Metastatic Ocular Melanoma to the Left Ventricle Inducing Near-Syncope Attacks in an 84-Year-Old Woman

Rosario, Raymond T.; DiMaio, Dominick J.; Lapham, Rosanna L.; Sweeney, Michael S.; Smalling, Richard W.; Barasch, Eddy

doi:10.1378/chest.118.2.551

Cited by 23 publications

(22 citation statements)

References 6 publications

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“…Several authors [2,6,15] described the high sensitivity and specificity for the diagnosis of the intracardiac masses that the echocardiogram can provide. The also describe the necessity of an association between this method of imaging and endovascular biopsy, either by the transseptal approach or directly on the intracardiac mass.…”

Section: Discussionmentioning

confidence: 99%

“…ROSÁRIO et al [15] reported the occurrence of heart metastasis of an ocular melanoma in an 84-year-old patient. According to the authors, cardiac tumours generally represent causes of symptoms such as syncope by obstruction and difficulties in the blood flow through the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

“…In this group, the melanomas correspond to up to 65% of the cardiac metastasis in patients with disseminated neoplasms. According to the report by the authors, there are only 16 cases of metastatic cutaneous melanoma published as a pedunculated intracardiac mass [15][16][17]. Typically the cardiac involvement of metastatic melanoma is related to spreading to the pericardial sac and myocardium.…”

Section: Discussionmentioning

confidence: 99%

“…There may be invasion and involvement of the right heart chambers at the moment of diagnosis or the appearance of the first symptoms [2,5,9,[13][14][15]20].…”

Section: Discussionmentioning

confidence: 99%

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<![CDATA[<b>Malignant cardiac tumours</b>]]>

Lima¹,

Crotti²

2004

Braz. j. cardiovasc. surg.

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Neoplasms of the cardiovascular system are rare pathologies associated with non-specific signs and symptoms. Cardiac neoplasms should be considered when treating cardiac arrhythmia, Hiss-Purkinje conduction system dysfunction and ischemic syndromes. Tumours of the cardiac muscle are rhabdomyosarcomas that develop frequently in the left chambers, mainly the left ventricle.Among endovascular tumours, the most common one is the myxoma of left atrium and its variant forms. Metastatic tumours of the heart, among them the malignant melanoma, affect the right ventricle more commonly (anterior wall and septum, with invasion of the left ventricle), in the nondisseminated form. Late diagnosis results in high morbidity and mortality rates whether surgical treatment is given or not. The authors describe the case of a right ventricle melanoma patient, comparing the diagnostic approach and treatment with published data. The treatment of choice of cardiac muscle malignant tumours (both primary and metastatic) is non-conclusive according to our literature review. Due to the low incidence of this pathology, the authors suggest additional meta-analytic studies should be performed to establish diagnostic and therapeutic criteria for the malignant tumours of the heart. Descriptors: Heart neoplasm. Melanoma. Myxoma. Arrhythmia. Cardiac surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…There may be invasion and involvement of the right heart chambers at the moment of diagnosis or the appearance of the first symptoms [2,5,9,[13][14][15]20].…”

Section: Discussionmentioning

confidence: 99%

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<![CDATA[<b>Malignant cardiac tumours</b>]]>

Lima¹,

Crotti²

2004

Braz. j. cardiovasc. surg.

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“…The heart may be colonized by metastatic cells of uveal melanoma through the vascular system but often the diagnosis is missed over a lifetime [3]. It has been known since 1954 that the right side of the heart is more commonly involved by metastases, whereas only few of them have been reported in the left heart [3][4][5]. …”

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confidence: 99%

Rare left ventricular metastasis from uveal melanoma

et al. 2017

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A 60-year-old white woman was admitted to our hospital, October 2016 because of two episodes of hematemesis in the previous 48 h, intensification of fatigue and lack of appetite. A review of the patient's history revealed that a stage IV right ocular melanoma had been diagnosed 7 years prior to admission. The patient underwent proton beam therapy and then first-line and second-line chemotherapy treatment. When the patient was admitted she was affected by multiple subcutaneous (Fig. 1A), pericardial (Fig. 1B, C), pulmonary and hepatic metastases. Subcutaneous metastases had been previously treated with electrochemotherapy. Blood analysis showed mild anemia (red blood cells 2.980.000 μL, hemoglobin 9.7 g/dL) and an increased inflammatory pattern (white blood cells 12540 μL procalcitonin 1.7 ng/mL, C reactive protein 10 mg/L) as observed in multiple metastasis [1]. Physical examination revealed pale skin color, increased liver consistency and volume; no other abnormalities were found, including cardiac auscultation. Electrocardiogram and hemogasanalysis were also normal. In order to rule out upper gastrointestinal bleeding, esophagogastroduodenoscopy was performed and showed no abnormalities. Given the suspicion of pulmonary embolism, due to advanced cancer and recurrent haemoptysis, we performed a trans-thoracic echocardiography that showed normal parameters (left ventricular diastolic and systolic diameter 44 mm and 29 mm, septal thickness 9 mm, posterior wall thickness 8 mm, ejection fraction 58%, left atrial area 14 cm 2 , right atrial area 12 cm 2 , right ventricular diastolic and systolic diameter 27 mm and 16 mm, TAPSE 18 mm) and there were no signs of right heart overload; unexpectedly, a pedunculated 15 × 13 × 14 mm mass was present, adherent to the endocardium, involving the lower third of both the interventricular septum and the left ventricle inferior wall (Fig. 1C, D). The mass was slightly hyperechoic and non-homogeneous with irregular margins (Fig. 1D). The color-Doppler did not show significant vascularization of the mass. No signs of patent foramen ovale were observed. The case was then discussed by a multidisciplinary team including oncologists and cardiac surgeons. Considering the evidence of multiple metastatic disease, the poor prognosis and thus the unfeasibility of any surgical and medical treatment of the patient, it was decided to stop any further diagnostic and/or therapeutical procedure and to continue palliative cure. The patient was then discharged 5 days after admission.Uveal melanoma is the most common primary intraocular malignancy; approximately 1500 cases are diagnosed in the United States each year, most commonly arising in the choroid followed by the ciliary body. The patient can be entirely asymptomatic and the tumour diagnosed only on routine ophthalmic screening [2]. The heart may be colonized by metastatic cells of uveal melanoma through the vascular system but often the diagnosis is missed over a lifetime [3]. It has been known since 1954 that the right side of the heart is ...

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Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes

et al. 2022

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Background Cardiac metastasis of melanoma is rare and typically diagnosed post‐mortem. Here we perform a retrospective cohort study and systematic review of patients with metastatic melanoma to characterize prevalence, clinical characteristics, and outcomes of cardiac metastasis. Methods We reviewed the electronic medical records of all outpatients with metastatic melanoma who underwent evaluation at the University of Michigan in Ann Arbor from January 2009 to January 2022, identifying patients with a clinical or histopathologic diagnosis of cardiac metastasis. We performed a systematic review of the literature to summarize the clinical characteristics and outcomes of patients with melanoma and cardiac metastasis. Results Overall, 23 of 1254 (1.8%) patients with metastatic melanoma were diagnosed with cardiac metastasis. Cardiac metastasis was reported in the right ventricle (65%), left ventricle (35%), and right atrium (35%). A total of 11 (48%) patients experienced at least one cardiovascular complication after the diagnosis of cardiac metastasis, the most common being arrhythmia (30%), heart failure (22%), and pericardial effusion (17%). Immunotherapy was more commonly used in patients with cardiac metastasis (80% vs 65%; p = 0.005). Mortality at 2‐years post‐diagnosis was higher for patients with cardiac metastasis compared to those without (59% vs 37%; p = 0.034). Progression of malignancy was the underlying cause of death of all patients. Conclusions Cardiac metastasis occurs in <2% of patients with metastatic melanoma, can affect all cardiac structures, and is associated with various cardiovascular complications and high mortality.

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Metastatic Ocular Melanoma to the Left Ventricle Inducing Near-Syncope Attacks in an 84-Year-Old Woman

Cited by 23 publications

References 6 publications

<![CDATA[<b>Malignant cardiac tumours</b>]]>

<![CDATA[<b>Malignant cardiac tumours</b>]]>

Rare left ventricular metastasis from uveal melanoma

Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes

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