Solitary cardiac metastasis from primary oral squamous cell carcinoma presenting as ST-elevation MI

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

doi:10.1136/bcr-2018-224732

Cited by 7 publications

(10 citation statements)

References 30 publications

(6 reference statements)

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“…With an additional complication of acute kidney injury, the scattered cardiac metastases observed on autopsy probably drove the acute hypertroponinemia observed in this patient's case, as has been observed in other head and neck cancers metastatic to the heart. A case of a 25-year-old woman with lingual squamous cell carcinoma with cardiac metastasis was notable for elevation in troponin-I and ST-elevation in leads V3–V6 attributed to metastatic infiltration of the myocardium rather than ischemic disease, although the case featured a much larger deposit of disease extending from the right ventricular free wall [ 34 ]. On-target toxicity from CIT may also have contributed.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events

Saqlain

Shalhout

Emerick

et al. 2020

Case Reports in Dermatological Medicine

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Merkel cell carcinoma is a rare cutaneous neuroendocrine carcinoma with a high rate of regional and distant metastasis and mortality. Here, we report a novel case of Merkel cell carcinoma which presented as a primary lesion to the left cheek with regional lymph node involvement and was treated with pembrolizumab and radiation. Widely metastatic disease eventually revealed on autopsy clinically mimicked immune-related organ insult leading to management with immunosuppressants. The patient also had a biopsy-confirmed immune-related cutaneous adverse event during admission. The case highlights a rare circumstance in which disease progression masqueraded as multiple immune-related end-organ adverse events. Contribution of on-target anti-PD-1 toxicity remains a possibility.

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Section: Discussionmentioning

confidence: 99%

Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events

Saqlain

Shalhout

Emerick

et al. 2020

Case Reports in Dermatological Medicine

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“…The most common tumours that metastasize to the heart are cancers of the lung, breast, oesophagus, malignant lymphoma, leukaemia, and melanoma 4 . Head and neck cancers are a rare cause of cardiac metastasis 3 .…”

Section: Discussionmentioning

confidence: 99%

“…As the tumours progress in size within the heart, patients may present with chest pain, valvular abnormalities, heart failure, cardiogenic shock, or tamponade 5 . Electrocardiogram changes may occur, including ST-segment changes along with troponin elevation due to tumour extension in the myocardium 4 . If the tumour invades into the conduction system, tachy- or bradyarrhythmias may develop 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Even when surgery is offered, treatment is customarily palliative 6 . Given the lack of evidence, there is an unclear role for chemotherapy or radiation in the setting of cardiac metastasis 4 …”

Section: Discussionmentioning

confidence: 99%

“…Hyperkalaemia can occur in cancer patients as a result of chemotherapy-induced tumour lysis syndrome. Several ECG changes can be seen, including narrow-based, peaked T waves, 12 ST elevation in the anterior leads, and ST depression in the inferior leads 4 . The downward sloping of the ST segment can help distinguish between hyperkalaemia-induced ST elevation and that caused by an acute coronary occlusion 12 …”

Section: Discussionmentioning

confidence: 99%

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Metastatic squamous cell carcinoma to the heart: an unusual cause of ST elevation—a case report

Tandon

Kethireddy

Balakumaran

et al. 2019

European Heart Journal - Case Reports

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Background Cardiac tumours are typically secondary in nature, and the most common malignancies metastasizing to the heart are cancers of the lung, breast, oesophagus, melanoma, and lymphoma. We present a unique case of squamous cell carcinoma of the tongue, metastasizing to the heart and manifesting with ST elevation in the inferior-leads on electrocardiogram (ECG). Case summary A 25-year-old woman was initially diagnosed with squamous cell carcinoma of the tongue at the age of 23 and treated with hemi-glossectomy with clear-margins. Sixteen months later, the tumour recurred in the oropharynx and the left upper lobe of the lung. She was treated with chemotherapy; however, the tumour progressed. Thus, she was initiated on immunotherapy and radiation therapy. One month later, she presented with chest pain. Electrocardiogram revealed ST elevation in the inferior-leads. Troponin-I was elevated. Transthoracic echocardiogram revealed focal areas of thickening within the left and right ventricular myocardium with associated hypokinesis. These findings suggested ECG changes were likely secondary to infiltrative metastases and not acute-coronary-syndrome. Cardiac magnetic resonance imaging showed infiltrative masses with increased T2-signal and heterogeneous enhancement on perfusion and delayed enhancement sequences. Imaging also demonstrated numerous extra-cardiac metastases. She was treated with analgesics and discharged to home hospice. Discussion Head and neck cancers are a rare cause of cardiac metastasis. ST elevation and troponin release are thought to be due to tumour extension into the myocardium. Cardiac metastases usually present in patients with advanced widespread malignancy. In a cancer patient with cardiac symptoms or ECG changes, it is important to consider a broad differential diagnosis and entertain the possibility of cardiac metastasis.

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Intracardiac echocardiographic‐guided right‐sided cardiac biopsy: Case series and literature review

Pearman

Wall

Chen

et al. 2020

Cathet Cardio Intervent

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Endomyocardial biopsy (EMB) is a common procedure used to aid in the diagnosis of diffuse myocardial diseases and, less commonly, in the diagnosis of cardiac tumors. As cardiac tumors are often found in high‐risk locations (ventricular free wall or atria), precision biopsy is paramount, and additional imaging, like transesophageal echocardiography is often required for guidance. The use of intracardiac echocardiography (ICE) to guide biopsy has been described, but there is no consensus on a standardized approach. We report our institutional approach with three cases of ICE‐directed EMB performed with the 2.4 mm Jawz bioptome directed with an 8.5‐Fr Agilis NxT steerable introducer. All cases were performed under guidance with the AcuNav ICE probe. There were no procedural complications and a definitive diagnosis was obtained in all three cases. We also review the available published cases of ICE‐guided EMB in the literature–noting the different procedural approaches, complication rate, and diagnostic yield. There were only two negative biopsies reported among the published cases and no reported complications. Our review of all these cases suggests that ICE‐guidance for EMB is superior to other forms of imaging in its ease of use and high definition of right‐sided cardiac structures. We also feel that the use of the Agilis steerable sheath allows for more precise directing of the bioptome and is a critical component in performing a successful targeted biopsy.

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Solitary cardiac metastasis from primary oral squamous cell carcinoma presenting as ST-elevation MI

Cited by 7 publications

References 30 publications

Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events

Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events

Metastatic squamous cell carcinoma to the heart: an unusual cause of ST elevation—a case report

Intracardiac echocardiographic‐guided right‐sided cardiac biopsy: Case series and literature review

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