Diagnostic and Therapeutic Challenges of Cardiac Metastasis in Advanced Malignancies: A Case Series and Literature Review

Abstract

Background: Cardiac metastases, though more common than primary cardiac tumors, remain under-recognized due to their often subtle clinical presentation. These tumors can lead to life-threatening complications, and their diagnosis is typically delayed. Objective: This paper is aimed at reviewing two distinct cases of metastatic cardiac tumors, shedding light on diagnostic challenges, clinical presentations, and management approaches. Methods: We present two cases of patients with metastatic melanoma and undifferentiated malignant spindle cell neoplasm, respectively. Diagnostic imaging, including echocardiography and PET scans, was used to identify the cardiac masses, and biopsy results provided histopathological confirmation. Treatment plans involved systemic immunotherapy, chemotherapy, and surgical resection. Results: In both cases, cardiac metastases were detected through advanced imaging, despite the patients presenting with nonspecific symptoms like abdominal pain and shortness of breath. The metastatic tumor in one patient responded to immunotherapy before surgical excision, while the other patient, in advanced stages, opted for supportive care. Conclusion: Cardiac metastasis should be considered in cancer patients who present with unexplained cardiac symptoms. A multidisciplinary approach, including imaging and biopsy, is crucial for accurate diagnosis. Despite aggressive treatment, the prognosis remains poor, emphasizing the need for early detection and better therapeutic strategies.

Figure 1

(a, b) Mobile left ventricular mass measuring 1.09 × 0.94 cm, originating from the mid anterolateral segment, close to the body of the papillary muscle.

Figure 2

Fixed mass in the left ventricular cavity measuring 4.3 × 2.5 cm with severe mitral regurgitation secondary to restriction of the papillary muscle movement by the tumor.

Figure 3

Hypermetabolic mass in the left ventricle.