Metastatic colorectal carcinoma to the right atrium: a case report and review of the literature

Abstract

Background Cardiac metastasis due to colon cancer is extraordinarily uncommon. Given the rarity of diagnosis, there is paucity of evidence and hence, no established guidelines for evaluation or clinical management strategy. Clinical presentation We present the case of a 59 year old male with a previously treated colonic carcinoma who presented with new onset exertional dyspnea. He was noted to be having a right atrial mass on an echocardiogram performed at his cardiologist’s office. Further workup with CT angiogram of the chest confirmed a right atrial mass measuring 4.0 cm. Serum CEA was normal. Biopsies of the right atrial mass demonstrated metastatic moderately differentiated colonic adenocarcinoma. Mismatch repair protein expression analysis by immunohistochemistry showed no loss of MLH1, MSH2, MSH6 or PMS2 expression. Next generation sequencing for RAS and BRAF mutations was negative. Patient received treatment with FOLFIRINOX/ bevacizumab with noted reduction in size of mass. Conclusion To the best of our knowledge, this is the first report of next generation sequencing results available on a biopsy of metastatic colorectal cancer to the heart with the largest literature review of 31 reported cases of metastatic colorectal cancer to the heart. It will help direct clinical management and also adds evidence to the potential efficacy of treatment of this rare aggressive disease with chemotherapy in combination with VEGF inhibitors.

Uncommon Cardiac Metastasis in Common Carcinoma Colon

“…Surgical resection of the tumor has also been tried; Koizumi et al reported that although surgery is rarely recommended for treating metastatic cardiac tumors, surgical treatment could be effective in obstructive and solitary lesions to provide symptom relief and increase life expectancy [8]. Among case reports review of 31 patients, 14 patients underwent only surgical resection of the cardiac tumor, three underwent only chemotherapy, four had surgery followed by chemotherapy, nine received no treatment, and two were lost to follow-up [3]. Due to the extensive spread of primary cancer in our patient, she was planned for palliative chemotherapy with a combination of capecitabine and oxaliplatin for six cycles, followed by maintenance with oxaliplatin.…”

“…Cardiac metastases in CA are rare, with an incidence of 1.4-7.2%, according to autopsy studies [2]. To our knowledge, only 31 cases have been currently reported [3]. In this article, we discuss a case of CA with cardiac metastasis presenting with abdominal distention, obstipation, vomiting, melena, pallor, and irregular pulse.…”

Symptomatic right atrial mass: an unusual presentation of rectal adenocarcinoma

“…The incidence of cardiac metastases varies from 2.3% to 18.3% 2 . Cardiac metastases result from primary tumour spread via haematogenous, lymphatic, direct invasion or intracavitary routes 3 . Primary tumours from the lung, including mesothelioma, breast and melanoma are most commonly associated with cardiac metastases 2 .…”

“…Primary tumours from the lung, including mesothelioma, breast and melanoma are most commonly associated with cardiac metastases 2 . By comparison, colorectal cancer rarely metastasizes to the heart with common sites of metastasis occurring in the liver, lung and peritoneum 3,4 …”

“…2 Cardiac metastases result from primary tumour spread via haematogenous, lymphatic, direct invasion or intracavitary routes. 3 Primary tumours from the lung, including mesothelioma, breast and melanoma are most commonly associated with cardiac metastases. 2 By comparison, colorectal cancer rarely metastasizes to the heart with common sites of metastasis occurring in the liver, lung and peritoneum.…”