Unusual Secondary Tumour of Heart

Abstract

Secondary tumours of the heart are not uncommon. Hudson (1965) gives a full bibliography. The degree and site of involvement, however, are variable. They may occur in widely disseminated neoplasms such as melanomas and lymphoblastomas, or be the result of tumours with a tendency to grow along veins. The latter may extend into the atrium; this appears to be less rare on the right than on the left side of the heart. Willis (1953) quoted Herzog (1917) who described a teratoma of testis which passed through the inferior vena cava to the right atrium and ventricle, and he himself reports that some cases of renal carcinoma and of chondrosarcoma have been described, extending through the inferior vena cava into the right side of the heart and even into the pulmonary arteries. Willis noted, however, that the pulmonary veins were invaded by tumour only rarely. In view of the rarity of invasion of the pulmonary vein by tumour tissue the surprising findings at necropsy in our case prompted us to make this brief report, particularly since in retrospect they probably explain the sudden onset of heart failure not understood by us at the time of its occurrence. Case ReportA 38-year-old man was admitted to Stobhill Hospital, Glasgow, on April 21, 1965 with polyarthritis. For some four months he had had recurring pain in the right shoulder and elbow joints and both ankle joints.Over this period he had experienced frequent severe sweats. There had been no significant change in weight. He had a cough which he attributed to a heavy cigarette consumption of up to 40 a day, but he had not noticed anything unusual about the character of sputum.There was striking finger-clubbing and some thickening of the right wrist. There was wasting of the right deltoid muscle. Clinical signs of consolidation were noted in the right upper lobe. The chest x-ray film was unusual; it showed two large homogeneous opacities in the upper'part of the right lung field (Fig. 1). The lateral view showed that one of them was in the apical segment and the other in the anterior segment of the right upper lobe. The right lobe of the diaphragm was raised.The diagnosis was made of intrapulmonary tumour of doubtful aetiology, pulmonary osteoarthropathy, and ? carcinomatous neuropathy. He was anemic (Hb-8-9 g./100 ml.). His sedimentation rate was 133 mm. in one hour, and his temperature was raised. His main complaint in the first few days after admission was of pain in the shoulder and wrist joints. The chest x-ray appearances prompted a search for a primary focus outside the lungs but none was found in breast, thyroid, kidneys, or alimentary tract. Bronchoscopy was not carried out, because the surgeon, like ourselves, was of the opinion that the lung involvement was almost certainly secondary, and because the patient was extremely distressed and dyspnoeic when seen by him four days after admission. He had become dramatically more dyspnaeic in these four days, and signs of rightsided heart failure had developed. This we were unable to explain on clinical grounds. H...

Advanced Bronchogenic Carcinoma Presented as Cardiac Tamponade

“…9 The most common sites of cardiac metastasis, regardless of the primary tumor's origin, are the pericardial layers and the myocardium, originating arrhythmias. 3,5 In this case, sudden death due to cardiac tamponade may be the first manifestation of an advanced metastatic disease. 9 As soon as metastasis is eliminated to pericardium, hemorrhagic or serosanguineous pericarditis may be apparent.…”

“…4 They arise mainly from the interatrial septum and expand into the left atrium. 5 Despite their frequency, metastatic heart tumors rarely gain clinical attention. Even rarer are granular cell tumors, mesotheliomas, and lymphangiomas.…”

“…They may be multifocal with limited expansion or they may form a large mass. 5 The presence of symptoms depends on the localization of the metastatic lesion and not on the histological type of the tumor. 5 Cardiac metastases often occur or become symptomatic in elderly individuals after the sixth and the seventh decade of life, with no sex preference.…”

“…5 Cardiac metastases often occur or become symptomatic in elderly individuals after the sixth and the seventh decade of life, with no sex preference. 3,5 In these cases, symptoms such as cardiac murmurs do not generate any concern to the patient, especially if a cardiac disease with overlapping clinical appearance and symptoms has been diagnosed. 9 The most common sites of cardiac metastasis, regardless of the primary tumor's origin, are the pericardial layers and the myocardium, originating arrhythmias.…”

Left atrial metastasis of chorion carcinoma, presenting as mitral stenosis.

“…A metastatic cardiac tumour seemed unlikely, since there was no clinical evidence of a primary tumour. Lymphatics and veins function as pathways for the metastasising chorion carcinoma (Hanfling 1960;Rogen and Moffat, 1967). Apparently, the left atrial metastasis was initially attached to the atrial endocardium after having passed the pulmonary circulation, and extended from there backwards into the pulmonary veins.…”