemical exposure, recurrent infections, medications, genetic predispositions, dietary influences, and tobacco use [2] .  \nMetastasis to muscle tissue is rare, comprising less than 5% of urothelial metastases, and cardiac metastases are exceedingly uncommon [1] . This report presents a case of UTUC in a patient with a prior history of bladder cancer, who subsequently developed metastasis to the right ventricle and myocardial wall.  \nThe CARE Checklist for case reports has been completed and is incl","cbCaisZvfW69i36A","https://ap.wps.com/l/cbCaisZvfW69i36A","pdf",1617044,"English","# Introduction\n# Case Presentation\n## Diagnosis and initial management\n## Recurrence and progression\n## Nephroureterectomy and pathology\n## Cardiac metastasis and treatment outcome\n# Conclusion","[{\"question\":\"How common is cardiac metastasis in upper tract urothelial carcinoma (UTUC)?\",\"answer\":\"UTUC accounts for about 5–10% of urothelial malignancies, but cardiac metastases are exceedingly uncommon compared with other metastatic patterns.\"},{\"question\":\"What treatment history preceded the detection of cardiac metastasis?\",\"answer\":\"The patient had recurrent anaplastic bladder tumors treated with multiple transurethral resections and intravesical therapies, followed by cystectomy in 2012, then later nephroureterectomy for right-sided hydronephrosis and hematuria.\"},{\"question\":\"What was found on the nephroureterectomy pathology?\",\"answer\":\"It showed papillary urothelial carcinoma with squamous differentiation, with staging reported as pT3pNxMx.\"},{\"question\":\"What was the clinical outcome after systemic chemotherapy for cardiac metastasis?\",\"answer\":\"Systemic chemotherapy produced minimal response, and the patient ultimately succumbed to progressive cardiac failure.\"}]","Cardiac Metastasis in Upper Tract Urothelial Carcinoma with Squamous Differentiation | PDF",1790162780,25]