Metastatic tumor of the heart from gall bladder cancer detected by echocardiography: a case report

Cardiac metastases have been reported increasingly partly because of the longevity of cancer patients, but its antemortem diagnosis is frequently missed. This is due to the nonspecific clinical manifestations or relative lack of characteristic signs which are masked by the underlying disease. This is a report of a 42-year-old man diagnosed as having a metastatic cardiac tumor by echocardiography, six months after operation for squamous cell carcinoma of the gall bladder. Echocardiography revealed abnormal structures in the regions of the posterior and lateral walls of the left ventricle and interventricular septum, suggesting metastatic tumors. The cytological findings of a fine-needle aspiration biopsy specimen were squamous cell carcinoma. The patient died of cardiac failure eight months after the echocardiographic diagnosis. At autopsy, the abnormal structures in the heart were identified as cardiac metastatic tumors from gall bladder cancer. Reports of cardiac metastasis of gall bladder cancer is very rare (0-3%). The myocardial metastasis may have a more serious prognostic importance than the primary neoplasm itself; thus, its definite diagnosis is mandatory.     

Cardiac metastasis from epidermoid esophageal cancer mimicking anterior myocardial infarction

Cardiac metastases are more common than primary tumors. Several types of malignant tumors have been reported to metastasize to the heart, mainly lung cancer, but in the setting of esophageal cancer, myocardial metastasis is comparatively rare. We report a case of a cardiac metastasis from esophageal squamous cell carcinoma detected 9 months after surgically curative esophagectomy, which presented mimicking acute myocardial infarction. The use of different imaging modalities was fundamental to a correct diagnosis considering the challenging presentation.     

Metastatic squamous cell carcinoma to the heart. Unusual cause of angina decubitus and cardiac murmur

A 61-year-old woman was admitted to the hospital with the new onset of angina at rest and an ECG consistent with anterior wall ischemia. She was also noted to have a new cardiac murmur. Eighteen months earlier, she had been treated for squamous cell carcinoma of the base of the tongue. Thirteen months ago, she had local recurrence treated with radiotherapy, but had no evidence of recurrent or metastatic disease at the time of present admission. Echocardiography revealed intracardiac and extracardiac masses; surgical biopsy confirmed metastatic carcinoma to the heart which was responsible for her symptoms and the new murmur. Symptomatic cardiac metastases from squamous cell carcinoma is an unusual situation which, in this case, was easily diagnosed with echocardiography.     

Two-dimensional echocardiographic findings in cardiac trauma

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The diagnosis is obscured because cardiac contusion usually occurs in a setting of multisystem trauma. Furthermore, the electrocardiographic changes are nonspecific. Experience with 2-dimensional echocardiography in evaluating cardiac trauma has not previously been emphasized. This report examines the results of 2-dimensional echocardiographic examinations in 7 patients after significant blunt chest trauma. Generalized right ventricular dilatation was identified in 4 cases; superimposed segmental areas of right ventricular dilatation occurred in 3. Three patients had localized myocardial thinning, and segmental wall motion abnormalities occurred in 2. Additional abnormalities identified included ventricular thrombi (4 right and 1 left ventricular), fibrinous pericardial effusion (1), ruptured tricuspid chordae with flail leaflet (1), and a small aneurysm of the sinus of Valsalva (1). It is concluded that 2-dimensional echocardiography is useful for diagnosing cardiac contusion, for estimating the extent of myocardial damage, and for identifying accompanying cardiac lesions such as thrombi, pericardial effusion, and valvular disruption.     

Cardiac metastasis due to pulmonary metastasis from a transitional cell carcinoma

We report a rare case of symptomatic cardiac metastasis froma transitional cell carcinoma of the renal pelvis diagnosedby echocardiography. A 75-year-old patient with a long historyof neoplasm since 1999 and coronary artery disease with CABGin 2003, was admitted to our department. He underwent cardiacsurgery using cardiopulmonary bypass with tumor excision. Histologicallyit was the same type of transitional cell neoplasm which wasoperated seven years before. We present all medical history, detailed 2D and 3D echocardiography,intraoperative pictures and discuss possible chain of changesfrom renal pelvis cancer to clinical manifestation of cardiacmass. There is proved a rapid progression of cardiac tumor withclinical manifestation few months after control TEE examinationwithout any evidence of cardiac mass. It is important that thisis a very rare case of left heart metastasis from right sideof circulatory system through pulmonary stage of cancer progression.     

Echocardiography as a first diagnostic step in kidney tumours

Intracardiac tumours are usually found after clinical symptoms lead to a positive imaging study, or as an incidental finding of imaging study, usually echocardiography. Cardiac tumours range from non-neoplastic lesions to high grade malignancies. The majority of primary cardiac tumours are myxomas (in 75% cases) or sarcomas (about 10% cases). In this paper we present cases of 2 patients with right atrial tumour, extending from renal carcinoma, invading renal vein and inferior vena cava into right atrium. Two different therapeutic strategies were undertaken in those patients.     

Endotracheal metastasis from basaloid squamous carcinoma of the esophagus

Endobronchial metastases from extrapulmonary neoplasms are rare events, and there is no report in the literature of metastasis originating from esophageal cancer. Basaloid squamous carcinoma of the esophagus is a rare histologic type that is known to be a biologically aggressive phenotype. We describe a rare case of metachronous endotracheal metastasis originating from esophageal basaloid squamous carcinoma. A 72-year-old Japanese man underwent esophagectomy for stage I esophageal cancer. Pathological diagnosis of the resected specimen was basaloid squamous carcinoma. One year later, a follow-up computed tomography scan displayed a tumor shadow in the tracheal wall. Bronchoscopy revealed a protruding tumor in the tracheal wall, and the pathologic diagnosis of the biopsy specimen was also basaloid squamous carcinoma. According to the diagnosis of metachronous endobronchial metastasis from esophageal basaloid squamous carcinoma, we treated the patient with chemotherapy comprising docetaxel, cisplatin, and 5-fluorouracil followed by chemoradiotherapy, and complete response was achieved. The patient has not suffered a recurrence of the disease for 23 months since the diagnosis of the endobronchial tumor. Careful follow-up is needed to ensure that rare types of metastasis are not missed in cases with biologically aggressive tumors.     

Intracardiac thrombus formation in association with hydatid disease

Cardiac hydatid disease is rare, but life threatening. A pedunculated hydatid cyst which mimicked a left atrial myxoma was diagnosed on two-dimensional echocardiography. The degree of cardiac involvement at necropsy was much greater than indicated by either echocardiography or limited cardiac catheterization. The suggestion that only echocardiography be performed before surgery is undertaken may be inappropriate in many cases.     

Left ventricular intracavitary mass and pericarditis secondary to metastatic renal cell carcinoma--a case report

Cardiac metastases from renal cell carcinoma are a well-recognized entity. However, this phenomenon is extremely rare in the absence of vena caval extension. The authors report a patient who after successful resection of renal cell carcinoma presented with left ventricular mass causing left ventricular outflow tract obstruction. There was also metastatic pericardial and intramyocardial involvement. Such a unique combination of cardiac metastasis, in the same patient, has not been reported previously.     

Cardiac metastasis from squamous cell carcinoma of gallbladder

A 65-year-old woman was admitted to our hospital with the diagnosis of gallbladder tumor. Right extended hepatic lobectomy plus lymph node dissection of the hepatoduodenal ligament and left hepaticojejunostomy with Roux-en-Y reconstruction was performed in July, 1993. The gallbladder tumor was histologically proven to be squamous cell carcinoma. Seventeen months later, the patient experienced dyspnea and pitting edema of the lower legs and was admitted, in December 1994, with a diagnosis of heart failure. Despite intensive cardiac support, she died 12 days after the second admission. Autopsy revealed multiple cardiac tumors in the left and right ventricles, left atrium, left coronary artery, and left diaphragm. Histologically, these tumors were shown to be squamous cell carcinoma, considered to have metastasized from the primary gallbladder carcinoma. As neither local recurrence of the gallbladder carcinoma. As neither local recurrence of the gallbladder carcinoma nor any lymph node metastasis was found, the cardiac metastasis of the gallbladder carcinoma may have occurred via the hematogenous route. Although rare, this route of cardiac metastasis of gallbladder carcinoma may be an important aspect of distant metastasis, which should be monitored for during follow-up after resection of the primary tumor.     

Increased incidence of carcinoma of the tongue in patients with systemic sclerosis

OBJECTIVE: To describe the incidence of carcinoma of the tongue in a large cohort of patients with systemic sclerosis (SSc). METHODS: In total, 769 patients with SSc were prospectively followed over 16 years for the development of cancer. Patients with a diagnosis of carcinoma of the tongue were identified to determine the incidence of this cancer in SSc. The results were compared to the incidence of tongue cancer in the SEER cancer registries. RESULTS: A total of 3775 patient-years of followup of 769 patients with SSc (392 diffuse cutaneous, 377 limited cutaneous) prospectively evaluated for the occurrence of cancer disclosed 9 patients who were diagnosed with oral cavity and pharyngeal carcinomas. Six of these patients had squamous cell carcinoma of the tongue. One of these had both pharyngeal and tongue squamous cell carcinomas within a 4-year period, and another had 3 separate squamous cell carcinomas of the tongue. The standardized incidence ratio of squamous cell carcinoma of the tongue observed in this cohort of patients with SSc was 25-fold higher than that expected in an age adjusted population from the SEER cancer registries. All patients with SSc identified within this cohort with oral cavity carcinomas had the diffuse subset of the disease. CONCLUSION: There is a highly significant increase in the incidence of squamous cell carcinoma of the tongue in patients with SSc. A remarkable observation was that all patients within this cohort who developed oral cancer had the diffuse subset of SSc. This suggests a relationship between the etiology or pathogenesis of the diffuse form of SSc and development of squamous cell carcinoma of the tongue in this group of patients.     

Radical surgery for advanced pure squamous cell carcinoma of the gallbladder: report of a case

Squamous cell carcinoma (SCC) of the gallbladder is frequently detected at an advanced stage because of its tendency to infiltrate adjacent organs. In addition, more rapid growth of this type of carcinoma compared to that of adenocarcinoma, the most frequent subtype of gallbladder carcinoma, has been reported. Although it is not rare to find squamous cell carcinoma components in cases other than the usual adenocarcinoma of the gallbladder, these cases must be distinguished from those of pure squamous cell carcinoma, as diagnosed in the present case. Pure squamous cell carcinoma is characterized by a well-localized growth, no visceral metastasis, and a rarity or lack of lymph node metastasis, even when the tumor has grown to a large size locally. Prognosis of SCC of the gallbladder has generally been considered poor. Nevertheless, long-term survival after curative resection in patients with SCC of the gallbladder has been sporadically reported. We performed extended right hemihepatectomy with portal vein resection after portal vein embolization for a 55-year-old woman with advanced SCC of the gallbladder. The patient has not developed any signs of recurrence 40 months after the surgery. Although such radical surgery remains challenging, it may lead to a favorable outcome in selected patients with advanced SCC of the gallbladder.     

Left atrial spindle cell sarcoma: A case report and literature review

Rationale:Cardiac primary spindle cell sarcoma is 1 of the rarest cardiac malignancies, with only a few cases reported so far. Herein, we reported a case of left atrial spindle cell sarcoma diagnosed and treated by a multidisciplinary approach, and retrospectively reviewed other reported cases.Patient concerns:A 49-year-old woman presented to our hospital with 2 weeks of gradual onset of dyspnea on exertion, dry cough and subacute fever.Diagnosis:The patient was initially revealed a left atrium mass by 2-dimensional transthoracic echocardiography. Based on the contrast-enhanced echocardiography and cardiac magnetic resonance imaging, she was subsequently suggested to have a cardiac malignant tumor. And the post-operative histopathology confirmed the tumor to be a cardiac primary spindle cell sarcoma.Interventions:The tumor was completely resected using autotransplantation. The patient was referred for polychemotherapy afterwards.Outcomes:Our patient underwent the tumor resection, with subsequent adjuvant polychemotherapy, and the tumor has not recurred during 12 months of follow-up.Lessons:Due to the rarity of these tumors and nonspecific symptoms, they are often difficult to diagnose preoperatively and missed occasionally. Thus, improving our understanding of the disease and facilitating its early diagnosis are essential.     

Anaplastic thyroid carcinoma with prominent cardiac metastasis, accompanied by a marked leukocytosis with a neutrophilia and high GM-CSF level in serum.

Cardiac metastasis of thyroid carcinoma is extremely rare. We treated a case of anaplastic thyroid carcinoma with prominent cardiac metastasis. The 61-year-old male was admitted because of high fever. Investigations revealed a cardiac mass and anaplastic thyroid carcinoma. Resection of the cardiac mass revealed that it was metastasis from the thyroid carcinoma. After 4 months, he died in spite of intensive therapy. Marked leukocytosis was observed during the clinical course, and a concomitant increase of granulocyte macrophage-colony stimulating factor (GM-CSF) level was demonstrated in the sera. It was suggested that the high GM-CSF level in serum contributed to leukocytosis.     

Renal Cell Carcinoma,Metastatic to the Left Ventricle

Left ventricular metastases from renal cell carcinoma without vena caval or right atrial involvement are extremely rare. Herein, we present the case of a 69-year-old man who had undergone radical nephrectomy for renal cell carcinoma in 1984. Eighteen years thereafter, we discovered metastatic disease in his left ventricle.When the metastasis was identified, the patient had no symptoms other than shortness of breath. He underwent surgical removal of a highly vascular mass from the left ventricular wall and resection of a nodule in the upper right pulmonary lobe. Upon pathologic examination, both tumors were metastatic renal cell carcinomas. The patient recovered uneventfully and was free of cardiac recurrence more than 6 years after the surgery. We describe our treatment of this patient and discuss some current approaches to the treatment of renal cell carcinoma that has metastasized to the heart.Key words: Carcinoma, renal cell/complications/pathology/secondary/surgery; coronary disease/etiology/surgery; heart neoplasms/diagnosis/secondary; heart ventricles; neoplasm invasiveness; time factors; treatment outcomeCardiac tumors are extremely rare, and metastatic disease that involves the heart is 20 to 40 times more frequent than are primary cardiac malignancies.¹ The most common secondary tumors of the heart originate from leukemia, melanoma, lung cancer, breast cancer, and lymphoma. Cardiac metastases from renal cell carcinoma (RCC), which are extremely rare, usually occur in either of 2 circumstances. First, advanced RCC characteristically extends into the renal vein and the inferior vena cava in 5% to 15% of patients, and into the right atrium in about 1% of patients, thereby obstructing venous return to the heart (1).^2,3 Second, there can be a primary tumor that metastasizes to the heart, which occurs in 10% to 20% of patients who are dying of widespread, systemic RCC. However, in the absence of either direct vena caval extension or systemic disease, involvement of the heart is extremely rare, with only 1 known report thereof in the medical literature.⁴ Here, we present the case of a 69-year-old man who experienced metastasis of RCC to the left ventricle and to the upper right lobe of the lung. We discuss our treatment of this patient, along with current surgical and therapeutic approaches to the treatment of RCC that has metastasized to the heart.     

Cardiac metastasis from a Merkel cell skin carcinoma. A case report

The authors report the case of a cardiac metastasis of a Market cell skin tumour in a 72 year old woman, presenting with chest pain and infero-lateral myocardial ischaemia simulating an acute coronary syndrome. The diagnosis, suspected on echocardiography, was confirmed by thoracic CT scan. Markel cell carcinoma is a rare skin tumour classified among the malignant neuroendocrine tumours. It has a high metastatic potential, especially to the gastrointestinal tract and the lung. On the other hand, cardiac metastases are quite exceptionally rare.     

Two cases of superficial basaloid squamous carcinoma of the esophagus

. Basaloid squamous carcinoma of the esophagus is very rare. We report two cases of basaloid squamous carcinoma of the esophagus. Both tumors histologically consisted of solid cell nests with intervening fibromyxoid stroma. In some tumor nests were comprised of pseudoglandular structures containing myxoid matrix, and displayed focal immunoreactivity for laminin. Thoracic esophagectomy with lymph node dissection was followed by intrathoracic esophagogastrostomy in both patients. The patients had uneventful postoperative courses. Regular periodic follow-up showed no evidence of recurrence or metastasis in the 22-month postoperative period.     

Extrathoracic staging of bronchogenic carcinoma

In assessing the value of systematic evaluation of extrathoracic extension for potentially resectable, non-small-cell bronchogenic carcinoma, a prospective study was conducted in 146 patients. The study protocol included computed tomographic (CT) scan of the brain and upper abdomen, abdominal ultrasonography, and whole-body bone scanning. The findings were matched with the clinical presentation, histologic features, and TN staging, having found out that non-small cell bronchogenic carcinoma does not follow a set pattern to metastasize. The rate of metastasis for adenocarcinoma is not only significantly larger (p less than 0.05) but it does not correlate with the TN staging, in contrast to what happens with the squamous cell carcinoma (p less than 0.01). None of the squamous cell carcinomas in intrathoracic stage I was found to metastasize. Twenty-one percent (4/19) of brain metastases were asymptomatic (three adenocarcinomas and one squamous cell carcinoma with multiorgan metastasis). Bone scanning detected metastasis in 3.4 percent (4/116) of the asymptomatic patients, and three of the four patients with asymptomatic metastasis had nonskeletal foci. In 61 percent (11/18) of patients with hepatic metastasis, we did not find organ-specific indicators to suspect it. The series showed a 7.5 percent incidence of adrenal metastasis. Our findings suggest the convenience of performing an upper abdominal CT scan and/or ultrasonography in all patients, except for those with asymptomatic stage I squamous cell carcinoma; we also suggest brain CT scanning for all patients with adenocarcinomas and large-cell carcinomas as well as for those with squamous cell carcinoma with neurologic symptoms, and whole-body bone scanning only in those patients with clinical and laboratory indication of possible bone involvement by metastatic disease.     

食管癌中细胞粘附分子E-钙粘素和CD44变异体表达及其临床意义

目的　探讨细胞粘附分子E 钙粘素 (E CD)和CD44变异体 (CD44V6)的表达与食管癌临床病理及预后的关系。方法　对 5 8例食管癌标本应用SP免疫组化染色法进行E CD、CD44V 6检测 ,并对其中 42例进行术后 3年随访。结果　E CD低表达和CD44V 6高表达与食管癌的浸润转移、复发和预后相关 (P <0 .0 5 )。E CD低阳性表达率与食管癌细胞分化程度相关 (P <0 .0 5 )。食管癌中E CD和CD44V6的表达无相关性 (P >0 .0 5 )。结论　E CD和CD44V 6在食管癌中的表达与食管癌的发生发展、侵袭转移和预后密切相关 ,E CD和CD44V6在食管癌中的表达无相关性 ,在食管癌的发生、发展、侵袭转移中是 2个独立的调节因子 ,可视为预测侵袭转移和估计预后的重要参考指标     

Echinococcal cyst of the interventricular septum with right ventricular protrusion

Although echinococcosis (echinococcal hydatidosis) is common in sheep-raising countries such as Turkey, cardiac involvement is rare; the presence of a hydatid cyst in the interventricular septum is rarer still. We report a case of hydatid cyst of the interventricular septum that was first revealed by 2-dimensional echocardiography and then confirmed by right ventricular angiography. The cyst was removed surgically under cardiopulmonary bypass. Within the context of the medical literature concerning this rare lesion, we discuss this case and 10 other cases of cardiac hydatidosis, previously unreported in the world literature, that we have treated from January 1967 through January 1987.