[Metastasis of Clear Cell Renal Cell Carcinoma to the Left Ventricle].

Cardiac metastasis from renal cell carcinoma (RCC) is relatively rare. It generally initiates from the right atrium with or without involvement of the inferior vena cava (IVC). Here, we report a case of metastasis of isolated clear cell RCC to the left ventricular( LV) papillary muscle. An 84-year-old male who had undergone renal resection due to RCC 19 years before, presented to our hospital with suspected LV tumor by echocardiography. The tumor was located near the posterior papillary muscle, with a size of 15×12 mm. The patient underwent resection of the LV tumor. Pathologically, the tumor was diagnosed as clear cell RCC. The postoperative course was stable, and he did not require any chemotherapy. Although there is no definite evidence of the mechanisms of metastasis, the tumor was supposed to metastasize lymphogeneously.

Ethnic differences in the VKORC1 gene polymorphism and an association with warfarin dosage requirements in cardiovascular surgery patients.

OBJECTIVES: Vitamin K epoxide reductase (VKORC1) is the drug target for inhibition by coumarin-based anticoagulant drugs such as warfarin. Warfarin therapy has been reported as a leading cause of drug-related hospitalization and there is therefore an urgent need to develop tests for better warfarin prescription. We report here the distribution of the intron 1 -136 T>C (1173 T>C intron) polymorphism of VKORC1, previously reported to be associated with warfarin maintenance dose in Caucasians and Japanese, in several ethnic populations from Japan and Israel, and describe its significance for warfarin dosage in Japanese cardiovascular surgery patients. METHODS: Subjects consisted of 132 Japanese individuals and 341 Israeli individuals from four Jewish ethnic groups (86 Ashkenazi Jews, 95 Yemenite Jews, 73 Moroccan Jews and 87 Libyan Jews). In addition, 31 Japanese patients receiving warfarin therapy after cardiovascular surgery, maintained with a target International Normalized Ratio, were studied. The genotyping for the 1173 T>C intron polymorphism of VKORC1 was determined using rapid real-time PCR. RESULTS: The allele frequency of the combined VKORC1 1173 CT and CC genotypes varied among the four Israeli ethnic groups and was, on average, much higher in the Israeli (0.728) than in the Japanese population (0.152). For the Japanese cardiovascular surgery patients, the maintenance dose of warfarin was significantly larger in the combined VKORC1 1173 TC and CC genotype group than in the 1173 TT genotype group (3.6 +/- 0.5 mg vs 2.8 +/- 0.7 mg, respectively; p = 0.02). CONCLUSION: The frequencies of the intron 1 VKORC1 1173 T>C SNP show significant differences between ethnic groups and are associated with warfarin dose requirements for achieving a recommended International Normalized Ratio range in Japanese cardiovascular surgery patients. This study supports the example of warfarin as an appropriate model for applying personalized medicine for anticoagulant drugs, and highlights the importance of ethnicity in pharmacogenetics.