Symptomatic cardiac metastases of breast cancer 27 years after mastectomy: a case report with literature review - pathophysiology of molecular mechanisms and metastatic pathways, clinical aspects, diagnostic procedures and treatment modalities

Abstract

Metastases to the heart and pericardium are rare but more common than primary cardiac tumours and are generally associated with a rather poor prognosis. Most cases are clinically silent and are undiagnosed in vivo until the autopsy. We present a female patient with a 27-year-old history of an operated primary breast cancer who was presented with dyspnoea, paroxysmal nocturnal dyspnoea and orthopnoea. The clinical signs and symptoms aroused suspicion of congestive heart failure. However, the cardiac metastases were detected during a routine cardiologic evaluation and confirmed with computed tomography imaging. Additionally, this paper outlines the pathophysiology of molecular and clinical mechanisms involved in the metastatic spreading, clinical presentation, diagnostic procedures and treatment of heart metastases. The present case demonstrates that a complete surgical resection and systemic chemotherapy may result in a favourable outcome for many years. However, a lifelong medical follow-up, with the purpose of a detection of metastases, is highly recommended. We strongly call the attention of clinicians to the fact that during the follow-up of all cancer patients, such heart failure may be a harbinger of the secondary heart involvement.

Right cardiac intracavitary metastases from a primary intracranial myxofibrosarcoma

“…Although less common, invasion of the myocardium can cause sustained ST-segment elevation, mimicking acute transmural myocardial infarction 19. Interestingly, there is no strong correlation between the extent of cardiac metastases and the clinical picture 20. Similar to most patients, our patient showed symptoms of congestive heart failure and embolisation 21.…”

“…Indeed, tumours spreading more extensively to the pericardium or cardiac chambers may give a dramatic presentation, causing medical emergencies. Whenever the right heart is involved, the interventricular septum is likely to be involved in the process, and the conduction system may be compromised 20. In our patient, the cardiac invasion led to a sustained monomorphic ventricular tachycardia with left bundle branch block, as documented when the patient was admitted to the emergency room.…”

Malignant cardiac metastasis from breast cancer: Imaging contribution to surgical attitude

“…Some reported cases, similar to ours, were diagnosed as a late cardiac disease on the left ventricle after a mastectomy and pulmectomy which could support this sort of dissemination [5]. On the contrary, an early soft-tissue recurrence on a rib cage and a right ventricle mass seemed to suggest that this cancer was spread by a direct pathway.…”

Large left ventricular metastasis in patient with liposarcoma

“…A tumor's ability to spread to the heart depends not only on many different factors as molecular, biological and physiopathological characteristics of the primary tumor, but also on the specific structural and functional characteristics of the heart. 1 Images in cardiovascular medicine The most common tumors associated with cardiac metastases are melanomas, soft tissue sarcomas and lung, breast and esophageal carcinomas. The main manifestations of cardiac metastases include arrhythmias, conduction disturbances, thromboembolic complications, pericardial effusions and congestive heart failure.…”