Cardiac Metastasis from Ascending Colon Cancer: A Case Report and Review of the Literature

Abstract

Cardiac metastasis from colorectal cancer is rare. Such metastasis is usually discovered during autopsy; antemortem diagnosis is rare. A 76-year-old woman in whom we had performed right hemicolectomy for ascending colon cancer was noted to have elevated tumor markers during a follow-up examination 4 months after the surgery. Chest CT indicated a cardiac tumor that was approximately 6 cm in diameter, and we suspected a metastatic cardiac tumor. Subsequently, obstructive jaundice developed as a result of lymph node metastases around an extrahepatic bile duct, and a stent was placed. The patient refused aggressive treatment and was simply followed up clinically. Within 2 months, the cardiac tumor enlarged enough to cause cardiac failure, and death ensued 7 months after the surgery. Autopsy revealed a myocardial tumor, approximately 7 x 5 cm, that extended from the right atrium to the right ventricle. The histopathologic diagnosis was cardiac metastasis from ascending colon cancer. We describe in detail this case of rapidly progressive cardiac metastasis that was discovered after surgical treatment of ascending colon cancer. In searching the medical literature, we found only 14 cases of metastasis of colorectal cancer to the heart. We describe our case in detail and review our experience in light of the available literature.

Surgical resection of colorectal carcinomas metastatic to the heart

“…Three cases were completely asymptomatic, presenting after 32, 12, and four months and CEA levels were elevated (29.6 and 66 ng/mL). There was an involvement of the right ventricle in two cases and massive invasion of the pericardium and right atrium in one.…”

“…The most frequent site of cardiac metastasis was the right atrium ( n = 12; 54.5%), followed by the right ventricle alone ( n = 5; 22.7%) and right ventricular outflow tract ( n = 3; 13.7%); in two cases (9.1%) direct spread between the right ventricle and pericardium was observed …”

“…At presentation, the most frequent symptoms were venous congestion along with dyspnea and cachexia (13/14 reports; 92.8%) that directly correlated with the site of cardiac metastasis: right atrium in eight cases, followed by RVOT in three cases, right ventricle in two cases, and pericardial involvement in one case with RV myocardial invasion…”

“…Colorectal cancer metastases to the heart are rare. They can occur in concomitance with the primary tumor or after several months . Obstructive symptoms are the commonest clinical presentation .…”

“…They can occur in concomitance with the primary tumor 1-5 or after several months. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Obstructive symptoms are the commonest clinical presentation. 2,3,[6][7][8][11][12][13]15,18,21 In selected patients surgical resection is advisable, but remains a "symptomatic" operation with high mortality and morbidity.…”