Right Ventricular Outflow Obstruction Due to Metastatic Neuroendocrine Tumor

Abstract

Neuroendocrine tumors (NETs) are rare malignant tumors that arise from neuroendocrine cells of the gastrointestinal tract and often metastasize to the liver, lung, and bone. Cardiac metastasis of NETs is uncommon. We report a patient with a past medical history of a neuroendocrine tumor of the left femur presenting with signs and symptoms of new onset heart failure. Transthoracic echocardiogram and cardiac magnetic resonance showed a large mass within the right ventricle causing right ventricular outflow obstruction. A positron emission tomographic/computed tomographic scan (PET-CT) revealed increased uptake of fluorodeoxyglucose (FDG) activity within the right ventricle consistent with metastasis. Cardiac biopsy of the right ventricular mass revealed metastatic nonfunctioning neuroendocrine tumor. In view of the fact that it was a tumor that caused the right ventricular obstruction, the patient was started on chemotherapy with improvement of symptoms. This case highlights that in patients with a history of neuroendocrine tumor presenting with heart failure, cardiac metastasis should be included in the differential.

A Right Ventricular Mass With Intracavitary Obliteration: Tumor or Thrombus?

“…Despite the poor prognosis, there are also publications stating that tumor resection with open heart surgery should be performed in such patients. It is stated that tumor resection prolongs life expectancy, improves the clinical picture, and prevents tumor and/or thrombus embolism [7,15].…”

Case report: Right ventricular outflow tract obstruction caused by multicomponent mesenchymal tumor

“…We reviewed the literature on RVOTO caused by cardiac tumors reported in the past decade ( Table 1 ). In terms of tumor types, the literature reported primary tumors such as fibroma ( 12 ), leiomyoma ( 13 ), hemangioma ( 17 ), rhabdomyoma ( 20 ), and metastatic cardiac tumor from sigmoid colon cancer ( 16 ), testicular tumor ( 15 ), neuroendocrine tumor ( 25 ) etc. Interestingly, tumors not located in the right ventricle can also cause obstruction, such as tumors located in the right atrium, interventricular septum, and anterior mediastinum ( 24 , 32 , 33 ).…”

A concealed carcinoid cardiac metastasis uncovered by comprehensive cardiovascular magnetic resonance-based tissue characterization: a case report

“…Several works have provided insights on the use of different imaging modalities to this end, varying from the readily available echocardiogram, 6 to the traditional In-111 Octreotide 7 or positron emission tomography 8 to CMR, 9 or combinations thereof. 10–12 Occasionally, biopsy of the mass is necessary for the diagnosis, 13 or the diagnosis is made post-mortem. We report here on multiparametric CMR approach, which in combination with by In-111 Octreoscan SPECT/CT, allowed us to achieve the final diagnosis.…”