External beam irradiation of myocardial carcinoid metastases: a case report

Abstract

The heart is an exceedingly rare site of metastatic involvement in carcinoid tumors. Only nineteen cases have been described in the literature over the past 30 years. We report here on a patient who presented with progressive carcinoid syndrome despite surgical resection of her liver metastases. She was found to have cardiac metastases on inidium-111-pentetreotide scintigraphy and subsequently underwent external beam radiation to the heart resulting in symptomatic palliation of her syndrome and objective radiographic response. To our knowledge, this is the first reported case of metastatic cardiac carcinoid treated with external beam irradiation.

A Matter of the Heart: Myocardial Metastases in Neuroendocrine Tumors

“…In individual patients other strategies, like external beam irradiation have been applied. Strosberg et al [23] described a case in 2007 in which surgical removal of a right ventricular and a larger left ventricular lesion had been too dangerous due to location and size of the tumors and a radiation scheme using a total of 45 Gray in 3D-conformal technique had been successful in reducing the tumor volume by 50 % and rendering the patient symptom free after the irradiation. So far no patient with cardiac metastases has been reported to have been treated with PRRT.…”

ENETS Consensus Guidelines for the Management of Brain, Cardiac and Ovarian Metastases from Neuroendocrine Tumors

“…As a single method, MRI is superior to echocardiography in the detection and quantification of cardiac metastases [25,[39][40][41] . Octreoscan or SPECT/CT may be helpful in somatostatin-receptor-positive lesions [23,42] , but when used alone lacks fine discrimination and cannot provide definitive anatomical localization. There is one report of a patient with two cardiac lesions detected by 18 F-DOPA-PET/CT, neither of which was visualized by echocardiography or octreoscan [43] .…”

Cardiac Magnetic Resonance for Diagnosis of Neuroendocrine Tumor Metastases to the Right and Left Ventricles with Carcinoid Heart Disease

“…While echocardiography allows for excellent real-time myocardial visualization with flow information, the CMR T2-weighted and postcontrast sequences allow for more specific mass characterization [13]. Cardiac metastases can affect the right or the left side of the heart, as well as the ventricular septum, and appear continuous with the affected myocardial wall [3, 11, 16]. CMR images in this case show the right ventricular myocardial tumor in close proximity to the tricuspid valve with markedly abnormal tricuspid valve closing.…”

“…In rare cases, NETs can metastasize to the heart [10, 11]. Cardiac metastases have been reported as myocardial nodules or pedunculated masses extending into the cardiac chamber, and these can mimic myxomas on echocardiography [12].…”