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Huge right ventricular mass lesion associated with genital malignant tumor: a case report
© The Author(s). 2017
Received: 19 July 2017
Accepted: 28 August 2017
Published: 3 October 2017
Primary heart tumors are rare, whereas metastatic heart tumors occur more frequently.
We report a case of a 75-year-old Japanese woman who had metastatic heart tumors of the right ventricle. Although she initially received antibiotic therapy following a diagnosis of pneumonia and pleuritis, her symptoms worsened, and she developed dyspnea and bilateral lower limb edema. Echocardiography showed a huge mass lesion occupying the entire right ventricle. Because the patient’s tumor markers were elevated, we used computed tomography to search for the primary lesion, which was located in the vagina or the uterus. Histology demonstrated the presence of basaloid squamous cell carcinoma in the vaginal tissue. Chemotherapy with paclitaxel and carboplatin was initiated.
These data suggest that the tumor in the right ventricle metastasized from the genital organs.
Primary heart tumors are rare, appearing in 0.02% of autopsies . Metastatic heart tumors occur more frequently, and their probability of occurrence ranges from 2.3% to 18.3% . In general, metastatic heart tumors are asymptomatic. Although these metastases rarely grow in the heart cavity, they often lead to lethal complications, such as embolism and obstruction of heart cavity inflow or outflow. We report a case of a patient with multiple metastases from the genital organs, including the right ventricle.
A 75-year-old Japanese woman was admitted to our clinic because of dyspnea associated with bilateral lower limb edema. She was well until 8 weeks before admission, when she began to complain of back pain and cough. Although a local doctor gave her antibiotics after a diagnosis of pneumonia, her symptoms worsened. One week later, she consulted our clinic, where different antibiotics were prescribed to relieve her symptoms. However, she complained of dyspnea with bilateral lower limb edema, which suggested congestive heart failure.
Most cases of cardiac metastatic tumor are asymptomatic until the tumor obstructs the heart chamber. In that situation, systemic chemotherapy has priority over resection of the tumor because surgical resection is indicated only for exceptional cases . If complete resection fails, postoperative mortality is high .
Basaloid squamous cell carcinoma is a rare and highly aggressive variant of squamous cell carcinoma . The most commonly involved sites are the larynx, hypopharynx, tonsils, and base of the tongue, not the heart . In our patient, the squamous cell carcinoma antigen was not elevated, although it is a variant of squamous cell carcinoma , as shown in other cases [8, 9]. Accordingly, in the case of our patient, it was difficult to diagnose the primary lesion on the basis of blood markers.
However, most tumors in the right side of the heart are metastatic malignant tumors , although some primary cardiac tumors have been reported . Our patient initially developed respiratory problems that were followed by congestive heart failure. Clinically, cardiac metastasis usually remains asymptomatic. However, echocardiography should be performed as soon as symptoms of heart failure, angina pectoris, embolism, or rhythm disturbances develop; if a new heart murmur becomes audible; or if heart size is increased on a chest x-ray. Alternatively, additional information may be obtained by computed tomography or magnetic resonance imaging .
We suggest that clinicians carefully examine the heart in patients with malignant tumors of the genital organs.
We appreciate Professor Masakazu Yamagishi for his assistance in revising the manuscript.
No financial support was received for this case report.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
All authors drafted the manuscript. All authors were involved in the care of the patient. All authors read and approved the final manuscript.
Ethics approval and consent to participate
The publication of this case report was approved by the clinical research ethics committees of Keijyu General Hospital.
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Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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