Solitary Cardiac Metastasis From Primary Oral Squamous Cell Carcinoma Presenting as St-Elevation Mi

Patel, Hiren; Francke, Michael; Stahura, Heather; El-Hajjar, Mohammad; Kambam, Madhavi L; Schulman‐Marcus, Joshua

doi:10.1016/s0735-1097(18)32912-7

Cited by 3 publications

(4 citation statements)

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“…[ 6 ] Several case reports of cardiac metastasis mimicking STEMI have been reported. [ 2 , 8 – 10 ] For these reasons, periodic ECG is necessary for cancer patients and rapid cardiac work-up is recommended especially, when ST-segment elevation is newly discovered. If ST-segment elevation is newly found in cancer patients, STEMI, takotsubo cardiomyopathy, myopericarditis, myocardial metastasis, hyperkalemia, pulmonary embolism should be considered as differential diagnoses.…”

Section: Discussionmentioning

confidence: 99%

ST-segment elevation due to myocardial invasion of lung cancer mimicking ST elevation myocardial infarction

Jung¹

2021

Medicine

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Introduction: When a cancer patient presents with ST-segment elevation on an electrocardiogram (ECG), several causes including acute myocardial infarction (MI) should be considered. Myocardial metastasis is one of the rare causes of ST-segment elevation in cancer patients and its clinical silence makes it difficult to diagnose. Patient concerns: A 78-year-old man with lung cancer presented to the emergency room for chest pain. ECG revealed ST-segment elevation in inferior and lateral leads. Interventions: After emergent coronary angiography, percutaneous coronary intervention (PCI) on proximal right coronary artery was performed. Outcomes: Even 7 days after PCI, ST-segment elevation in inferior and lateral leads still existed. Cardiac markers continued to be within the normal range. Diagnosis: We found evidence of metastasis of lung cancer on the inferolateral wall of the myocardium by trans thoracic echocardiogram and positron emission tomography (PET)/computed tomography (CT). We diagnosed myocardial metastasis as the cause of ST-segment elevation in the patient. Conclusion: Myocardial metastasis is one of the differential diagnosis of ST-segment elevation in cancer patients. Periodic ECG is necessary for lung cancer patients and rapid cardiac work-up is recommended when ST-segment elevation is newly discovered.

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Section: Discussionmentioning

confidence: 99%

ST-segment elevation due to myocardial invasion of lung cancer mimicking ST elevation myocardial infarction

Jung¹

2021

Medicine

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“…Given the lack of evidence, the role for chemotherapy or radiation remains undetermined. [ 17 ] Ferris et al suggested that a PD-L1 expression level of 1% or more tended to be associated with a better overall survival. [ 18 ] In this case report, PD-L1 expression was determined by using Combined Positive Score (CPS), which is the number of PD-L1 staining cells (tumor cells, lymphocytes, and macrophages) divided by the total number of viable tumor cells, multiplied by 100.…”

Section: Discussionmentioning

confidence: 99%

Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT

Delabie¹,

Evrard²,

Zouhry³

et al. 2021

Medicine

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Introduction: The most common malignancies metastasizing to the heart are cancers of the lung, breast, mesothelioma, melanoma, leukemia, and lymphoma. Cardiac metastasis from a tongue cancer is a rare finding and only a few cases have been reported previously in the literature. In this case report and literature review, we discuss the main clinical features of patients with cardiac metastases secondary to a tongue cancer and imaging modalities performed, especially the 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT). Patient concerns: This is a case of a 39-year-old woman who in April 2018 was diagnosed with an invasive well differentiated squamous cell carcinoma of the movable tongue. She underwent a left hemiglossectomy followed by a revision of hemiglossectomy and ipsilateral selective neck lymph nodes dissection levels II to III because of pathological margins. An early inoperable clinical recurrence was diagnosed and she received radiochemotherapy with good clinical and metabolic response. She remained asymptomatic thereafter. Diagnosis: In January 2020, a pre-scheduled 18 F-FDG PET/CT showed a diffuse cardiac involvement. In February 2020, a biopsy of the lesion revealed a metastatic squamous cell carcinoma. Interventions: She was deemed to not be a cardiac surgical candidate and treated by palliative chemotherapy: taxol-carboplatin associated with cetuximab then cetuximab alone because of adverse effects. A re-evaluation imaging performed in April 2020 evidenced a progression of the cardiac involvement, which led to switch chemotherapy by immunotherapy with nivolumab. Outcomes: This patient had a very poor prognosis and succumbed to major heart failure 4 months after the diagnosis of cardiac metastasis. Conclusion: In this case report, 18 F-FDG PET/CT proved to be useful in detecting cardiac metastasis and changed the therapeutic management of the patient. It suggests that patients with tongue malignancies in a context of poor initial prognosis should be followed-up early by 18 F-FDG PET/CT with HFLC diet to facilitate detection of recurrence.

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“…As acknowledged, patients with secondary cardiac involvement have a poor prognosis [3]. The role of radio-or chemotherapy remains unclear for the lack of evidence; palliative therapy remains the most widely used therapeutic strategy [4].…”

Section: Discussionmentioning

confidence: 99%

“…Metastatic disease has been identified as a rare case of Acute Myocardial Infarction or artery occlusion [1][2][3]. Tumour compression of a coronary artery or its extension in the myocardium could also cause ST elevation [4][5][6]. Many authors have reported persistent ST elevation in patients with malignancies with heart metastasis [7,8].…”

Section: Introductionmentioning

confidence: 99%

A Case of ST-Elevation due to a Primitive Extracardiac Origin in a Cancer Patient: Differential Diagnosis and Review of Literature

Valotta¹,

G²,

Anna³

et al. 2020

Int J Clin Cardiol

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Introduction: Vast of cases ST elevation is due to coronary occlusion. Metastatic disease has been identified as a rare case of Acute Myocardial Infarction or artery occlusion. Case description:This case is about a 65-year-old man with a diagnose of stage IV Thymic Carcinoma in 2012, with two recurrences and past surgical treatment followed by radiation and chemotherapy. From that time, CPAP addicted for respiratory failure. He went to emergency department with worsening dyspnoea in the last few days. The ECG showed an ST-elevation in DI-aVL and V4-V6 suggesting an Acute Coronary Syndrome (ACS). The emergency coronary angiogram showed no significant coronary artery stenosis. The transthoracic echo revealed a mass infiltrating the left ventricular myocardium with consequent akinesia of lateral and anterior wall. A thoracic CT scan revealed a mass of 17*10*12 cm that infiltrated the myocardium surrounding the left circumflex coronary artery, which was the reason of ST-elevation. Discussion: After multidisciplinary medical evaluation, considering the clinical context and the surgical risk, we dropped to perform any other invasive or bioptic exam. In agreement with the patient and his relatives, the patient was hospitalized Palliative Care Unit. Conclusion:The ECG changes due to metastatic lesions or myocardial infiltration are different from those of an ACS. They are characterized by the persistence of ST-elevation without the typical evolution such as Q waves or T inversion. In addition, in any patient with history of malignancies, multidisciplinary discussion and multimodality imaging play a key role for the correct diagnosis and management.

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Solitary Cardiac Metastasis From Primary Oral Squamous Cell Carcinoma Presenting as St-Elevation Mi

Cited by 3 publications

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ST-segment elevation due to myocardial invasion of lung cancer mimicking ST elevation myocardial infarction

ST-segment elevation due to myocardial invasion of lung cancer mimicking ST elevation myocardial infarction

Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT

A Case of ST-Elevation due to a Primitive Extracardiac Origin in a Cancer Patient: Differential Diagnosis and Review of Literature

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