Intracardiac Metastasis of Esophageal Squamous Cell Carcinoma: Report of a Case

Abstract

We report a case of a 48-year-old man with a history of violent coughing fits and general fatigue underwent urgent surgery for cardiac tamponade, and who was later diagnosed with metastatic intracardiac squamous cell carcinoma of the esophagus. After admittance to Munakata Suikokai General Hospital, Fukuoka, Japan, echocardiography showed extensive pleural and pericardial effusion and a mass, 4 by 2 cm, with a solid echo pattern in the right ventricular cavity. The working diagnosis was primary malignant cardiac tumor of unknown origin with multiple metastases. To prevent sudden death due to obliteration of the outflow tract of the right ventricle, we performed urgent surgery for cardiac tamponade. Histological examination of the resected tumor revealed squamous cell carcinoma. Fiberoptic esophagoscopy showed hypertrophy of the esophageal wall and a submucosal tumor extending throughout the esophagus. Microscopic examination of the esophagus biopsy specimen showed moderately differentiated squamous cell carcinoma, the histology of which was similar to that of the resected tumor and cytology of pericardial effusion. The patient recovered and was able to return home for a few days; however, he was readmitted, and despite maximal supportive therapy, he died one month after the operation.

Solitary Cardiac Metastasis from Esophageal Cancer

“…In all, 12 cases were solitary cardiac metastases. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most of the cardiac metastasis are detected on autopsy studies. These studies reported the incidence of cardiac metastasis was 2.3%-18.3% of cancer patients and 0.2%-6.5% of unselected autopsy series.…”

“…According to the past 15 reports of cardiac metastasis from esophageal cancer, the median time from the detection of primary tumor to the onset of cardiac metastasis was 8.9 months. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The differential diagnosis of cardiac mass is difficult. In case of a cardiac tumor, metastasis is more frequent than a primary tumor.…”

Isolated Cardiac Metastasis from Squamous Cell Esophageal Cancer

“…Generally patients symptomatic for intracardiac metastases die within a few weeks; sometimes resection of cardiac metastases can be attempted, but median survival is 4 weeks (3, 12, 13). Our patient survived 1 year between diagnosis and death and the cardiac lesion remained the only one.…”

“…Cardiac involvement is generally a sign of disseminated disease. Surgical resection of cardiac metastases is recommended only for single intracardiac lesions; the treatments of choice are chemotherapy and/or radiotherapy, for palliative purposes and relief of symptoms (3).…”

Cardiac tamponade and purulent pericarditis secondary to an oesophageal pericardial fistula as an initial presentation of squamous cell carcinoma of the oesophagus

“…Cardiac tamponade and pericardial effusions have previously been reported in association with various cancers including oesophageal cancers 1. There are many mechanisms, including direct invasion, metastasis and post radiotherapy 2. Rarely oesophageal pericardial fistulas (OPF) have been reported as the culprits 3.…”