Abstract
A 56-year-old female with history of stage IIA adenosquamous lung carcinoma treated 13 months prior to presentation with lobectomy, mediastinal lymph node dissection, and adjuvant chemotherapy, presented for several weeks of worsening dyspnea. Exam was non-focal aside from tachycardia. Computed tomography of the chest revealed a large 4 cm × 5 cm mass in the bilateral ventricular myocardium. There was also evidence of metastatic disease elsewhere in the body, including a supraclavicular lymph node that was positive for metastatic adenosquamous lung carcinoma. She started whole heart radiotherapy and was to commence chemotherapy but passed away. This report discusses important aspects of diagnosis of this not uncommon condition that many oncologists may come across. We also discuss differential diagnosis of an isolated intracardiac mass as first-diagnosis presentations, and discuss the great importance of multidisciplinary cardio-oncologic management and clinical prioritization.
Highlights
A 56-year-old woman presented for several weeks of worsening dyspnea on exertion and nonproductive cough
Most commonly from lung cancer (30–40%), are not as uncommon as expected, with incidences up to 18% in the literature; the average incidence around 10% of all patients with malignancies seems less in clinical practice, likely due to most metastases having been discovered incidentally and smaller in size (2)
Treatment is very variable from study to study, and is quite controversial. It is usually done on a case-by-case basis, and Though tumor recurrence in this patient was the most likely diagnosis, first-time diagnoses in similar patients provide a discussionworthy differential diagnosis
Summary
A 56-year-old woman presented for several weeks of worsening dyspnea on exertion and nonproductive cough She had a history of stage IIA adenosquamous carcinoma of the lung (left lower lobe) treated 13 months ago with lobectomy and mediastinal lymph node dissection and adjuvant chemotherapy (carboplatin/paclitaxel and subsequently pemetrexed), with no evidence of disease on multiple subsequent computed tomography (CT) scans. Though the cardiac mass was not biopsied, its radiological appearance (1) as well as relatively quick growth to 4 × 5 cm size in 13 months was concerning for tumor recurrence She was to have port placement for chemotherapy, and started whole heart radiotherapy at a dose of 3,000 cGy in 12 fractions of 250 cGy each. Treatments have ranged from surgical resection (7), chemotherapy (8), and even primary radiotherapy (9)
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