Invasion of poorly differentiated large‐cell neuroendocrine tumor of the lung through right pulmonary veins into the left atrium: A very rare case report

Abstract

Intracavitary cardiac metastasis is a rare manifestation of primary lung cancer which can be associated with a very poor prognosis. In this condition, the right chambers of the heart are more commonly involved and the invasion of the left atrium (LA) through the venous routes is highly exceptional. Poorly differentiated large-cell neuroendocrine tumors also include only 3% of all primary lung carcinomas which can have adverse outcomes. Therefore, in this report, a rare case of a 72-year-old male patient with poorly differentiated large-cell neuroendocrine carcinoma of the right lung spreading to the LA through the right pulmonary veins was described.

Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach

“…50 Left atrial tumors occupying also one or more pulmonary veins may be an extension of lung cancer, cardiac or other intrathoracic tumors. [51][52][53][54][55][56][57] Cardiac lymphomas may occupy any cardiac chamber or the pericardial space and show usually a very fast growth (Figure 4).…”

“…The tumors arising in the pulmonary artery or in the aorta are usually intimal sarcomas; in other cardiac cavities (atria, ventricles) the most frequent histotype are spindle cell sarcoma and leiomyosarcoma 50 . Left atrial tumors occupying also one or more pulmonary veins may be an extension of lung cancer, cardiac or other intrathoracic tumors 51–57 …”

“… 50 Left atrial tumors occupying also one or more pulmonary veins may be an extension of lung cancer, cardiac or other intrathoracic tumors. 51 , 52 , 53 , 54 , 55 , 56 , 57 …”

Cardiac Metastatic Tumors

“…6,9,10 Secondary malignant tumors in the heart tend to be located in the pericardium or myocardium, whereas intracavital location is rare. [11][12][13] According to Ziccardi et al, 5 in an autopsy series, the incidence of metastatic cardiac tumors among patients with cancer diagnosis was ∼20%. In theory, metastases can be caused by any malignant neoplasm, but the most common carcinomas that metastasize to the heart are listed in Table 1.…”

“…1,5,14 Masses can spread by direct tumor invasion, by lymphatic vessels, veins, or arteries. 5,12,15,16 Lymphogenous transmission in most cases affects pericardial metastases, whereas hematogenous spread tends to cause myocardial secondary tumors. 1 Breast, esophageal, and lung cancers in most cases spread directly or by lymphatic veins.…”