Isolated Intracardiac Metastasis: The First Sign of Hepatocellular Carcinoma

Metastatic hepatocellular carcinoma (HCC) to the right atrium without invasion of the inferior vena cava is a very rare and difficult diagnosis, especially when the primary tumour is yet to be known. A 68-year-old man with symptoms of heart failure was admitted to the emergency department; his transthoracic echocardiogram showed a mass comprehending almost the totality of the right atrium, obliterating its entrance nearly completely and impeding the normal auricular–ventricular flux, described as a possible auricular myxoma. The patient was promptly transferred to cardiothoracic surgery and submitted to an urgent surgery to completely remove the mass, which was macroscopically described as suspected of malignancy. Further investigation demonstrated a single nodule in the liver with malignant imaging characteristics, and the histology confirmed the diagnosis of metastatic HCC of the right atrium, without metastatic disease elsewhere. He was then submitted to radiofrequency ablation and medicated with sorafenib. The disease progressed slowly but subsequently involved the inferior vena cava and portal vein, culminating in his death 4 years and 3 months after the diagnosis. Although the prognosis for metastatic HCC may be poor, especially with intracavitary heart metastasis, this case shows that an aggressive initial approach with surgical metastasectomy may prolong the median survival of the patients.

Metastatic Carcinoid Tumor to the Heart, A Dreadful Complication of Neuroendocrine Tumors Yet Under Estimated: About an Observation

Cardiac metastases are uncommon in neuroendocrine tumors (NET). Features of patients with metastatic carcinoid tumor involving the heart have not been well described. Although carcinoid tumors have been described in almost every organ, few reported cases of confirmed cardiac involvement. The overall incidence of myocardial carcinoid metastases among patients with metastatic carcinoid disease is about 4%. There is limited knowledge on the prevalence, clinical presentation, and management of heart metastasis. The availability and increasing use of modern imaging techniques leads to more frequent discovery of rare metastatic sites. Our aim is to further clarify the clinical manifestations of heart metastasis, to increase the knowledge of rare localizations of NET metastasis and insist on the systematic screening of metastatic carcinoid heart disease as an integral part of the echocardiographic evaluation in patients with carcinoid syndrome. We report the case of a 67-year-old male with history of a low differentiated neuroendocrine tumor, presenting with palpitations and dyspnea and which investigations have led to diagnose myocardial metastasis signing the progression of the NETs.

Cerebral Liposarcoma Embolus From Heart Metastasis Successfully Treated by Endovascular Extraction Followed by Cardiac Surgery

The current case presents a patient with a tumor emboli stroke as a presenting symptom of a liposarcoma metastasis to the heart that was treated successfully with endovascular mechanical retrieval, followed by subsequent cardiac surgery. The patient is still alive, under chemotherapy treatment, 3 years following the interventions. This scenario should be considered as a part of the differential diagnosis of oncology patients presenting with new central neurological symptoms. This active approach can be an effective treatment if the patient is fit and there is no evidence of widespread disease.

Anaplastic Lymphoma Kinase-Positive Anaplastic Large Cell Lymphoma with Cardiac Metastasis and Arterial Tumor Embolisms during First-Course Chemotherapy

We described an 11-year-old boy suffering from pediatric anaplastic lymphoma kinase-positive anaplastic large cell lymphoma with heart metastasis at diagnosis and arterial tumor embolisms during chemotherapy. Both the heart metastasis and pericardial effusion showed improvement with prednisolone, but numbness and pallor sequentially developed in his lower extremities during the first course of chemotherapy. Contrast-enhanced imaging revealed occlusion of the right anterior tibial artery and left popliteal artery. These symptoms were spontaneously remitted due to the compensation of other arteries. Arterial tumor embolism is a rare but possible complication when a lymphoma shows intracardiac infiltration.

Thymic Epithelial Tumor with Heart Metastasis in a Horse

Thymic malignancy is rare in horses. Thymic epithelial tumor was diagnosed in an 18-year-old mare with invasion and metastasis to the pericardium and heart. At necropsy, the cranial thoracic cavity was obliterated by a large mass located in the thymic region and the right atrium was also expanded and effaced by a similar mass. Histologically, the neoplasm was composed of sheets of spindle cells with intraparenchymal Hassall's corpuscles and formation of pseudorosettes around blood vessels compatible with type A thymic epithelial tumor according to World Health Organization classification. The neoplastic cells were diffusely immunoreactive for cytokeratin and negative for vimentin, S100, neuron specific enolase, glial fibrillar acidic protein, chromogranin A, synaptophysin, CD3 and CD79a markers. To the authors' knowledge, cardiac invasion and distinct histological pattern of pseudorosette formation have not been described in equine thymic epithelial tumors previously.