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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 50-51

A rare case of cardiac metastasis from non-small cell lung cancer


1 Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
2 Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
3 Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India

Date of Web Publication10-May-2019

Correspondence Address:
Dr. Venkata Pradeep Babu
Room No. 2258, 2nd Floor C Block, Rajiv Gandhi Cancer Institute and Research Centre, Sector - 5, Rohini - 110 085, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JICC.JICC_8_19

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  Abstract 


Heart is reported to be one of the least common sites of tumor metastasis. The lung is the most common cancer worldwide, and the metastasis to heart from lung cancer has rarely been described. Here, we describe a patient with lung cancer whose tumor metastasized to the left atrium of heart while on treatment.

Keywords: Cardiac metastasis, Lung cancer, NSCLC


How to cite this article:
Sharma M, Goyal S, Gupta M, Batra U, Jajodia A, Babu VP. A rare case of cardiac metastasis from non-small cell lung cancer. J Indian coll cardiol 2019;9:50-1

How to cite this URL:
Sharma M, Goyal S, Gupta M, Batra U, Jajodia A, Babu VP. A rare case of cardiac metastasis from non-small cell lung cancer. J Indian coll cardiol [serial online] 2019 [cited 2019 Jul 22];9:50-1. Available from: http://www.joicc.org/text.asp?2019/9/1/50/257963




  Introduction Top


Heart is reported to be one of the least common sites of tumor metastasis. The lung is the most common cancer worldwide, and the metastasis to heart from lung cancer has rarely been described. Here, we describe a patient with lung cancer whose tumor metastasized to the left atrium of heart while on treatment.

Nearly half of all patients with newly diagnosed lung cancer have metastasis at presentation, cardiac metastasis is unusual.[1] Cardiac metastasis is asymptomatic in most cases making clinical diagnosis of this rare presentation difficult.[2] Moreover, even if the symptoms are present, they may be attributed to the symptoms of advanced lung cancer.[3] Hence, intracardiac metastasis from lung cancer poses a diagnostic dilemma. A high index of suspicion will aid prompt diagnosis and treatments.


  Case Report Top


A 41-year-old male patient presented to the medical oncology department with complaints of intermittent progressive dry cough, low-grade fever, and breathlessness for 4 months. He is a current smoker with a history of 20 pack-years of smoking. Investigations revealed normal liver, kidney, and marrow functions. X-ray chest revealed a mass in the hilar region of the left lung. Two-dimensional echocardiography revealed normal ejection fraction. Further investigation with positron emission tomography–computed tomography (PET-CT) scan revealed 4.9 cm × 4.8 cm fluorodeoxyglucose (FDG)-avid lesion in the suprahilar region of the left lung along with multiple FDG-avid mediastinal lymph nodes and multiple bony metastases [Figure 1]. Bronchoscopic biopsy from the lung lesion revealed squamous cell carcinoma. The patient was started on palliative chemotherapy with injection gemcitabine 1.0 g/m2 day 1 and day 8, injection carboplatin AUC 5 day 1 of 3 weekly cycles, and injection zoledronic acid IV 4 mg every 4 weeks. After three cycles of palliative chemotherapy, PET-CT scan revealed metabolically active progressive disease with left lung lesion, lymph nodes skeletal, and liver lesions showing a significant increase in number, size, and metabolic activity. Left atrial tumor thrombus, left pericardial effusion, right lung nodules, and pleural deposits were new developments.
Figure 1: 18F-fluorodeoxyglucose positron emission tomography–computed tomography image (a) (axial computed tomography) and (b) (fused axial) show metabolically active left lung mass with pleural thickening and effusion. A metabolically active filling defect is seen in the left atrium (white arrow) suggestive of tumor thrombus

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  Discussion Top


The most common sites of metastasis of lung cancer are lymph nodes, liver, brain, bone, and adrenal glands.[4] Among the reported cases in the literature, adenocarcinoma is the most common histological subtype of lung cancer to metastasize to the heart.[5] The most common site of cardiac metastasis in decreasing order of frequency is epicardium/pericardium, myocardial, endocardial, intracavitary, and valves.[6] Consistent with the literature, the histology in our patient was adenocarcinoma of the lung, and the chamber of the heart affected was left atrium. However, in the majority of the reported cases, approximately 90% of the patients, cardiac metastasis is silent and diagnosed only on autopsy, whereas our patient has metastasis on progression. He succumbed to severe pulmonary embolism despite starting him on anticoagulation therapy. The clinical features related to the cardiac metastasis were not present in our case except for few atrial ectopics.


  Conclusion Top


Cardiac metastasis usually reflects widespread malignancy and grave prognosis. With the widespread availability of the newer techniques and the improvement in survival of lung cancer patients, more patients will be detected to have cardiac metastasis. The pathogenesis of metastasis of lung cancer to rarer sites still needs to be understood.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Katalinic D, Stern-Padovan R, Ivanac I, Aleric I, Tentor D, Nikolac N, et al. 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. World J Surg Oncol 2013;11:14.  Back to cited text no. 1
    
2.
Gadgeel SM, Kalemkerian GP. Lung cancer: Overview. In: Arenber D, Keshamouni V, Kalemkerian GP, editors. Lung Cancer Metastasis: Novel Biological Mechanisms and Impact on Clinical Practice. 1st ed. New York: Springer; 2009. p. 1-28.  Back to cited text no. 2
    
3.
Giuffrida D, Gharib H. Cardiac metastasis from primary anaplastic thyroid carcinoma: Report of three cases and a review of the literature. Endocr Relat Cancer 2001;8:71-3.  Back to cited text no. 3
    
4.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.  Back to cited text no. 4
    
5.
Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol 2007;60:27-34.  Back to cited text no. 5
    
6.
Borsaru AD, Lau KK, Solin P. Cardiac metastasis: A cause of recurrent pulmonary emboli. Br J Radiol 2007;80:e50-3.  Back to cited text no. 6
    


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