Solitary Cardiac Metastasis from Esophageal Cancer

Abstract

A 72-year-old woman with past medical history of rectal cancer resection (adenocarcinoma, pT3N1aM0) presented with a 2-month history of dysphagia. Imaging studies found a thoracic esophageal cancer, for which subtotal esophagectomy with gastric conduit reconstruction via retrosternal route followed by chemoradiotherapy were performed (squamous cell carcinoma, pT4N1M0, RM1). Seven months after the esophagectomy, a contrast-enhanced computed tomography (CT) demonstrated a new asymptomatic mass inside the right atrium. A thrombus or a tumorous lesion was suspected. Positron emission tomography (PET)/CT showed abnormal uptake in the mass. After a thorough discussion by a multidisciplinary oncology group, we performed 1-week anticoagulant therapy first, resulting in mass enlargement. Then tumorectomy was carried out. The final pathological findings revealed that the mass was squamous cell carcinoma, yielding the diagnosis of cardiac metastasis from esophageal cancer. The patient's postoperative course was unremarkable. PET/CT may help to estimate malignancy and to omit invasive heart surgery.

Keywords: cardiac metastasis; esophageal cancer; positron emission tomography/computed tomography; resection.

Fig. 1. Contrast-enhanced CT demonstrating an irregularly shaped defect of contrast material inside the right atrium (arrow). CT: computed tomography

Fig. 2. Intraoperative findings. (A) The right auricle looked stiff due to the existence of the solid tumor (arrow). (B) After the right atrial incision, a floating material protruding from the tumor could be seen (arrow).

Fig. 3. Pathological findings from the resected specimen. (A) Cancer cells are invading into the heart muscle (Hematoxylin and eosin staining results; ×100). (B) The resected specimen is positive to p40, a marker of squamous cell carcinoma (p40 immunostain; ×100).