Case Report: Cardiac metastasis from urothelial carcinoma with predominant squamous differentiation in a young woman: first reported case treated with enfortumab vedotin plus pembrolizumab
(2026) Frontiers in Oncology — Vol. 16 (2026)
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- Abstract
- Cardiac metastases from urothelial carcinoma (UC) are rare and have a poor prognosis. A 36-year-old woman presented with de novo metastatic muscle-invasive bladder cancer, bulky retroperitoneal lymphadenopathy, and a large right ventricular mass nearly obliterating the cavity and extending to the pulmonary artery. Because of impending right ventricular outflow tract obstruction, urgent surgical debulking was performed; a friable tumor encasing the tricuspid valve filled the right ventricle, valve preservation was not feasible, and postoperative pacing was required. Transurethral resection of the bladder tumor showed high-grade UC with predominant (80%) squamous differentiation, while the cardiac lesion demonstrated a pure squamous phenotype with immunohistochemistry supporting urothelial origin. Given a very high tumor burden and postoperative cisplatin ineligibility, first-line enfortumab vedotin plus pembrolizumab was initiated, but the patient rapidly deteriorated with early radiologic progression and died~8 weeks after diagnosis. This case illustrates the aggressive course of squamous-dominant metastatic UC with intracardiac involvement, the therapeutic trade-off of urgent cardiac surgery, and the limited evidence for enfortumab vedotin-based regimens in squamous-predominant disease. KEYWORDS cardiac metastasis, enfortumab-pembrolizumab, squamous differentiation, surgery, urothelial carcinoma Frontiers in Oncology
- Affiliations
Cliniques universitaires Saint-Luc Department of pathology
Citations
Vansteeger, A., Benlemlih, E., Delmarche, A., Thiry, S., Dano, H., Castaigne, J., Pasoglou, V., Van Nieuwenhove, S., Gerber, B., Aphram, G., Shagera, Q. A., Beauloye, C., Galot, R., van Marcke de Lummen, C. J., & Seront, E. (2026). Case Report: Cardiac metastasis from urothelial carcinoma with predominant squamous differentiation in a young woman: first reported case treated with enfortumab vedotin plus pembrolizumab. Frontiers in Oncology, 16. https://doi.org/10.3389/fonc.2026.1786375 (Original work published 2026)