Unusual sites of metastatic involvement: intracardiac metastasis from laryngeal carcinoma

Cardiac metastatic squamous cell laryngeal carcinoma is rare.We report the case of a 49-year-old man with recurrent squamouslaryngeal carcinoma presenting with right leg acute ischaemiaand large mobile right and left cardiac masses. The patienthas history of laryngeal squamous cell cancer surgically treatedwith total laryngectomy, thyroidectomy, and tracheostomy 2 yearsago. He was admitted to our intensive care unit with acute rightleg pain, left sided chest pain, hypotension 92/55, and tachycardia112 bpm. On physical exam, he had a faint pulse of his rightPosterior Tibial artery with a cold foot, but no discoloration.Heart sounds were normal with no murmur. Initial workup showeda Troponin of 0.27. An electrocardiogram showed sinus tachycardia,with inverted T waves in the Infero-lateral leads. Emergentsurgical thrombectomy was done on his right leg with restorationof arterial blood flow to the affected limb. An echocardiogramshowed a preserved left ventricular function with multiple areasof echogenic masses in all four cardiac chambers located atthe annulus of the tricuspid valve, the right ventricular freewall and along the inter-ventricular septum. No intracardiacshunt was detected by contrast study. Computed tomography scanof the heart confirmed the presence of multiple exophytic intracardiacmasses within the left atrium, the right ventricle, interventricularseptum, and lateral free wall of the left ventricle. Immunohistochemicalstaining with cytokeratin of the emboli was consistent withmalignant squamous cell carcinoma consistent with metastasesof his known laryngeal squamous cell cancer.