Isolated metastasis of hepatocellular carcinoma in the right ventricle

Abstract

Background: Hepatocellular carcinoma (HCC) with right ventricle metastasis without inferior vena cava and right atrium involvement is very rare and the prognosis of HCC with RV metastasis is generally poor. The mass in the cardiac chamber may lead to lethal instability of hemodynamics, however, the initial symptom is probably non-specific, which means that diagnosis timely becomes even harder.

Case presentation: We present a 63-year-old male with isolated metastasis of HCC in the right ventricle which caused inflow obstruction. Moreover, we reviewed a series of studies of isolated metastasis of hepatocellular carcinoma between 1980 and 2018, and summarized the relative outcomes.

Conclusions: Isolated metastasis of hepatocellular carcinoma in the right ventricle is extraordinarily rare. It may damage cardiac structure and broke hemodynamic balance. Multimodality imaging plays an important in accurate pre-operation assessment. Nowadays, palliative treatments could relieve fatal symptoms to some degree, however, standard treatment has not been well established.

Keywords: Echocardiography; Hepatocellular carcinoma; Inflow obstruction; Metastasis; Right ventricle; Treatment.

Fig. 1

Echocardiographic findings. A huge mass occupying almost the whole RVOT (yellow arrow). Massive pericardial effusion can be observed. (A); Color Doppler showed fine and high velocity flow in cavity and inflow tract of RV. (B); Continuous-wave Doppler spectrum of the high-velocity flow in the inflow tract of RV, with the peak velocity of 2 m/s.(C); CE showed higher enhancement of contrast agent in the mass than the myocardium.(D). (AO: aortic artery, CE: contrast echocardiography, LA: left atrium, PA: pulmonary artery, PE:pericardial effusion, RA: right atrium)

Fig. 2

Cardiac MRI, T2 weighted image showed intracavity RV mass in lobular appearance, with blurred outline with myocardium

Fig. 3

Histopathological findings of the mass showed tumor cells with markedly enlarged nucleus, pink-stained cytoplasm, gathering in cords or nests with intercellular sinusoids and necrosis (Hematoxylin and Eosin stain × 100)