Metastatic Squamous Cell Carcinoma to the Heart

Werbel, Gordon B.; Skom, Joseph H.; Mehlman, David J.; Michaelis, Lawrence L.

doi:10.1378/chest.88.3.468

Cited by 30 publications

(9 citation statements)

References 8 publications

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“…The mechanism of metastasis to the heart is not well understood. Hematogenous spread through the coronary arteries to the myocardium, direct contiguous extension, and retrograde spread through the lymphatic system have all been postulated as possible mechanisms [7]. In descending order of involvement, tumors typically metastasize to the pericardium, myocardium, epicardium, endocardium, and intracavitary regions [5, 8].…”

Section: Discussionmentioning

confidence: 99%

Right Heart Mass in Transit with a Hemorrhagic Pericardial Effusion: A Diagnostic Dilemma

Nanda

Khouzam

Jefferies

et al. 2019

Cureus

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Metastatic disease to the heart is more often a post-mortem diagnosis due to non-specific symptoms and a low index of suspicion. Our case is a unique presentation of a rare case of cardiac metastasis from oropharyngeal cancer, which eluded echocardiographic diagnosis despite the presence of a hemorrhagic pericardial effusion. The cardiac metastasis, in fact, starts as pericardial seeding, as illustrated by the positron emission tomography (PET) imaging. The pericardial metastatic disease then becomes rapidly invasive into the cardiac chambers, hence presenting as a large mass on the echocardiogram and computed tomography (CT) scan of the chest. This is the first such case of pericardial metastasis from a squamous cell carcinoma of the tongue being reported and highlights the importance of an aggressive multimodality diagnostic approach in cases where such a clinical suspicion exists. While a two-dimensional (2D) echocardiogram is the most readily available modality, we recommend that this is complemented by the use of a three-dimensional (3D) echocardiogram, as well as metabolic and radiologic imaging with PET and CT scans.

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Section: Discussionmentioning

confidence: 99%

Right Heart Mass in Transit with a Hemorrhagic Pericardial Effusion: A Diagnostic Dilemma

Nanda

Khouzam

Jefferies

et al. 2019

Cureus

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“…[7,8] It is currently accepted that cardiac metastasis can result from 4 mechanisms: direct extension, blood stream, lymphatic pathway, and intracavitary via inferior vena cava or pulmonary veins. [2] …”

Section: Discussionmentioning

confidence: 99%

“…[1] However, myocardial metastasis that originated from tongue carcinoma is much less common when compared with other malignancies (1% in head and neck cancers compared with 2–20% in others). [2–4] …”

Section: Introductionmentioning

confidence: 99%

Cardiac metastasis of tongue squamous cell carcinoma complicated by pulmonary embolism

Malekzadeh

Platon²,

Poletti³

2017

Medicine

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Rationale:Cardiac metastasis is known as a rare complication of head and neck malignancy.Patient concerns:We present a 58-year-old woman patient with a history of tongue carcinoma who was admitted in emergency department for sudden chest pain. Imaging work-up by computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) diagnosed a cardiac metastasis complicated by intraventricular thrombus and pulmonary embolism.Diagnosis:Cardiac metastasis from tongue carcinoma complicated by pulmonary embolism.Interventions:After undergoing 2 cycles of palliative chemotherapy, the patient declined any further treatment.Outcomes:Patient died 3 months after the diagnosis of cardiac metastasis.Lessons:Cardiac metastasis should be considered as a differential diagnosis in patients with a history of head and neck malignancy who present non-specific cardiac symptoms.

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“…Other reported cases include two cases from Nagata, et al of metastases to the pericardium, which proved fatal [ 7 ], and a report from Werbel, et al of a 61-year-old white woman with a prominence in the right ventricle pathologically shown to be metastatic from a base of the tongue primary [ 2 ]. In another report, Cheruvu, et al described a man with metastatic adenocarcinoma of an unconfirmed primary [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In most malignancies, cardiac metastases occur at rates between 2 and 20% [ 1 - 2 ]. For head and neck cancers, the incidence appears to be lower ( ~ 1%) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Solitary Myocardial Metastasis from Locoregionally Controlled Squamous Cell Carcinoma of the Oral Cavity

Martell¹,

Simpson²,

Skarsgard³

2016

Cureus

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We present the case of a 62-year-old male originally diagnosed with squamous cell carcinoma (SCC) of the right retromolar trigone, Stage cT2N2bM0. He was treated radically with a pharyngotomy and segmental mandibular resection, right selective neck nodal dissection, and then reconstruction with a free fibular flap. The pathologic stage was T4aN1. He then received adjuvant chemoradiation therapy with a radiation dose of 6,000 cGy in 30 fractions, along with cisplatin, 100 mg/m2 every three weeks.Good local control was repeatedly documented for two years. He then presented with shortness of breath and new-onset atrial fibrillation (AF) with rapid ventricular response. Computed tomography/pulmonary embolus protocol (CT/PE) showed no evidence of pulmonary embolism but did show a small pericardial effusion. His AF was refractory to medical management, and he was later admitted to hospital with congestive heart failure. He was found to have a large mass arising from the free wall of the right ventricle, a biopsy of which confirmed squamous cell carcinoma consistent with his head and neck primary. The patient declined further therapy and passed away within one month of presentation.This case is unusual in that the only known site of metastatic disease seen was to the myocardium of the right ventricle, presenting as cardiac arrhythmia and congestive heart failure. Although post-mortem studies show cardiac metastases to occur in 2 to 20% of cancer patients, it is rarely seen as a sole site of relapse in clinical practice.

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Metastatic Squamous Cell Carcinoma to the Heart

Cited by 30 publications

References 8 publications

Right Heart Mass in Transit with a Hemorrhagic Pericardial Effusion: A Diagnostic Dilemma

Right Heart Mass in Transit with a Hemorrhagic Pericardial Effusion: A Diagnostic Dilemma

Cardiac metastasis of tongue squamous cell carcinoma complicated by pulmonary embolism

Solitary Myocardial Metastasis from Locoregionally Controlled Squamous Cell Carcinoma of the Oral Cavity

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