Case report—right atrial mass: a very rare presentation of endometrial cancer metastasis

Abstract

Background We report a case of a 47-year-old woman with right atrial metastasis of endometrioid adenocarcinoma, which is an uncommon clinical presentation for patients with endometrial cancer (EC). The principal aim of this case is to demonstrate the possibility of distant metastasis, something rarely encountered among this group of patients. Case Summary Our patient, diagnosed with EC, and receiving chemotherapy, and radiotherapy after surgery, was found to have enhanced 18-FDG (Fluorodeoxyglucose) uptake inside the right atrium on the repeat PET-CT (positron emission tomography and computed tomography) scan at the 9th month after initial diagnosis. Following transesophageal echocardiography, cardiac magnetic resonance imaging showed a hyper-vascular mass with right atrial lateral wall involvement likely to be malignant in nature. A right atrial tumor was successfully removed by cardiovascular surgeons, and a pericardial patch was placed at the site of the excised atrium. The pathological examination showed EC metastasis. Following surgery, systemic treatment was planned for recurrent EC. The patient had an uneventful recovery after the surgery. Discussion Endometrial cancer is the most common gynecologic malignancy and the fourth most common cancer in women. The lymphatic pathway is the main metastatic behavior of EC; however, hematogenous metastases are not uncommon, especially in patients with higher stages of the disease. Our patient did not show any signs and symptoms of cardiac involvement. Nevertheless, clinicians should be alert for symptoms of cardiac involvement like new-onset murmur, embolism, or dyspnea. Having known the behavioral pattern of the primary tumor, timely utilization of diagnostic imaging methods in accordance with clinical suspicions in patients with rapidly growing tumors can be lifesaving.