Small cell carcinoma presenting as a biatrial mass with obstructive physiology: a case report

Abstract

Background Small cell carcinoma is a highly aggressive and often fatal cancer that most commonly arises in the lung, although it can occasionally arise from other sites, such as the gastrointestinal tract, prostate or cervix. Cardiac involvement, however, is extremely uncommon and therefore has been poorly documented in the literature. Case presentation We describe a rare case of a 31-year-old male with small cell carcinoma presenting as a massive, 15-cm cardiac tumor invading the bilateral atria, interatrial septum, and pericardium without an apparent primary malignancy on PET CT and cardiac MRI. With extensive tissue necrosis, traditional methods of obtaining a right atrial endomyocardial biopsy via internal jugular venous access failed and a diagnosis was made via endoscopic ultrasound guided transesophageal fine needle aspiration of the left atrial mass. Due to the extensive tumor invasion, the patient was not a suitable candidate for surgical resection, debulking, or heart transplant. The patient was treated with etoposide, carboplatin, atezolizumab, and radiation therapy with initial monitoring in the intensive care unit due to concern that tumor lysis may cause rapid cardiac decompensation. Unfortunately, 4 months after chemoradiation therapy, the malignancy progressed and the patient passed away 6 months after the initial diagnosis. Conclusion We describe a rare occurrence of small cell carcinoma presenting as a massive cardiac tumor without apparent primary malignancy. This case demonstrates useful alternative diagnostic strategies and treatment considerations for patients presenting with a rare cardiac mass.

An extensive surgical resection in stage T4 small cell lung cancer with cardiac invasion: A case report and literature review

“…A case reported by Kim, A. C., et al did not include information about the treatment and its outcome [ 12 ]. Similarly, in the case reported by Ratican, S et al the primary lung foci were not seen and were presumably too small to be detected by MRI or PET/CT [ 13 ]. Of the remaining cases with cardiac metastases, 3 cases had concurrent brain metastases, 1 case had extensive liver, intestinal, and bone metastases, and 1 case had local rib metastases.…”

“…After an extensive search, we discovered that none of the 7 precedents reported cases involving cardiac invasion of SCLC had surgical resection of the lung cancer ( Table 1 ) [ [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. Most patients were not eligible for surgery because of poor health or the presence of multiple extrapulmonary metastases.…”

Difficulty in Diagnosing Rare Cardiac Tumors: A Case Series

“…However, other cancers, such as melanoma, also tend to metastasize to the heart [2]. Cardiac involvement by small cell cancer, either via primary tumor or metastatic disease, is rare and only documented sporadically by several case studies [3][4][5][6]. Although in case 2, the initial pathology report stated "small cell carcinoma suspecting from pulmonary metastasis," no identifiable pulmonary primary tumor was found on either the PET scan, CT scan, or MRI of the chest.…”