Cardiac Metastasis in a Patient with Head and Neck Cancer: A Case Report and Review of the Literature

Kim, Joseph K.; Sindhu, Kunal K.; Bakst, Richard L.

doi:10.1155/2019/9581259

Cited by 13 publications

(11 citation statements)

References 27 publications

(17 reference statements)

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“…[ 7 ] In a literature review of cardiac metastasis of head and neck cancer detected ante-mortem, Kim et al reported 23 cases of which 12 were tumors of the tongue thus representing a large majority with 52%. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT

Delabie¹,

Evrard²,

Zouhry³

et al. 2021

Medicine

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Introduction: The most common malignancies metastasizing to the heart are cancers of the lung, breast, mesothelioma, melanoma, leukemia, and lymphoma. Cardiac metastasis from a tongue cancer is a rare finding and only a few cases have been reported previously in the literature. In this case report and literature review, we discuss the main clinical features of patients with cardiac metastases secondary to a tongue cancer and imaging modalities performed, especially the 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT). Patient concerns: This is a case of a 39-year-old woman who in April 2018 was diagnosed with an invasive well differentiated squamous cell carcinoma of the movable tongue. She underwent a left hemiglossectomy followed by a revision of hemiglossectomy and ipsilateral selective neck lymph nodes dissection levels II to III because of pathological margins. An early inoperable clinical recurrence was diagnosed and she received radiochemotherapy with good clinical and metabolic response. She remained asymptomatic thereafter. Diagnosis: In January 2020, a pre-scheduled 18 F-FDG PET/CT showed a diffuse cardiac involvement. In February 2020, a biopsy of the lesion revealed a metastatic squamous cell carcinoma. Interventions: She was deemed to not be a cardiac surgical candidate and treated by palliative chemotherapy: taxol-carboplatin associated with cetuximab then cetuximab alone because of adverse effects. A re-evaluation imaging performed in April 2020 evidenced a progression of the cardiac involvement, which led to switch chemotherapy by immunotherapy with nivolumab. Outcomes: This patient had a very poor prognosis and succumbed to major heart failure 4 months after the diagnosis of cardiac metastasis. Conclusion: In this case report, 18 F-FDG PET/CT proved to be useful in detecting cardiac metastasis and changed the therapeutic management of the patient. It suggests that patients with tongue malignancies in a context of poor initial prognosis should be followed-up early by 18 F-FDG PET/CT with HFLC diet to facilitate detection of recurrence.

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Section: Discussionmentioning

confidence: 99%

Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT

Delabie¹,

Evrard²,

Zouhry³

et al. 2021

Medicine

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“…In patients with lymphoma, the cardiac involvement is seen in 8–15% of the cases and most of them are of B cell origin [ 34 ]. Clinical manifestations are highly variable, including heart failure, arrhythmias, valvular disease, and cardiac tamponade [ 35 ]. Due to the varying clinical presentations of cardiac lymphoma metastases, the detection is often incidental.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic pitfalls: intramyocardial lymphoma metastasis mimics acute coronary syndrome in a diffuse large B cell lymphoma patient—case report

et al. 2021

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Background Cardiac tumors are very uncommon compared to other cardiac diseases. Their clinical symptoms can vary from absent to non-specific. The most common symptoms are arrhythmias, blood flow obstruction due to valvular dysfunction, shortness of breath, systemic embolization, and accumulation of pericardial fluid. Hereby, we describe a very rare case of a diffuse large B cell lymphoma patient who presented with the symptoms and signs of acute coronary syndrome (ACS) but the patient’s complaints were caused by his intramyocardial lymphoma metastasis. Case presentation Forty-eight-year-old diffuse large B cell lymphoma patient was admitted to our emergency department with chest pain, effort dyspnea, and fever. The patient had normal blood pressure, blood oxygen saturation, sinus tachycardia, fever, crackles over the left lower lobe, novum incomplete right bundle branch block with Q waves and minor ST alterations, elevated C-reactive protein, high-sensitivity troponin-T, and d-dimer levels. Chest X-ray revealed consolidation on the left side and enlarged heart. Bed side transthoracic echocardiography showed inferior akinesis with pericardial fluid. Coronary angiography showed no occlusion or significant stenosis. Chest computed tomography demonstrated the progression of his lymphoma in the myocardium. He was admitted to the Department of Hematology for immediate chemotherapy and he reached complete metabolic remission, followed by allogeneic hematopoietic stem cell transplantation. Unfortunately, about 9 months later, he developed bone marrow deficiency consequently severe sepsis, septic shock, and multiple organ failure what he did not survive. Conclusions Our case demonstrates a very rare manifestation of a heart metastasis. ACS is an unusual symptom of cardiac tumors. But our patient’s intramyocardial lymphoma in the right atrium and ventricle externally compressed the right coronary artery and damaged the heart tissue, causing the patient’s symptoms which imitated ACS. Fortunately, the quick diagnostics and immediate aggressive chemotherapy provided the patient’s remission and suitability to further treatment.

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“…In patients with lymphoma the cardiac involvement is seen in 8-15% of the cases and most of them are of B cell origin [25]. Clinical manifestations are highly variable, including heart failure, arrhythmias, valvular disease, and cardiac tamponade [26]. Due to the varying clinical presentations of cardiac lymphoma metastases the detection is often incidental.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Pitfalls: Intramyocardial Lymphoma Metastasis Mimics Acute Coronary Syndrome in A Diffuse Large B Cell Lymphoma Patient – Case Report

Prenek

Csupor

Besztercán

et al. 2020

Preprint

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Background: Cardiac tumors are very uncommon compared to other cardiac diseases. Their clinical symptoms can vary from absent to nonspecific. The most common symptoms are arrhythmias, blood flow obstruction due to valvular dysfunction, shortness of breath, systemic embolization, accumulation of pericardial fluid. Hereby, we describe a very rare case of a diffuse large B cell lymphoma patient who presented with the symptoms and signs of acute coronary syndrome (ACS) but the patient’s complaints were caused by his intramyocardial lymphoma metastasis.Case presentation: 48-year-old diffuse large B cell lymphoma patient was admitted to our emergency department with chest pain, effort dyspnea and fever. The patient had normal blood pressure, blood oxygen saturation, sinus tachycardia, fever, crackles over the left lower lobe, novum incomplete right bundle branch block with Q waves and minor ST alterations, elevated C-reactive protein, high-sensitivity troponin-T and d-dimer levels. Chest X-ray revealed consolidation on the left side and enlarged heart. Bed side transthoracic echocardiography showed inferior akinesis with pericardial fluid. Coronary angiography showed no occlusion or significant stenosis. Chest computed tomography demonstrated the progression of his lymphoma in the myocardium. He was admitted to the Department of Hematology for immediate chemotherapy and he reached complete metabolic remission, followed by allogeneic hematopoietic stem cell transplantation. Unfortunately, about 9 months later, he developed bone marrow deficiency consequently severe sepsis, septic shock and multiple organ failure what he did not survive.Conclusions: Our case demonstrates a very rare manifestation of a heart metastasis. ACS is an unusual symptom of cardiac tumors. But our patient’s intramyocardial lymphoma in the right atrium and ventricle externally compressed the right coronary artery, causing the patient’s symptoms which imitated ACS. Fortunately, the quick diagnostics and immediate aggressive chemotherapy provided the patient’s remission and suitability to further treatment.

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Cardiac Metastasis in a Patient with Head and Neck Cancer: A Case Report and Review of the Literature

Cited by 13 publications

References 27 publications

Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT

Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT

Diagnostic pitfalls: intramyocardial lymphoma metastasis mimics acute coronary syndrome in a diffuse large B cell lymphoma patient—case report

Diagnostic Pitfalls: Intramyocardial Lymphoma Metastasis Mimics Acute Coronary Syndrome in A Diffuse Large B Cell Lymphoma Patient – Case Report

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