Abstract
BackgroundCardiac metastasis due to colon cancer is extraordinarily uncommon. Given the rarity of diagnosis, there is paucity of evidence and hence, no established guidelines for evaluation or clinical management strategy.Clinical presentationWe present the case of a 59 year old male with a previously treated colonic carcinoma who presented with new onset exertional dyspnea. He was noted to be having a right atrial mass on an echocardiogram performed at his cardiologist’s office. Further workup with CT angiogram of the chest confirmed a right atrial mass measuring 4.0 cm. Serum CEA was normal. Biopsies of the right atrial mass demonstrated metastatic moderately differentiated colonic adenocarcinoma. Mismatch repair protein expression analysis by immunohistochemistry showed no loss of MLH1, MSH2, MSH6 or PMS2 expression. Next generation sequencing for RAS and BRAF mutations was negative. Patient received treatment with FOLFIRINOX/ bevacizumab with noted reduction in size of mass.ConclusionTo the best of our knowledge, this is the first report of next generation sequencing results available on a biopsy of metastatic colorectal cancer to the heart with the largest literature review of 31 reported cases of metastatic colorectal cancer to the heart. It will help direct clinical management and also adds evidence to the potential efficacy of treatment of this rare aggressive disease with chemotherapy in combination with VEGF inhibitors.
Highlights
Colorectal carcinoma is the third most common malignancy and the third most common cause of cancer deaths in both men and women in the United States [1]
To the best of our knowledge, this is the first report of generation sequencing results available on a biopsy of metastatic colorectal cancer to the heart with the largest literature review of 31 reported cases of metastatic colorectal cancer to the heart
We provide the largest review of literature of cardiac metastases from colorectal carcinoma
Summary
Metastatic cardiac tumors have been linked with an aggressive disease course and poor outcomes in general. Given the recent developments in diagnostic and therapeutic modalities, integration of generation sequencing; management options have evolved over the years for metastatic colorectal involvement of the heart. This literature review will help guide clinical management and add to the evidence available. Further studies are needed to formulate treatment strategies for this rare entity
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