Carcinoma of the Cervix Causing Massive Intracardiac Embolus

Mohammed, Suneel; Khodadoust, Kavous

doi:10.1006/gyno.1995.1049

Cited by 12 publications

(6 citation statements)

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“…In the present case, tumor embolism was not directly diagnosed by imaging but was highly suspected based on indirect findings such as acute onset type I respiratory failure, dilatation of peripheral pulmonary arteries, mosaic ground-grass opacities in chest CT images, significant pulmonary hypertension, presence of a mass in the right ventricle, and elevated right ventricular pressure. Pulmonary tumor embolism in cervical cancer has been reported mostly in patients with cardiac metastasis (Table II) (7)(8)(9)(10)(11)(12)(13)(14)(15), suggesting that pulmonary tumor embolism should be considered in the differential diagnosis of patients with findings that suggest cardiac metastasis, even in the absence of typical imaging findings (e.g., perfusion defects in major pulmonary arteries).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

Okazaki

Abe

Takayanagi

et al. 2018

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Abstract. Background Pulmonary tumor embolism is a rare and fatal complication in cancer patients. It leads to progressive clinical manifestations including respiratory failure, pulmonary hypertension, right heart failure, and sudden death (1). Generally, tumor embolism is more common in patients with adenocarcinoma compared to other histological types (2). This report describes a case in which a patient with squamous cell carcinoma of the uterine cervix developed pulmonary tumor embolism and followed a fatal clinical course within a few days after the onset of symptoms, along with multimodal diagnostic imaging and autopsy findings. Case PresentationClinical findings. A 60-year-old female visited a local clinic with a chief complaint of continuous genital bleeding. She was referred to our institution with suspected cervical cancer. Pelvic examination revealed an easily bleeding mass occupying the external uterine orifice, with bilateral parametrial and lower vaginal infiltration. Magnetic resonance imaging (MRI) revealed a large tumor in the uterine cervix that had invaded into the uterine corpus, bilateral parametria, vagina, rectum, and bladder (Figure 1). MRI also showed multiple enlarged pelvic lymph nodes. Computed tomography (CT) revealed multiple low-density lesions in the liver, suggesting liver metastases. A biopsy of the cervical mass revealed a keratinizing squamous cell carcinoma of the uterine cervix, and the patient was diagnosed with stage IVB (cT4N1M1) cervical cancer. One week later, she developed progressive dyspnea, cyanosis, tachycardia (105 beats per minute), and tachypnea (30 breaths per minute). Her peripheral capillary oxygen saturation was 80-85%, and her blood pressure and body temperature were normal. No abnormal findings were noted on auscultation of both lungs. Arterial blood gas analysis showed alkalemia (pH 7.482), decreased levels of arterial oxygen tension (PaO 2 , 54.9 mmHg), arterial carbon 337

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Section: Discussionmentioning

confidence: 99%

Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

Okazaki

Abe

Takayanagi

et al. 2018

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“…This indicates that the 2 years subsequent to the completion of the initial treatment is a critical period during which uterine cervical cancer patients should be carefully monitored for symptoms of cardiac metastasis. Dyspnea and chest pain were frequently reported as chief complaints in patients with cardiac metastasis ( 1 , 6 , 11 – 13 , 16 , 18 , 20 – 23 ). Electrocardiogram frequently exhibited low voltages and T-wave abnormalities in chest leads, which is indicative of myocardial disability and/or pericardial effusion ( 10 , 13 , 14 , 17 , 19 , 21 – 23 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…A review of the English language literature revealed that only 13 well‐documented cases of right ventricular (intracavitary) metastases from cervical cancer have been described 6 –16 . The 14 cases (including the present case) are summarized in Table 2.…”

Section: Discussionmentioning

confidence: 99%

“…Metastatic tumor may be totally intracavitary; usually following implants of tumor cells on the endocardium 22 . According to the literature, intracavitary mass without ventricular invasion accounts for 40% (4/10) of cases 8 –10 , 14 . The mean age of these patients is 46 years (range, 28–77 years).…”

Section: Discussionmentioning

confidence: 99%

“…Uterine cervical carcinoma with cardiac metastases is less common; 2 , 3 , 5 with endocardial (intracavitary) metastases being particularly rare. Only 13 cases with right intracavitary metastasis are found in the English literature 6 –16 . We present an autopsy case of squamous cell carcinoma (SCC) of the uterine cervix that developed intraventricular metastasis, and a review of other reported cases.…”

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confidence: 99%

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Right intraventricular metastasis of squamous cell carcinoma of the uterine cervix: An autopsy case and literature review

Senzaki

Uemura

Yamamoto

et al. 1999

Pathology International

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An autopsy case of squamous cell carcinoma of the uterine cervix, which developed cardiac intracavitary metastasis in a 28-year-old Filipina, is reported. At autopsy, the right ventricle contained a soft, red-purple, cauliflower-like mass. Histologically, this mass was made up of sheets of malignant squamous cells similar to the primary uterine foci. The metastases were extensive and associated with multiple organ involvement. Although this case was stage Ib at operation, vascular invasion at the primary site was characteristic, and the intracavitary tumor of the right ventricle developed without myocardial involvement. The carcinoma of the primary site extended along the inferior vena cava and settled as an intracardiac obstructive mass. A literature review (including the present case) disclosed only 14 uterine cervical carcinomas with right intracavitary metastasis. The mean age of these patients was 46 years of age (range, 28-77 years). The clinical stage was Ib in two cases, IIa in one case, IIb in six cases, and IIIb in two cases. The prognosis of these cases was poor; 13 of the patients died at an average of 19.1 months after diagnosis.

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Carcinoma of the Cervix Causing Massive Intracardiac Embolus

Cited by 12 publications

References 0 publications

Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

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

Right intraventricular metastasis of squamous cell carcinoma of the uterine cervix: An autopsy case and literature review

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