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Case Reports
. 2016 Dec 15:1:16.
doi: 10.1186/s41199-016-0018-5. eCollection 2016.

An unusual case of tracheo-pleural fistula and cardiac metastases in oropharyngeal carcinoma: a case report and review of the literature

Daris Ferrari  1   2 , Carla Codecà  1 , Giulia Viale  1 , Barbara Bocci  1 , Francesca Broggio  1 , Francesca Crepaldi  1 , Martina Violati  1 , Andrea Luciani  1 , Dario Bauer  3 , Laura Moneghini  3 , Gaetano Bulfamante  4 , Paolo Foa  5
Affiliations
Case Reports

An unusual case of tracheo-pleural fistula and cardiac metastases in oropharyngeal carcinoma: a case report and review of the literature

Daris Ferrari et al. Cancers Head Neck. .

Abstract

Background: Oropharyngeal cancer is frequently associated with human papilloma virus, that also represents a strong prognostic factor. Local relaps and treatment-related complications are frequent, whereas distant metastases occur in about 25% of patients.

Case presentation: A 49 years-old male presented with a loco-regionally advanced oropharyngeal squamous cell carcinoma and was treated with concomitant chemoradiation. A complete clinical and pathological response was achieved, but the occurrence of necrotising tracheo-esophagitis, with tracheo-mediastino-pleural fistula formation, further complicated the subsequent clinical course. The patient died suddenly. Autopsy revealed multiple myocardial and epicardial metastases from oropharyngeal squamous cell carcinoma.

Conclusions: Even in case of a transient complete local response, the potential occurrence of severe complications and distant metastases, although infrequent, should be considered. Cardiac metastases are frequently underestimated, as they are often asymptomatic, but may lead to sudden death. Further efforts are needed to improve diagnosis and therapy in this setting.

Keywords: Cardiac metastases; Chemoradiotherapy; Oropharyngeal carcinoma; Risk factors; Tracheo-pleural fistula.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Contrast-enhanced CT-scan showing an air-filled communication between trachea and mediastinum
Fig. 2
Fig. 2
Transversal section of the trachea with evidence of wall disruption
Fig. 3
Fig. 3
Sections of the hearth at ventricular level, with evidence of metastases at the interventricular septum and the walls of the right and the left ventricle
Fig. 4
Fig. 4
Left: low power picture of the wall of left ventricle with evidence of metastatic infiltration (Hematoxylin & Eosin, 4X). Right: the same field at 10X
See this image and copyright information in PMC

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