A Rare Discovery of Neuroendocrine Tumor: Cardiac Mass

Abstract

Carcinoid tumors are rare, slow-growing neoplasms of neuroendocrine origin commonly affecting the gastrointestinal or respiratory system. They metastasize to lymph nodes and the liver based on their lymphatic and venous drainage of their tissue of origin. Metastasis to the heart is exceedingly rare accounting for <2 % of cases. Exceedingly rare is the incidental detection of cardiac carcinoid metastasis as the initial presentation of carcinoid syndrome. Here, we describe a case of metastatic cardiac carcinoid detected during a routine echocardiogram done for evaluation of a systolic murmur.

Keywords: Cardiac carcinoid; Metastatic carcinoid; Neuroendocrine neoplasm.

Fig. 1

Echocargiogram (left) and MRI (right) highlighting a well circumcribed mass in the interventricular septum.

Fig. 2

CT scan of the abdomen showing hypodense lesions in the liver representing metastasis (red arrow) and an intra-luminal growth in the distal small bowel presenting as a filling defect with oral contrast (blue arrow).

Fig. 3

Demonstration of H and E stain of NET (blue arrow) with normal liver cells (red arrow) in the left, corresponding IHC stain for synaptophysin in the middle, with magnified view of H and E stain of NET in the right showing well-differentiated cells with round to oval nuclei arranged in nests.