Valvular and Outflow Tract Metastases From Germ Cell Tumors

BACKGROUND: Nonseminomatous testicular germ cell tumors (TGCTs) rarely metastasize to the heart, posing cardiovascular diagnostic and management challenges. CASE SUMMARY: We present 2 young men (20 and 28 years) with advanced mixed TGCTs. One developed acute ischemic stroke and myocardial infarction, the other a multifocal murmur. Both showed elevated alpha-fetoprotein, beta human chorionic gonadotropin, and pulmonary nodules. Transthoracic echocardiography revealed atrioventricular valves and outflow tract masses. DISCUSSION: In TGCT, embolic or new cardiovascular findings should prompt urgent transthoracic echocardiography to assess cardiac metastases. Early multimodality imaging can uncover silent disease and guide timely multidisciplinary care. Management focuses on definitive tumor resection and platinum-based chemotherapy. TAKE-HOME MESSAGES: Cardiac metastases from testicular cancer may first present with neurological or cardiovascular symptoms. Right-sided secondary cardiac tumors may be silent, whereas left-sided involvement may cause embolic events.