Cardiac metastasis from yolk sac tumor: case report and review

Abstract

Cardiac metastasis of germ cell tumors is extremely rare, particularly in females. We report a case of a 26-year-old previously healthy woman who presented with a 5-month history of abdominal pain, weight loss, fever, generalized lymphadenopathy, and acanthosis nigricans. Biopsy of cervical lymph nodes revealed a poorly differentiated neoplasm. Immunohistochemical staining was positive for alpha-fetoprotein suggesting the diagnosis of a germ cell tumor. During the investigation, the patient developed heart failure and a mass attached to the right ventricle was detected by the echocardiogram. In a few days, she developed multiple organ failure and died. Post-mortem examination revealed a malignant mixed germ cell tumor of the right ovary with extensive hematogenic and lymphatic dissemination, a polypoid mass attached to the right ventricle, emboli in the endocardial and epicardial vessels, and infiltration surrounding the coronary arteries. To the best of our knowledge this is the third report of grossly visible heart metastases from a yolk sac tumor in a female patient. A summary of all published cases of germ cell tumors with cardiac metastasis over the last 20 years is also presented.

Metastatic testicular germ cell tumor with left atrial metastasis via the right pulmonary vein

“…Three case reports described patients with rapidly progressive disease who died within six months of diagnosis. 3,5 A favorable outcome was seen in a Turkish patient who had surgical resection of the left atrial mass. 6 The mechanism for intracavitary spread to the left atrium can be hematogenous via the pulmonary vein, 7 lymphatic, or contiguous spread from surrounding structures.…”

“…Cardiac metastasis arising from testicular germ cell tumors is rare. 5 Only twenty cases of testicular metastatic tumor extending from the pulmonary vein into any cardiac chamber have been reported in the literature. Of these, only four cases had left atrial involvement.…”

Right Ventricular Heart Failure from a Cardiac Yolk Sac Tumor

“…A review of the literature revealed two reports of primary intracardiac yolk sac tumors: a two-year-old male and a three-year-old female [ 9 , 10 ]. In 2013, Nunes et al published a comprehensive review of germ cell tumors with intracardiac involvement [ 11 ], totaling 18 cases including their own cases. Only four of these cases had discrete right ventricular involvement and all were metastatic disease.…”

“…Taghavi et al reported a non-seminoma, teratoma RV tumor in a 32year-old male; the tumor was not surgically resected but treated with chemotherapy [ 14 ]. Nunes et al reported a 26-year-old female with mixed germ cell tumor with yolk sac predominance found in the right ventricle [ 11 ]. This case held similarity to ours in that the metastasis was from a gonadal primary, which was eventually found on autopsy in the right ovary [ 11 ].…”

“…Nunes et al reported a 26-year-old female with mixed germ cell tumor with yolk sac predominance found in the right ventricle [ 11 ]. This case held similarity to ours in that the metastasis was from a gonadal primary, which was eventually found on autopsy in the right ovary [ 11 ].…”