Metastatic Cardiac Tumor from Primary Tongue Cancer: A Case Report

Abstract

Purpose: To report a case of cardiac metastasis from primary squamous cell carcinoma of tongue presented as malignant pericardial effusion causing cardiac tamponade. This case was proven by pathologic evidence. Case report: This 67 years old male patient was diagnosed of left tongue carcinoma with initial staging of T2N0M0 and received local excision in March 2004 in another hospital. However, left submandibular lymph node recurrence occurred in October 2004. Restaging work-up was arranged and no evidence of distant metastasis was found. Then he received salvage treatment of concurrent chemo-radiotherapy (CCRT) since October 28, 2004. For radiotherapy, the total dose to recurrent LN and primary tumor bed with whole lymphatic chain were 79.8 Gy and 62.4 Gy, respectively. The regimen of chemotherapy was taxotere (12 mg/m2) plus cisplatin (30 mg/m2) weekly for 6 cycles. The total treatment course was completed smoothly on December 24, 2004 except for WHO Grade Ⅱ mucositis that developed during treatment period. Unfortunately, pericardiac effusion occurred as diagnosed by cardiac echography in February 2005. Refractory pericardiac effusion caused cardiac tamponade was still persistent despite of repeated pericardiocentesis. Chest computed tomography (CT) showed that a mass within the right ventricle and massive pericardiac effusion. Surgery was performed owing to progressive degradation of cardiac function on February 24, 2005. Result: The myocardiac tumor biopsy proved metastatic squamous cell carcinoma. Unfortunately, this patient died of heart failure even after intensive supportive treatment, 12 days after surgery. Conclusion: Although primary tongue cancer is frequent in head and neck tumor, metastatic cardiac cancer is a rare occurrence. The diagnosis of metastasis to heart is difficult because of various cardiac symptoms. Most importantly, the diagnosis of cardiac metastasis should be kept in mind if a new onset of cardiac disease occurred in cancer patient.