Abstract
Cardiac metastasis of germ cell tumors is extremely rare, particularly in females. We report a case of a 26-year-old previously healthy woman who presented with a 5-month history of abdominal pain, weight loss, fever, generalized lymphadenopathy, and acanthosis nigricans. Biopsy of cervical lymph nodes revealed a poorly differentiated neoplasm. Immunohistochemical staining was positive for alpha-fetoprotein suggesting the diagnosis of a germ cell tumor. During the investigation, the patient developed heart failure and a mass attached to the right ventricle was detected by the echocardiogram. In a few days, she developed multiple organ failure and died. Post-mortem examination revealed a malignant mixed germ cell tumor of the right ovary with extensive hematogenic and lymphatic dissemination, a polypoid mass attached to the right ventricle, emboli in the endocardial and epicardial vessels, and infiltration surrounding the coronary arteries. To the best of our knowledge this is the third report of grossly visible heart metastases from a yolk sac tumor in a female patient. A summary of all published cases of germ cell tumors with cardiac metastasis over the last 20 years is also presented.
Highlights
Ovarian germ cell neoplasm includes tumors with multiple histological patterns, and variable biologic behaviors [1]
As a highly malignant neoplasm, yolk sac tumors metastasize at an early stage as well invade the surrounding structures and organs [1,3,4,5,6]
Cardiac metastases can arise from different cancers, they are more frequently associated with carcinoma of the lung, breast and esophagus, hematological malignancies including lymphoma and leukemia, and malignant melanoma, which shows the highest affinity to metastasize to the heart [4]
Summary
Ovarian germ cell neoplasm includes tumors with multiple histological patterns, and variable biologic behaviors [1]. These tumors grow rapidly, are usually unilateral and confined to one ovary in two thirds of the cases, and predominate in girls and young women. As a highly malignant neoplasm, yolk sac tumors metastasize at an early stage as well invade the surrounding structures and organs [1,3,4,5,6]. Post-mortem examination revealed a malignant mixed germ cell tumor of the right ovary with predominance of endodermal sinus (yolk sac) tumor elements, and extensive hematogenic and lymphatic dissemination to the lungs, kidneys, liver, intestines, uterine tube, mediastinum, and thyroid gland. The guardian of the patient provided written informed consent in accordance with the Declaration of Helsinki
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