Cardiac Metastasis Research Articles

An unusual metastatic tumor to the heart

Metastatic tumors of the heart are 20 to 40 times more common than the primary cardiac tumors. Cardiac metastasis from pelvic malignancy is rare and gynecological tumors rarely metastasize to the heart. Metastasis into the heart is rare and most of the cases are diagnosed postmortem during autopsy. We report a case of metastatic squamous cell carcinoma of uterine cervix into heart causing obstruction of the right ventricle and pulmonary artery causing dyspnea on exertion and eventually patient's demise.

Melanoma to the Heart

Malignant melanoma is the third most common skin cancer yet has the highest mortality rate due to its predilection for metastasis. While the diagnosis of antemortem melanoma with cardiac metastasis is relatively uncommon, diagnosing malignant melanoma itself by first identifying a cardiac metastasis is even more rare. This vignette describes an antemortem diagnosis of melanoma in a 50-year-old woman through identification of metastasis to multiple sites, including the tricuspid valve.

An extremely rare case of a high-grade pleomorphic cardiac sarcoma and likely cerebral metastasis in a young patient

To date, there have been less than a 100 confirmed case reports of primary cardiac malignant fibrous histiocytomas, a rare form of sarcoma. In this report, we discuss the case of a 15-year-old girl who initially presented with a histiocytic cerebral sarcoma that was treated with aggressive resection and chemotherapy. Three years later, the same patient developed increasing shortness of breath and was found to have a high-grade pleomorphic undifferentiated cardiac sarcoma that likely represents the primary tumour from which the cerebral lesion metastasised. This represents an extremely unique case; in 2010, a research group in Germany claimed the very first description of a true cardiac sarcoma with brain metastasis [1]. However, even as far back as 1960, there were three case reports [2] and more extensive sarcoma studies recently have revealed further cases [3]. Nevertheless, there have probably been less than 10 cases in the literature up until this point.

Superposition of lung metastases of prostate adenocarcinoma on heart as a cardiac metastases: A case report

Abstract Background Primary or secondary malignancies of the heart is rare and difficult to diagnosis. Most cardiac masses are detected incidentally. Positron emission tomography-computed tomography, thorax computed tomography are valuable tools for staging the disease of patient with a history of malignancy. As prognosis is poor, if a physician suspects a suspicious metastasis on heart, it must evaluated carefully in order to prompt therapeutic interventions. Herein. we report a false-positive positron emission tomography-computed tomography finding which was superposition of lung metastasis of prostate adenocarcinoma via confirming by thorax computed tomography and echocardiography. Case report A 71-year-old man diagnosed with prostate adenocarcinoma presented with a mass on the posterior-anterior lung graphy after 8 years of the diagnosis date. Positron emission tomography-computed tomography, thorax computed tomography, echocardiography, fine needle aspiration biopsies were performed in order to reveal the final diagnose. Although positron emission tomography-computed tomography revealed a cardiac metastasis, the other tools showed that it was not cardiac metastasis but lung metastasis of prostate adenocarcinoma. Conclusion A patient with a history of malignancy and clinical cardiac symptoms must be evaluated carefully in order to prevent a false-positive findings and to prompt therapeutic interventions.

Disseminated skeletal muscle and cardiac metastasis from squamous cell carcinoma of the lung detected with FDG and FLT PET/CT

Lung cancer is one of the leading cancers all over the world. Positron emission tomography (PET) using 18F fluorodeoxyglucose (18F FDG) is useful for staging of the disease and decide the appropriate management. 3’-deoxy-3’-18 F-fluorothymidine (18F FLT) is a tracer being extensively evaluated currently and is said to represent tumor proliferation. Common sites of metastases from lung cancer include adrenal glands, bone, and brain. Muscle metastasis and cardiac metastasis are uncommon findings. We report a case of squamous cell carcinoma of the lung with metastases to multiple skeletal muscles and myocardium detected with both FDG and FLT PET/computed tomography (CT).

An autopsy case of right ventricular cardiac metastasis from squamous cell carcinoma of the left hand

We here report a 60-year-old woman in whom autopsy revealed a metastasis in the right cardiac ventricle from a well-differentiated squamous cell carcinoma (SCC) of the left hand. The tumors in the myocardium and left hand were both well-differentiated SCCs with keratinization and sporadic keratin pearls. High concentrations of heart failure markers together with a pericardial effusion suggested antemortem chronic heart failure. Our case is particularly unusual because there were no regional lymph node metastases and the cardiac metastasis was not one of multiple metastases; thus, hematogenous metastasis to the right side of the heart alone had occurred.

Evaluation of cardiac tumors by multidetector computed tomography and magnetic resonance imaging

Cardiac tumors, are a rare pathology (0.002-0.3%) in all age groups, however, they have a clinic importance, due the affected organ. They are classified in primary (benign or malignant) and secondary (metastasis) types. Among primary type, mixoma, is the most common benign tumor, and sarcoma represents most of the malignant injuries. Cardiac metastasis are more frequent than primary tumors. Clinic effects of cardiac tumors are unspecific and vary according their location, size and agresivity. The use of Multidetector Computed Tomography (MDCT) and Magnetic Resonance Imaging (MRI) assist on the location, sizing, anatomical relationships and the compromise of adyacents structures, besides, MRI is useful for tissue characterization of the tumor. Due to the previous reasons, studies based on noninvasive cardiovascular imaging, have an important role on the characterization of these lesions and the differential diagnosis among them.

Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging

BackgroundCardiac magnetic resonance (CMR) imaging is well validated for tissue characterization of cardiac masses but has not been applied to study pattern and prognostic implications of cardiac metastases (CMETs) among patients with systemic cancer.Methods and ResultsThe population consisted of 60 patients with stage IV cancer (32 patients with CMETs, 28 diagnosis‐matched controls) undergoing CMR. CMET was defined as a discrete mass with vascular tissue properties on delayed enhancement CMR. CMET‐positive patients and controls had similar clinical characteristics, cardiac geometry, and function (P=NS). Leading cancer types associated with CMET were sarcoma, melanoma, and gastrointestinal. Patients with CMETs had similar distribution of extracardiac metastatic disease compared with controls (organs involved: 3.4±2.0 versus 2.7±1.9, P=0.17). In 94% of patients with CMETs, there were metastases involving ≥1 extracardiac organ (66% lung involvement). CMET location varied (right ventricle 44%, right atrium 19%, left ventricle 28%, left atrium 9%, pericardial 25%); 22% of cases had multichamber involvement. Right‐sided chamber involvement was common in hematologic/lymphatic spread (67%); pericardial involvement was common with direct spread (64%). Regarding tissue properties on delayed enhancement CMR, CMETs commonly (59%) demonstrated heterogeneous enhancement (41% diffuse enhancement). Heterogeneous lesions were larger and had increased border irregularity (P<0.05). Survival 6 months post‐CMR was numerically lower among patients with CMETs (56% [95% CI 39–74%]) versus stage IV cancer–matched controls (68% [95% CI 50–86%]), although differences between groups were nonsignificant (P=0.42).Conclusions CMETs vary regarding etiology, location, and tissue properties on CMR, highlighting need for comprehensive surveillance of cardiac involvement regardless of cancer origin. Prognosis remains poor with for patients with CMETs, albeit similar to that for stage IV cancer controls matched for cancer etiology.

Unusual Clinical Presentation of Disseminated Gestational Trophoblastic Neoplasia [19P

INTRODUCTION: Gestational trophoblastic neoplasia (GTN) is comprised of malignant tumors characterized by an abnormal proliferation of trophoblastic tissue. Subtypes include invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Clinical presentation of GTN varies based on location and extent of disease. Here we report the case of a patient who presented with atypical symptoms of GTN and was ultimately found to have massive disseminated tumor burden, greater than any prior reported case. METHODS: We report a case of a 35-year-old woman who presented with acute limb ischemia secondary to malignant obstruction of bilateral femoral arteries. She was found to have extensive intracranial, pulmonary, hepatic, splenic and cardiac metastasis two years after a first trimester spontaneous abortion. Her initial β-HCG was 1,228,233 IU/L. RESULTS: The patient was treated initially with whole brain radiation therapy (WBRT) for two weeks with concurrent weekly etoposide and cisplatin to address extensive metastatic disease in both the brain and liver. EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) was withheld initially due to concern for bleeding with concurrent radiation therapy. Upon completion of WBRT, the patient completed eleven cycles of EMA-CO She also successfully underwent bilateral lower extremity embolectomies. CONCLUSION: After completion of multi-agent chemotherapy and whole brain radiation therapy, the patient had total resolution of radiographic findings of metastatic disease and normalization of β-HCG. This case highlights the variable presentation of GTN and reiterates excellent response to treatment despite massive tumor burden.

Right Ventricle Metastasis of Pleomorfic Undifferentiated Sarcoma Detected by FDG PET/CT and Three‐Dimensional Echocardiography

Mini‐AbstractHigh‐grade undifferentiated pleomorphic sarcomas are rare disease with poor prognosis. The most commonly metastasis sites of pleomorphic sarcomas are lungs, liver, and bone. Cardiac metastasis of these tumors is extremely rare. Herein, we report a case with cardiac metastasis of pleomorphic sarcoma detected by FDG PET/CT and three‐dimensional transesophageal echocardiography.

Solitary cardiac metastasis of uterine cervical cancer with antemortem diagnosis: A case report and literature review.

Cardiac metastasis of uterine cervical cancer with antemortem diagnosis is extremely rare. Therefore, its landscape epidemiology has not been well elucidated to date. In the present study, a case of solitary cardiac metastasis of uterine cervical cancer diagnosed antemortem is reported, and a review of the currently available literature (which includes 18 cases of cardiac metastasis of uterine cervical cancer) is conducted. In January 2013, a 78-year-old woman with squamous cell carcinoma (SCC) of the uterine cervix (International Federation of Gynecology and Obstetrics stage IIIb) underwent definitive radiotherapy at Gunma University Hospital (Gunma, Japan). Follow-up examination at 5 months after completion of the treatment indicated no evidence of recurrence or metastasis. In April 2014, the patient reported epigastric discomfort and general malaise. Electrocardiogram suggested myocardial dysfunction. Transthoracic echocardiography revealed the presence of a mass occupying the right ventricle and pericardial effusion. Cine magnetic resonance imaging demonstrated a filling defect in the right ventricle, and transcatheter biopsy confirmed SCC. The patient was diagnosed with a solitary cardiac metastasis of uterine cervical cancer. Despite aggressive medical therapy, the patient succumbed to disease 31 days after admission to hospital. A review of the current literature revealed that 84% of cases of cardiac metastasis develop within 2 years of completion of the initial treatment, and that electrocardiogram and echocardiography reveal findings of myocardial dysfunction and the presence of a mass in the right ventricle, respectively. A treatment strategy for cardiac metastasis of uterine cervical cancer has not been standardized thus far, and the prognosis is very poor, as the majority of patients succumbed to disease within 1 year. In summary, the current case and the literature review conducted in the present study suggest that: i) Cardiac metastasis should be included in the differential diagnosis in cases with nonspecific complaints such as epigastric discomfort and general malaise when patients have a history of uterine cervical cancer, particularly within the previous 2 years; and ii) electrocardiogram and echocardiography are convenient and effective modalities for the diagnosis of cardiac metastasis of uterine cervical cancer.

Intracardiac metastasis originated from chondrosarcoma

Primary cardiac tumors are extremely rare. By comparison, metastatic involvement of the heart is over 20 times more common and has been reported in autopsy series in up to one in five patients dying of cancer. Cardiac metastasis of chondrosarcoma is absolutely not frequent. In the recent literature, a cardiac metastasis from chondrosarcoma has never been described. We report the case of an 18-year-old man with a diagnosis of cardiac metastasis that originated from a left scapular chondrosarcoma. Chondrosarcoma is a skeletal tumor with various grades of malignancy, rapidly evolving, and with a strong tendency to metastasize, with low responsiveness to chemotherapy. The onset of characteristic systemic symptoms in the late stage of the disease led to the diagnosis of a mass localized in the right atrium. Management and differential diagnosis of infective heart lesions were also very complex in a rapidly evolving life-threatening condition.

Pericardial Metastasis Induced Tamponade from Urothelial Carcinoma: A Rare Entity.

Urothelial carcinoma in a few cases may result in cardiac metastasis. A rare presentation of this condition is its diagnosis as a result of cardiac tamponade. Tamponade is an unusual entity as a result of urothelial carcinoma and has only been reported in four cases. There have also been only a total of fifteen cases of cardiac metastasis from this form of malignancy. It is through this discussion that we emphasize the importance of early detection and monitoring of cardiac symptoms with the implementation of echocardiogram imaging. Although not feasible in all patients it may be considered in those presenting with cardiac and pulmonary symptoms. In this case we discuss the presentation of a 71-year-old gentleman with a history of urothelial carcinoma after cystectomy and while on chemotherapy presented with new onset atrial fibrillation and later was diagnosed with cardiac tamponade as a result of malignant metastasis.

心筋転移をきたした非喫煙女性の肺扁平上皮癌の1例

心筋転移をきたした非喫煙女性の肺扁平上皮癌の1例

Multidisciplinary Management of a Rare Case of Esophageal Adenocarcinoma with Cardiac, Pulmonary, Liver, Adrenal Gland and Brain Metastasis

Multidisciplinary Management of a Rare Case of Esophageal Adenocarcinoma with Cardiac, Pulmonary, Liver, Adrenal Gland and Brain Metastasis

Multidisciplinary Management of a Rare Case of Esophageal Adenocarcinoma with Cardiac, Pulmonary, Liver, Adrenal Gland and Brain Metastasis

We report the case of a 48-year-old gentleman affected by diffuse metastatic gastroesophageal junction (GEJ). Positron emission tomography (PET) scan demonstrated diffuse metastatic disease involving brain, heart, lungs, liver and adrenal glands. Transthoracic echocardiogram showed a mass in the left ventricular apex measuring 2.46 cm × 1.32 cm. Cardiac Magnetic resonance imaging (MRI) showed 2.3 cm mass in the apex of the left ventricle. Peripheral blood circulating tumor DNA (ctDNA) analysis confirmed dissemination of cancer and showed mutations in TP53, AR, PIK3CA, and Erbb2 amplification. Combination chemotherapy consisting of trastuzumab, capecitabine and oxaliplatin was initiated with a significant reduction of tumor markers: CEA from 60.7 to 19.7 ng/mL (67.5%) and CA19-9 from 2104 to 139 Units/mL (93.4%). A repeated PET scan demonstrated resolution of FDG avidity of left ventricle/pericardium, decreased avidity and size of adrenal gland masses, lung nodules and primary esophageal mass. We reviewed and summarized the recent literatures regarding the clinical presentations, diagnostic tools, tumor histology, treatment modalities and clinical prognosis of cardiac metastases from esophageal cancer. This report also highlights the potential role of ctDNA as a cost effective marker in the management of metastatic esophageal cancer.

Cardiac metastasis of synovial sarcoma presenting with superior vena cava syndrome

Cardiac metastasis of synovial sarcoma presenting with superior vena cava syndrome

A rare case of hepatocellular carcinoma with right atrial invasion

An elderly male came with h/o loss of appetite and weight loss since 3 months. On evaluation, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) values were high. Hepatitis B surface antigen (HbSAg) screening was reactive and serum alfa-fetoprotein (AFP) was raised. Ultrasound examination revealed a hepatic mass with inferior vena caval extension and direct invasion of the right atrium. Computed tomography (CT) scan of the lower thorax and abdomen was performed, which confirmed the ultrasound diagnosis. The patient had a brief stay in the hospital and got discharged against medical advice; he was not available for follow-up. Hepatocellular carcinomas (HCCs) commonly metastasizes to the lung, bone, brain, and adrenal glands. About 70% of the patients with HCCs have hepatic and portal vein invasions but encroachment into the right atrium is very rare. The most common symptoms of cardiac metastasis include asymptomatic cases, bilateral lower leg edema, and exertional dyspnea in that order. Typical complications of intravascular tumor extension lead to secondary Budd-Chiari syndrome, right heart insufficiency, or massive pulmonary embolism. The prognosis of HCC with atrial invasion is poor, with median survival ranging from 1 month to 4 months. HCC in these cases may be more aggressive, with a shorter doubling time. The risk for cardiopulmonary collapse is higher, with heart failure or sudden death. Surgical interventions as well as nonsurgical approaches have been used in the treatment of patients with symptomatic inferior vena cava (IVC)/right atrial tumor thrombi. There are few reports of en bloc hepatectomy and resection of the right atrial thrombus under cardiopulmonary bypass. Routine screening in patients with HCC, such as including chest imaging as part of surveillance computed tomographic scans, may facilitate earlier detection and treatment.

Utility of Indium-111 Octreotide to Identify a Cardiac Metastasis of a Carcinoid Neoplasm

Carcinoid heart disease is classically described as right-sided valvular pathology. Solid cardiac metastases from carcinoid tumors are seldom reported. A multimodality imaging approach is needed to diagnose and localize this disease. Biopsy remains the gold standard to confirm the diagnosis of carcinoid. Octreotide uptake is characteristic of carcinoid tumor but not myxoma; thus, an indium-111 octreotide scan is very specific for the diagnosis of carcinoid tumor and helps in assessing the extent of carcinoid disease. We present a case in which an indium-111 octreotide scan revealed uptake in three distinct masses in the colon, liver, and right ventricle. The results of the scan were contradictory to the biopsy results, which were diagnostic for hepatic carcinoid and cardiac myxoma.

Cardiac Metastasis of Leiomyosarcoma Complicated with Complete Atrio-Ventricular Block and Ventricular Tachycardia.

We described a case of a 54-year-old male who presented with dizziness and dyspnea due to cardiac metastasis of leiomyosarcoma. Cardiac metastasis of leiomyosarcoma caused both bradyarrhythmia and tachyarrhythmia in the patient. He was treated with implantation of a permanent pacemaker for management of complete atrio-ventricular block and anti-arrhythmic drug that suppressed ventricular tachycardia successfully.