Right intraventricular metastasis of squamous cell carcinoma of the uterine cervix: An autopsy case and literature review

Sixty-three-year-old woman with a past medical history of uterine cancer and complaint of fatigue and dyspnea on mild exertion. Physical examination revealed hypertension and rales at lung bases. A transthoracic echocardiogram showed a mass with reduced mobility in the right ventricle. The patient was taken to surgery during which a mass involving the anterior wall of the pulmonary artery, tricuspid valve, right atrium, and posterior wall of the right ventricle was found. The pulmonary artery and the right ventricle were reconstructed with a bovine pericardium patch and the tricuspid valve was replaced by a number-31 biological prosthesis. The pathological examination revealed metastasis of squamous cells with well-differentiated infiltrative areas. The patient was discharged one month after surgery. Four months later, however, she was readmitted to hospital in terminal stage, confirming the guarded prognosis of the disease at this stage. Cardiac metastases from squamous cell carcinoma of the uterine cervix are uncommon findings; however their diagnosis and successful surgical treatment are even rarer.Among the several different types of neoplasia that may affect the heart, secondary tumors are 40 times more common than primary tumors 1 and the most varied types of tumors may attack the heart The main tumors to metastasize to the heart are, in descending order, melanoma, leukemias, bronchogenic tumors, and breast cancer. Metastasis from squamous cell carcinoma of the uterine cervix is one of the less frequent metastases, occurring in 5.9% of the cases 2 .The metastatic squamous cell carcinoma of the uterine cervix is one of the less common secondary tumors and it is difficult to be diagnosed; most of them are only found in autopsies. When symptomatic, it may cause arrhythmias, and may lead to complete heart block, pericardial tamponade, congestion due to myocardial replacement by tumor cells, intracardiac obstructions, myocardial infarction, peripheral embolism, and others. True myocardial infiltration or a simple intracardiac extension of the vena cava or of the pulmonary vein may occur 3 .In the present case, we report the in vivo diagnosis and the importance of considering cardiac metastasis in carcinoma of the uterine cervix, since this is a common disease among women and the symptoms of metastases are unspecific. Case ReportFemale, 63 years of age, born in the State of Santa Catarina, Brazil, was referred to the Department of Cardiovascular Surgery of a University Hospital in the city of Curitiba with a previous diagnosis of cardiac tumor and past medical history of uterine cervix cancer diagnosed at the age of 30 after three miscarriages, and treated with surgical resection (conization), 35 sessions of radiation therapy, and 3 sessions of chemotherapy.Two months prior to the hospitalization for evaluation of the cardiac tumor mass, the patient underwent angioplasty, and the obstruction of the anterior descending coronary artery was reduced by 80%. At admission she complained of fatigue and dyspnea on mild ...

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“…Metastasis from squamous cell carcinoma of the uterine cervix is one of the less frequent metastases, occurring in 5.9% of the cases 2 .…”

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confidence: 99%

Tumor metastático espinocelular de cérvix uterino para coração: diagnóstico ante mortem

Ferraz

Martins

Souza

et al. 2006

Arq. Bras. Cardiol.

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“…Although metastasis to the lung, bone, and lymph nodes from uterine cervical carcinoma is well reported [1][2][3], cases of metastasis from uterine cervical cancer to the heart are sporadic, with few reports of metastasis to a large area of the epicardium from a primary uterine cervical carcinoma [4]. In this case, no pathological recurrence was detected at either the uterine site or within another organ.…”

Section: Discussionmentioning

confidence: 84%

“…Some reports [3,11] have described that metastasis to the right ventricle possibly occurred by direct metastasis through venous return, although such cases typically had evidence of pulmonary microembolism by the tumor. In our case, there was no evidence of tumor emboli or metastasis in the lungs.…”

Section: Discussionmentioning

confidence: 99%

Difficult preoperative diagnosis in a case of rapidly progressive carcinomatous pericarditis

Wada

Anai

Shuto

et al. 2014

Gen Thorac Cardiovasc Surg

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A 54-year-old woman initially diagnosed with stage IIIb squamous cell carcinoma of the uterine cervix was treated with chemotherapy and radiation therapy. After 8 months, she developed dyspnea, leg edema, pleural effusion, pericardial effusion, and liver congestion. Her cardiac ejection fraction was normal and cardiomegaly was not evident. Metastatic carcinomatous pericarditis or pleurisy was suspected, but laboratory findings, including tumor markers, were normal. She was transferred to our hospital for the repair a cardiac injury caused by a pericardial drainage procedure. Emergency surgery was performed for the misplaced drainage catheter in the right atrium and for an abnormal mass in her right and left atria. The clinical diagnosis of carcinomatous pericarditis was made; however, her condition rapidly deteriorated, and she died 6 days postoperatively. At autopsy, metastasis was identified in a large area of the pericardium and myocardium.

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“…In the present case, tumor embolism was not directly diagnosed by imaging but was highly suspected based on indirect findings such as acute onset type I respiratory failure, dilatation of peripheral pulmonary arteries, mosaic ground-grass opacities in chest CT images, significant pulmonary hypertension, presence of a mass in the right ventricle, and elevated right ventricular pressure. Pulmonary tumor embolism in cervical cancer has been reported mostly in patients with cardiac metastasis (Table II) (7)(8)(9)(10)(11)(12)(13)(14)(15), suggesting that pulmonary tumor embolism should be considered in the differential diagnosis of patients with findings that suggest cardiac metastasis, even in the absence of typical imaging findings (e.g., perfusion defects in major pulmonary arteries).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

Okazaki

Abe

Takayanagi

et al. 2018

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Abstract. Background Pulmonary tumor embolism is a rare and fatal complication in cancer patients. It leads to progressive clinical manifestations including respiratory failure, pulmonary hypertension, right heart failure, and sudden death (1). Generally, tumor embolism is more common in patients with adenocarcinoma compared to other histological types (2). This report describes a case in which a patient with squamous cell carcinoma of the uterine cervix developed pulmonary tumor embolism and followed a fatal clinical course within a few days after the onset of symptoms, along with multimodal diagnostic imaging and autopsy findings. Case PresentationClinical findings. A 60-year-old female visited a local clinic with a chief complaint of continuous genital bleeding. She was referred to our institution with suspected cervical cancer. Pelvic examination revealed an easily bleeding mass occupying the external uterine orifice, with bilateral parametrial and lower vaginal infiltration. Magnetic resonance imaging (MRI) revealed a large tumor in the uterine cervix that had invaded into the uterine corpus, bilateral parametria, vagina, rectum, and bladder (Figure 1). MRI also showed multiple enlarged pelvic lymph nodes. Computed tomography (CT) revealed multiple low-density lesions in the liver, suggesting liver metastases. A biopsy of the cervical mass revealed a keratinizing squamous cell carcinoma of the uterine cervix, and the patient was diagnosed with stage IVB (cT4N1M1) cervical cancer. One week later, she developed progressive dyspnea, cyanosis, tachycardia (105 beats per minute), and tachypnea (30 breaths per minute). Her peripheral capillary oxygen saturation was 80-85%, and her blood pressure and body temperature were normal. No abnormal findings were noted on auscultation of both lungs. Arterial blood gas analysis showed alkalemia (pH 7.482), decreased levels of arterial oxygen tension (PaO 2 , 54.9 mmHg), arterial carbon 337

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Right intraventricular metastasis of squamous cell carcinoma of the uterine cervix: An autopsy case and literature review

Cited by 24 publications

References 24 publications

Tumor metastático espinocelular de cérvix uterino para coração: diagnóstico ante mortem

Tumor metastático espinocelular de cérvix uterino para coração: diagnóstico ante mortem

Difficult preoperative diagnosis in a case of rapidly progressive carcinomatous pericarditis

Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

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