Right Ventriculostomy for Resection of Cardiac Metastasis from Cervical Cancer / 日本心臓血管外科学会雑誌

Cardiac metastasis from cervical cancer is rare. We herein present a case involving a 54-year-old woman with cervical cancer who was undergoing radiotherapy for left supraclavicular lymph node metastasis. The patient was admitted to the hospital because of shortness of breath. Transthoracic echocardiography showed a large mass in the right ventricle. To rescue the patient from circulatory collapse, we surgically resected the intracardiac mass via a right ventricular incision parallel to the posterior descending artery and left anterior descending artery. This approach prevented right ventricular outflow tract obstruction and perioperative pulmonary embolization, which could have led to death. The intracardiac mass was diagnosed as squamous cell carcinoma. After hospital discharge, the patient underwent chemotherapy. An echocardiography performed 3 months postoperatively showed recurrence of the cardiac metastasis, and the patient died 5 months later. Cardiac metastasis in the right ventricle can present as pulmonary embolization. Although rare, most cases of metastasis from cervical carcinoma to the heart have an extremely poor prognosis.

Metástasis cardíaca de carcinoma anaplásico de tiroides / Cardiac metastasis from primary anaplastic thyroid carcinoma

Resumen Las neoplasias cardíacas son entidades poco frecuentes en la práctica clínica cardiológica y dentro de éstas, la afectación metastásica es 20 a 40 veces más frecuente que la forma primaria, corres pondiendo al 95% de todos los tumores cardíacos; no obstante, debido a las características clínicas y oncológicas del tumor primario, los tumores cardíacos metastásicos son habitualmente subdiagnosticados. En este trabajo se presentan dos casos de pacientes con carcinoma anaplásico de tiroides, una mujer de 69 años con metástasis en ventrículo derecho y un varón de 61 años con metástasis en aurícula derecha. Ambos pacientes fallecieron durante la internación y a uno de ellos se le realizó autopsia.

Abstract Cardiac neoplasms are rare entities in the clinical practice. Cardiac metastatic involvement is 20 to 40 times more frequent than the primary form, representing 95% of all cardiac tumors; however, they are frequently underdiagnosed because of their clinical and oncologic features. In this report, we present two cases of cardiac metastasis from primary anaplastic thyroid carcinoma: a 69-years-old woman with right ventricular metastasis and a 61-years-old man with right atrial metastasis. Both patients died during their hospitalization and one of them underwent an autopsy.

Right ventricular metastatic tumor from a primary carcinoma of uterine cervix: A cause of pulmonary embolism

The presence of intracavitary cardiac metastasis from squamous cell carcinoma of the uterine cervix is extremely rare. The diagnosis is made almost exclusively postmortem. Apart from causing intracardiac obstruction, it can present as pulmonary emboli and the prognosis is extremely poor. It is important to suspect this diagnosis in patient with recurrent pulmonary emboli. Due to the rarity of this condition it is very difficult to standardize care for these patients. However, it is possible that aggressive therapy may lengthen patients' survival and quality of life. We present a case of isolated intracavitary cardiac metastasis arising from a squamous cell carcinoma of the cervix, 44-year-old woman, diagnosed as stage complaint of fatigue and dyspnea on mild exertion. The echocardiogram showed a mass in the right ventricle and suspicious pulmonary embolism. We took an aggressive therapeutic approach. The pathological examination of the resected tissue revealed metastatic squamous cell carcinoma.

Extensive left ventricular, pulmonary artery, and pericardial metastasis from myxoid liposarcoma 16 years after the initial detection of the primary tumour: a case report and review of the literature

Liposarcoma is regarded as the second most common soft tissue malignant tumour. Metastasis of liposarcoma to the heart is very rare, and to date, less than 40 cases have been reported in the literature. We report a 46 year-old male with myxoid liposarcoma of the lower extremity who developed extensive metastasis to the left ventricle, pulmonary artery, and pericardium. The patient presented with acute symptoms of dyspnea 16 years after surgical resection of the primary tumour, and his dyspnea progressed to cardio-respiratory arrest within the first few days of hospital admission.

Rapidly Growing Right Ventricular Outflow Tract Mass in Patient with Sarcomatoid Renal Cell Carcinoma

Cardiac metastasis from renal cell carcinoma (RCC) without inferior vena cava (IVC) involvements is extremely rare with few reported cases. Sarcomatoid RCC with rhabdoid feature is a rare pathologic type of RCC having aggressive behavior due to great metastatic potential. Here, we report a case of rapidly growing cardiac metastasis of RCC which brought on right ventricular outflow tract (RVOT) obstruction without IVC and right atrial involvement in a 61-year-old woman. Cardiac arrest occurred during radical nephrectomy and echocardiography revealed mass nearly obstructing the RVOT which was not recognized by preoperative echocardiography 1 month ago. Postoperative immunohistochemical evaluation of renal mass revealed sarcomatoid RCC with rhabdoid feature.

Recurrent acinic cell carcinoma in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy / 영남의대학술지

Acinic cell carcinoma (ACC) is an uncommon malignant tumor of the salivary glands that is difficult to diagnose. It grows slowly and shows distant metastasis rarely. We experienced a case of recurrent ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy. The 29-year-old man had been suffering from severe multiple bones and joints pain for 2 months. Ten years earlier, he underwent superficial parotidectomy due to a right subauricular mass. The mass was diagnosed with ACC. After surgery, the tumor recurred twice. Then the patient was diagnosed with cardiac metastasis via positron emission tomography-computed tomography and trans-thoracic echocardiography. He also had hypertrophic osteoarthropathy with multiple bone metastasis. He was given palliative radiotherapy and conservative treatment. ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy has not yet been reported in literature. From this case, it is recommended to evaluate multiple distant metastasis in the ACC of the parotid gland when joint and bone pain are present.

Death due to Cardiac Metastasis after Treatment of Oral Squamous Cell Carcinoma: An Autopsy Case / 대한법의학회지

A 60-year-old man presented with electrocardiographic abnormalities after treatment for oral squamous cell carcinoma with surgical resection and radiation therapy 7 months ago. The patient died within 2 h without response to CPR after sudden arrest. Electrocardiographic changes 9 h before death included low QRS voltage and sinus tachycardia. Autopsy revealed cardiac metastasis with chronic active fibrinoid pericarditis accompanied by tumor cell infiltration. Although the frequency of cardiac metastasis in patients with oral cancer is reportedly low, clinicians should be aware that cardiac metastasis may exist if there are electrocardiographic changes in patients receiving follow-up care for primary malignancy. We report a rare medicolegal case of cardiac metastasis-related sudden death.

Isolated Intracavitary Metastatic Esophageal Cancer of the Right Atrium and Right Ventricle / 日本心臓血管外科学会雑誌

We report a rare case of isolated intracavitary metastatic esophageal cancer of the right atrium and ventricle. A 67-year old woman had been treated for esophageal carcinoma for three years. Combined radiotherapy and chemotherapy had been performed, and partial remission had been achieved. Recent follow up computed tomography of the chest revealed intracavitary cardiac mass in her right atrium and right ventricle. On echocardiography a mobile, irregularly shaped large mass was detected in her right atrium. She was admitted for emergency operation. We resected the mass under cardiopulmonary bypass. The pathological examination revealed intracavitary metastasis of squamous cell carcinoma of the esophagus. She was discharged on the 29th postoperative day. Six months later, she died from multiple metastases of squamous cell carcinoma. Even though the operation was not curative, it might have been effective for preventing tumor embolism to the lung and elongating life expectancy.

Electrocardiographic changes suggesting ischemic heart disease in a case of lung cancer with myocardial metastasis / 대한내과학회지

Metastatic tumors to the myocardium proper are uncommon and difficult to diagnose because they have nonspecific signs and symptoms. Electrocardiogram (ECG) changes mimicking ischemic heart disease often develop when non-conducting tumor tissue replaces cardiac muscle. Hence, a high level of suspicion is required to differentiate ECG changes caused by myocardial metastasis from those caused by coronary heart disease in cancer patients. We describe a case of primary lung cancer with myocardial metastasis that showed diffuse ST segment elevation and T wave inversion on the ECG, with a relevant literature review.

A Case of Intracardiac Metastasis of Hepatocellular Carcinoma Presenting with Functional Tricuspid Valve Stenosis Accompanied with Hepatopulmonary Syndrome

Intracardiac metastasis of hepatocellular carcinoma with functional tricuspid valve stenosis is not common. Furthermore, hepatopulmonary syndrome associated with hepatocellular carcinoma is rarely encountered. We present a case of intracardiac metastasis of hepatocellular carcinoma presenting with functional tricuspid valve stenosis accompanied with hepatopulmonary syndrome.

Hipertensión ventricular derecha severa secundaria a obstrucción metastásica por hepatocarcinoma / Severe right ventricular hypertension secondary to metastatic obstruction due to hepatocarcinoma

La hipertensión ventricular derecha es una entidad esperada en enfermedades cardiopulmonares. La obstrucción mecánica del tracto de salida del ventrículo derecho es una de ellas. Presentamos el caso clínico de un paciente masculino de 69 años de edad con historia de hepatocarcinoma previamente tratado, quien presentó hipertensión ventricular derecha por obstrucción metastásica única al ventrículo derecho. El comportamiento clínico es de un síndrome de hipertensión venosa sistémica. Los estudios no invasivos, como el ecocardiograma y la tomografía axial computarizada la delimitaron. No se demostró actividad neoplásica o metástasis en otros órganos. La neoformación intra-ventricular derecha fue corroborada mediante cardio-angiografía y la biopsia tumoral confirmó el diagnóstico.

Right ventricular hypertension (RVH) is an entity that could be expected in various cardiopulmonary diseases. Mechanical obstruction to the right ventricle outflow tract is a cause of RVH. We present the case of a 69 year-old male with a history of hepatocarcinoma previously treated. The developed RVH due to mechanical obstruction secondary to metastatic infiltration of the right ventricle. The clinical syndrome was characterized by systemic venous hypertension. Non-invasive studies, such as electrocardiogram and computed tomography scan limited the metastasis to the right ventricle; the diagnosis was confirmed by cardio-angiography and endocardial biopsy. The studies did not demonstrate neoplastic activity at any other level. (Arch Cardiol Mex 2005; 75: 170-177).

Non-small Cell Lung Cancer Initially Presenting with Intracardiac Metastasis

Intracardiac metastasis as the initial presentation of malignant neoplasm is very rare. We report here on a 64-year-old man with non-small cell lung cancer (NSCLC) initially presenting with intracardiac metastasis which was identified with 18-F fluorodeoxyglucose positron emission tomography (FDG PET). The patient was admitted with complaints of exertional dyspnea and vague chest discomfort that had developed a few weeks ago. Two-dimensional echocardiography revealed a heart mass attached to its akinetic wall in the right ventricular chamber. CT and MRI demonstrated a large tumor involving the epicardium and myocardium in the right ventricle, and there was a mass in the right lower lobe of the lung along with multiple lymphadenopathies. Cytologic examination of the percutaneous needle aspiration of a lymph node in the anterior mediastinum revealed malignant epithelial cell nests, and this was strongly suggestive of squamous cell carcinoma. Subsequent FDG PET confirmed that the intracardiac mass had an abnormally increased FDG uptake, and again this was strongly suggestive of malignancy. By systemically considering these imaging studies, we were able to diagnose the mass as intracardiac metastasis of NSCLC.

4 Cases of Intracardiac Metastasis of Hepatocellular Carcinoma

Antemortem diagnosis of inferior vena cava (IVC) and cardiac metastasis of hepatocellular carcinoma (HCC) is difficult but important to decide on treatment strategy. There are only a few cases of cardiac metastasis of HCC which have been diagnosed antemortem by echocardiography. We experienced 3 cases of IVC and Right atrial metastasis and 1 case of Left atrial metastasis of HCC. The tumor was discovered during computed tomography scanning. The patients had exhibited no signs of cardiac involvement. In this case, transesophageal echocardiography was valuable in providing information regarding the exact location of the tumor and its relation to surrounding anatomical structures. Left atrial metastasis of HCC is unusual patterns and probably related to tumor growth from the pulmonary veins following massive metastasis to the lung.

Obstruction of Right Ventricular Outflow Tract by Extended Cardiac Metastasis from Esophageal Cancer

We report a case in whom there was right ventricular outflow tract obstruction by extended metastasis from esophageal cancer. A 65-year-old man was admitted to hospital for evaluation of recent onset of weight loss of recent onset and a heart murmur. Physical examination revealed a regular heart rate of 62 beats per minute and a blood pressure of 110/70 mmHg. On cardiac auscultation, a grade 4/6 systolic murmur was heard over the area of pulmonic valve. Electrocardiography showed low voltage. Chest radiography showed a normal cardiac configuration and no pulmonary abnormality was seen. Esophagogram and endoscopy showed a 10cm sized ulcerative and infiltrative esophageal cancer. This esophageal cancer was histologically proven to be a squamous cell carcinoma. To assess the cardiac metastasis, echocardiography, MRI, coronary angiography, and endomyocardial biopsy were performed. The MRI, echocardiography and right ventriculography revealed a 7 cm sized lobulated mass extending to the right ventricular outflow tract, right ventricle, septum, and anterior wall of the left ventricle. Interestingly, the feeding vessels of the tumor were identified by echocardiography and coronary angiography. Histologically, the cardiac tumor was proven to be have the same pathologic findings as the an esophageal cancer, compatible with carcinomatous metastasis.

Clinical Characteristics of 4 Cases with Recurrent Cervical Cancer Showing Cardiac Metastasis / 대한산부인과학회잡지

BACKGROUND: The presence of cardiac metastasis from cervical cancer is very rare. Due to the rarity of this condition, clinical characteristics of the patients with cardiac metastasis from cervical carcinoma is not well known. This study is to investigate the clinical profiles and outcomes of patients with cardiac metastasis from the carcinoma of the uterine cervix. MATERIALS AND METHODS: From Jan. 1990 to May 1999, 4 patients with cardiac metastasis from cervical cancer during the course of the disease were registered in Korea Cancer Center Hospital. The clinical characteristics of these patients were reviewed retrospectively. RESULTS: Mean age of patients was 49 years, and median interval from initial diagnosis to recurrence was 27 months. Histologically, all 4 cases were squamous cell type carcinoma. The stage distribution is two patients with FIGO stage II, one with stage I and one with stage III. Clinical symptoms of patients were dyspnea and facial edema in 2 patients, facial edema in one patients, and dyspneas only in one patient. All patients were confirmed histologically by pericardiocentesis. Synchronous metastatic lesions were supraclavicular lymph node, lung parenchyme and paraaortic, mediastinal lymph node. Following pericardiocentesis or pericardiodesis, all patients were improved clinically and survived for mean interval of 5.3 months. CONCLUSIONS: The patients with pericardial metastasis from cervical carcinoma showed a short survival time, but could be managed by pericardiocentesis or pericardiodesis with improvement of clinical symptoms.

A Case of Cardiac Metastasis to Left Atrium from Large Cell Carcinoma of the Lung

Metastatic tumors to the heart are far more frequent than primary tumors of the heart. Cardiac metastasis may be detected up to 30 percent of patients with fatal lung cancers. Metastatic cancer to the heart is difficult to suspect. Where cardiac metastasis is diagnosed ante-mortem, signs and symptoms of the primary cancer are usually the presenting features and the presence of cardiac involvement is often incidentally detected. We experienced a case of 35-year-old woman with metastatic lung cancer invading the left atrium via pulmonary vein, which was not proved pathologically. She presented with hemoptysis and chest pain. Transthoracic echocardiography demonstrated massive cardiac infiltration with tumor and decreased cardiac wall motion, correlating with the chest CT findings, which were also remarkable for the presence of intracardiac mass and direct invasion to adherent pericardium, pulmonary vein and left atrium. We suggest that careful examination of 2D echocardiography can be noninvasive and valuable tool for diagnosis of metastatic cancer to the heart.