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Thymoma is a relatively uncommon thoracic solid tumor, and considered to possess malignant potential. Usually, the lung, pleura, and mediastinum are the most frequently affected sites for metastasis in thymoma. However, the thymoma presenting simultaneous intrathoracic and extrathoracic metastases are exceedingly rare. Herein, we present an exceptionally uncommon case of invasive thymoma with multiple metastases. Furthermore, our case underscores the indispensable role of multimodality imaging in confirming the primary diagnosis and guiding treatment decisions. [ABSTRACT FROM AUTHOR]

Metastasis to the heart is uncommon compared to other organs, posing notable diagnostic challenges. Incidence in autopsy studies typically ranges between 0.7% and 3.5%. Lung, breast, and hematologiccancers are the main sources of such metastases, leading to varied clinical presentations and severe complications. Postmortem viscera from a 47 year old male with a suspected history of jaundice. Only limited information was available. Gross examination showed a solid mass in the gall bladder with areas of hemorrhage and necrosis, while no other abnormalities were observed in other viscera received. Brain examination showed congested blood vessels, while heart sections exhibited atypical cell deposits in the pericardium and myocardium. Coronary arteries displayed pathological thickening. Lung and liver sections also displayed similar metastatic atypical cell deposits, infiltrating tissue and causing necrosis. Gall bladder examination revealed irregular glandular formations lined with polygonal tumor cells positive for cytokeratin. The final diagnosis based on histomorphological features and immunohistochemistry confirmed gall bladder adenocarcinoma metastasising to the heart, liver and lungs. [ABSTRACT FROM AUTHOR]

Background: Liposarcoma, one of the most prevalent sarcoma histologies, is recognized for its tendency for extra-pulmonary metastases. While oligometastatic cardiac disease is rarely reported, it poses a unique challenge as oligometastatic sarcomas are often managed with surgical resection. Case Report: We present a case of a 62-year-old man diagnosed with an oligometastatic myxoid liposarcoma (MLPS) to the heart 19 years after the primary tumor resection from the lower limb. The metastatic mass, situated in the pericardium adjacent and infiltrating the left ventricle, was not managed surgically but with a combination of chemotherapy and radiotherapy. The patient’s disease remains stable to date, for more than 10 years. Literature Review: We conducted a review of the literature to determine the preferred management approach for solitary cardiac metastases of sarcomas. We also conducted an in-depth analysis focusing on reported cases of MLPS metastasizing to the heart, aiming to extract pertinent data regarding the patient characteristics and the corresponding management strategies. Conclusions: Although clinical diagnoses of solitary or oligometastatic cardiac metastases from sarcomas are infrequent, this case underscores the significance of aggressive management employing chemotherapy and radiotherapy for chemosensitive and radiosensitive sarcomas, especially when surgical removal is high-risk. Furthermore, it challenges the notion that surgery is the exclusive therapeutic option leading to long-term clinical benefit in patients with recurrent sarcomas.

We present two cases of cardiac metastases adjacent to the right ventricle in a 55-year-old male and a 61-year-old female, both treated with magnetic resonance (MR)-guided adaptive stereotactic radiation therapy (SBRT). The prescribed regimen was 30Gy delivered in 3 fractions using a 1.5 Tesla magnetic resonance linear accelerator (MR-linac). Patients exhibited favorable tolerance to the treatment, with no observed acute toxicity. [ABSTRACT FROM AUTHOR]

Background: Liposarcoma, one of the most prevalent sarcoma histologies, is recognized for its tendency for extra-pulmonary metastases. While oligometastatic cardiac disease is rarely reported, it poses a unique challenge as oligometastatic sarcomas are often managed with surgical resection. Case Report: We present a case of a 62-year-old man diagnosed with an oligometastatic myxoid liposarcoma (MLPS) to the heart 19 years after the primary tumor resection from the lower limb. The metastatic mass, situated in the pericardium adjacent and infiltrating the left ventricle, was not managed surgically but with a combination of chemotherapy and radiotherapy. The patient's disease remains stable to date, for more than 10 years. Literature Review: We conducted a review of the literature to determine the preferred management approach for solitary cardiac metastases of sarcomas. We also conducted an in-depth analysis focusing on reported cases of MLPS metastasizing to the heart, aiming to extract pertinent data regarding the patient characteristics and the corresponding management strategies. Conclusions: Although clinical diagnoses of solitary or oligometastatic cardiac metastases from sarcomas are infrequent, this case underscores the significance of aggressive management employing chemotherapy and radiotherapy for chemosensitive and radiosensitive sarcomas, especially when surgical removal is high-risk. Furthermore, it challenges the notion that surgery is the exclusive therapeutic option leading to long-term clinical benefit in patients with recurrent sarcomas. [ABSTRACT FROM AUTHOR]

Abstract Atrial myxomas are typically found in the left atrium and are the most common among overall rare cardiac tumors. Herein, we describe the clinical course of a 72-year-old female with non-small cell lung adenocarcinoma found to have an atrial mass during an imaging for evaluation for lung cancer progression. Differentiating between distinct types of masses can pose a challenge to the treatment team especially in the setting of exiting malignancy. This case demonstrates the complex decision making involved in the diagnosis, and timing of intervention to remove atrial mass in patients with frailty and a fast-growing cardiac mass.

Background Melanoma can metastasize to distal organs including the heart although presentation with a symptomatic cardiac metastasis is rare. The optimal management remains uncertain particularly in the era of immunotherapy. Case summary We report a case presenting with a large unresectable cardiac metastasis from melanoma that responded well to treatment with immunotherapy. Conclusion Melanoma can metastasize to the heart and is often challenging to diagnose. Combination immunotherapy can be an effective treatment option even in the setting of a symptomatic and unresectable cardiac metastasis. [ABSTRACT FROM AUTHOR]

A 56-year-old man presented to the emergency department with a painful abdominal lump with redness of the overlying skin in the right iliac fossa, swelling, and redness of the scrotum. Laboratory tests revealed a marked increase in white blood cell count (50.73x109/L), neutrophil count (48.18x109/L), and C-reactive protein levels (37.36 mg/dL). Abdominal contrast-enhanced Computed Tomography (CT) scan showed a voluminous neoplastic lesion involving the ascending colon, the cecum, and the last ileal loop, which was in communication with a large abscess located in the anterior abdominal wall and extended craniocaudal up to the right scrotum; a mass within the right ventricle was also seen. The patient underwent a right hemicolectomy and a right orchiectomy. Histological examination revealed a low-grade mucinous adenocarcinoma of the right colon as well as a significant abscess of the right testis' tunica vaginalis. The patient died one month after surgery.

ST-segment elevation on the electrocardiogram typically indicates acute myocardial infarction but can mimic ST-segment elevation myocardial infarction in various conditions. We present a case of a patient with an intramyocardial mass and anterior ST-segment elevation without significant myocardial biomarker elevation. Multimodality imaging was crucial in revealing cardiac metastasis as the attributable cause. [ABSTRACT FROM AUTHOR]

Lung cancer is currently one of the most common malignancies worldwide. Among all metastatic sites of this cancer, cardiac metastases are exceptional, and long-term prognosis in these patients is very poor. 18F-FDG PET/CT is a valuable imaging tool for initial staging and assessment of treatment response of various neoplasms. In the case of lung cancer, its role is clearly defined, and its effectiveness is superior to other diagnostic imaging methods. We present a rare 18F-FDG PET/CT image finding in a 71-year-old man with biopsy-proven lung squamous cell carcinoma, showing increased cardiac 18F-FDG uptake subsequently found to be compatible cardiac metastasis. [ABSTRACT FROM AUTHOR]

A 23‐year‐old man with a history of a testicular germ cell tumor (GCT) that was incompletely treated, is presented with dyspnea. Significant bilateral pulmonary masses were seen on computed tomography (CT). A large, hypermobile mass in the left atrium (LA) as well as mitral valve dysfunction and moderate pulmonary hypertension was detected by transthoracic echocardiography (TTE). Urgent cardiac surgery was performed to prevent the tumor embolism in addition to restore mitral valve function and reduce pulmonary hypertension. Pathologic reports confirmed testicular GCT. GCT metastasis to the heart and lungs is an incredibly rare phenomenon. To our knowledge, this is the first case of simultaneous GCT metastasis to both lungs and LA. This article highlights the importance of cardiac examinations and imaging in germ cell tumor patients. If there is a functional complication for vital organs such as the heart or lungs, surgical interventions are given priority before starting chemotherapy. [ABSTRACT FROM AUTHOR]

We report the case of an 83-year-old woman that presented with progressive dyspnoea due to an intraluminal right atrial metastasis of an endometrial carcinoma that had been diagnosed 4 years earlier. Treatment up to that point consisted of an hysterectomy and resection and radiation of local recurrences. Follow-up had been interpreted as negative, despite a PET-CT 8 months before presentation which had shown increased FDG uptake in the right atrium, but was unfortunately considered benign. After confirmation of metastasis, first-line chemotherapy was started. However, due to poor tolerance and rapid symptom progression, chemotherapy had to be stopped early. She died 2 months later. Cardiac metastasis in endometrial carcinoma is rare. However, the incidence is increasing simultaneously with prolonged cancer survival. Because advances in systemic and radiotherapy now allow curative treatment, more focus should be put on early detection, for example by PET-CT. This way aggressive combined therapy can be started before the burden of cardiac metastasis does not allow it any longer. [ABSTRACT FROM AUTHOR]

Resection of multiple organ metastasis of breast cancer is rare. We experienced a case of breast cancer with resection of metachronous metastases to the colon and heart. The case was a 76-year-old woman with a complaint of epigastric pain. Nineteen years ago, she had undergone radical mastectomy for right breast cancer. Endoscopic examination revealed a stenosis in the transverse colon which was diagnosed by a biopsy specimen as metastasis from breast cancer. Enhanced CT scan revealed a mass of the right ventricle which was suspected to be cardiac metastasis. We decided on surgical resection initially, and performed laparoscopy assisted colectomy for resection of the transverse colon in September 2021. Pathological diagnosis was colonic metastasis from breast cancer. After discharge, she underwent adjuvant therapy. Because the cardiac tumor had grown, cardiac tumor was resected at another hospital in January 2022. Pathological diagnosis was cardiac metastasis from breast cancer. She had no recurrence for 14 months after colectomy. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to explore the clinical features and prognosis of cardiac metastatic tumors. In addition, whether continuing antitumor therapy after the development of cardiac metastases can benefit patients and the response of cardiac metastases were investigated. Methods A retrospective analysis was conducted on patients with malignancies who were admitted to Fujian Cancer Hospital and Fujian Provincial Hospital from January 2007 to September 2022, and the follow-up period ended in March 2023. Clinical data were gathered, treatment efficacy was evaluated, and survival analysis was performed. Results After the patients developed cardiac metastasis, the overall 30-day, 3-month, 6-month, and 12-month survival rates were 85.00%, 59.00%, 51.00% and 38.00%, respectively. With continued treatment, the average survival time was 27.33 months (95% confidence interval [CI]: 16.88–37.79), which exceeded the 6.6 months (95% confidence interval [CI]: 0.03–13.69) observed for patients who withdrew from treatment (P

Introduction: Cardiac metastasis (CM) is a rare lung cancer location. It often remains clinically silent but may cause life-threatening complications. Better survival rates thanks to the immunotherapy revolution and the improving performance of imaging lead to an increasing number of CM diagnosis. Case Presentation: We report a case of a 54-year-old woman who was diagnosed with a stage IIIa non-small cell lung cancer. She developed a right ventricular CM without symptoms during treatment by immunotherapy after concurrent chemoradiotherapy. Cardiac magnetic resonance imaging confirmed the presence of an endocavitary lesion in the right ventricle apex. Complete surgical resection through a right ventriculotomy was performed. Conclusion: The diagnosis of similar cases has become more frequent due to immunotherapy and more advanced imaging technology. Our case report also highlights the fact that CM surgery has to be considered as a successful therapeutic option in those oligo-progression situations. Guidelines on the management and treatment of lung cancer CM are needed as well as larger studies to evaluate the survival benefit from surgical treatment.

Cardiac metastasis from endometrial cancer is a very rare finding. The article presents a case of death, demonstrating the aggressive clinical course of endometrial serous carcinoma. In this clinical example the disease was accompanied by generalized metastasizing through a lymphogenous route to unexpected distant organs (peribronchial lymph nodes, pleura, pericardium).

Carcinoma lung is a concerning cause of mortality worldwide. Approximately half of the cases are metastatic at diagnosis and uncommon metastatic sites confer a worse prognosis. Intracardiac metastasis from lung cancer is rare and limited to a few case reports.The authors describe the case of a 54-year female with left ventricular cavity mass as one of the rarest presentations of lung malignancy. She presented to the cardiology outpatient department with a history of progressive dyspnea for the last two months. Her 2D echocardiogram showed a large heterogeneous mass in the left ventricle cavity along with gross pericardial and pleural effusion. CT guided lung biopsy revealed adenocarcinoma of the lung. The patient was started on tablet geftinib along with other supportive therapy, while awaiting reports of next generation sequencing (NGS) for mutation analysis and immunohistochemistry. However, the patient's condition rapidly worsened and she succumbed to death within one week of hospital admission.Cardiac metastasis is one of the rarest sites for lung cancer spread. Intracavitary metastasis as in our case is an extremely rare presentation. Treatment is not yet well defined for such cases and it carries a poor prognosis despite available therapies. This case required multidisciplinary approach with involvement of cardiologist, oncologist, pulmonologist and intensivists. Further research is required to help define better treatment options.

Key message Existence of poorly differentiated tumour cells or paraneoplastic hypereosinophilia indicates extensive disease progression and poor prognosis in patients with malignancy. When these conditions are present, it is necessary to consider the possibility of intracardiac metastasis even in cases of lung adenocarcinoma.

Background: This study aimed to explore the clinical features and prognosis of cardiac metastatic tumors. In addition, whether continuing antitumor therapy after the development of cardiac metastases can benefit patients and the response of cardiac metastases were investigated. Methods: A retrospective analysis was conducted on patients with malignancies who were admitted to Fujian Cancer Hospital and Fujian Provincial Hospital from January 2007 to September 2022, and the follow-up period ended in March 2023. Clinical data were gathered, treatment efficacy was evaluated, and survival analysis was performed. Results: After the patients developed cardiac metastasis, the overall 30-day, 3-month, 6-month, and 12-month survival rates were 85.00%, 59.00%, 51.00% and 38.00%, respectively. With continued treatment, the average survival time was 27.33 months (95% confidence interval [CI]: 16.88–37.79), which exceeded the 6.6 months (95% confidence interval [CI]: 0.03–13.69) observed for patients who withdrew from treatment (P < 0.001). The responses of cardiac metastases corresponded to the responses of the primary tumors. Patients with a cardiac response had a median survival time of 55.60 months, which exceeded the 13.40 months observed for those without a cardiac response. However, there was no significant difference (P = 0.375). Conclusions: In conclusion, continuing antitumor therapy after the development of cardiac metastases can significantly prolong patient survival. Cardiac metastases and primary tumors respond consistently to antitumor treatment. The risk of death due to heart failure in cancer patients with cardiac metastases needs to be further investigated. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Screening echocardiography aids in identifying cardiac emboli causes and asymptomatic cardiac metastases in high‐grade neoplasms. Conversely, cardiac MRI provides advanced tissue characterization and broader extracardiac assessment. [ABSTRACT FROM AUTHOR]

This paper presents a rare case of malignant melanoma metastasizing to the heart, highlighting the diagnostic journey, therapeutic considerations, and clinical implications. Enhanced awareness of atypical metastases aids early recognition and treatment strategies for improved patient care. Comprehensive understanding of cardiac involvement in melanoma contributes to better outcomes and clinical decision making. (Level of Difficulty: Beginner.)

Key Clinical Message Screening echocardiography aids in identifying cardiac emboli causes and asymptomatic cardiac metastases in high‐grade neoplasms. Conversely, cardiac MRI provides advanced tissue characterization and broader extracardiac assessment.

A 55-year-old male underwent surgery for thymus gland tumors six years previously, and for lung and pancreas tumors three years previously, which were pathologically diagnosed as neuroendocrine tumors (NETs). During routine medical checkups, a giant negative T-wave was observed on the electrocardiogram. Echocardiography revealed a tumor at the apex. A surgical biopsy was performed; the tumor was diagnosed as a cardiac metastasis of NETs, and chemotherapy was initiated. Two years later, echocardiography confirmed that the tumor had not increased in size. A 2-year follow-up of NETs cardiac metastasis is rare; we therefore report this case. Neuroendocrine tumors are considered slowly progressing tumors, but despite the presence of cardiac metastasis, accurate diagnosis and appropriate treatment have allowed the patient to survive the disease for more than two years. [ABSTRACT FROM AUTHOR]

Myxofibrosarcoma is an aggressive soft tissue sarcoma, previously known as myxoid variant of malignant fibrous histiocytoma. Primary cardiac myxofibrosarcomas are the rarest forms of cardiac malignant tumors that often remain asymptomatic until metastasis occurs. In this case report, we describe a rare left atrial cardiac myxofibrosarcoma in a patient with recurrent renal cell carcinoma. We discuss the multimodality imaging approach to diagnose and evaluate cardiac masses as well as imaging characteristics to differentiate cardiac masses from thrombus.

Background: Malignant primary cardiac tumors are exceedingly rare, and despite surgical exeresis or chemotherapy, their prognosis remains poor. Cardiac invasion by metastatic tumors, while more common, also entails an unsatisfactory outcome. This study aimed to review patients diagnosed with malignant primary and secondary cardiac tumors in a tertiary center between 1995 and 2022. Methods: Clinical data, echocardiographic, computed tomography, and magnetic resonance assessments of tumor location and morphology, histology, treatment, and survival were retrospectively analyzed. Results: Sixty malignant cardiac tumors were diagnosed: 17 primary (A) and 43 metastatic (B) tumors. A: the most common types were angiosarcoma (41%), undifferentiated sarcoma (23%), and fibrosarcoma (18%). Patients with primary tumors were younger than patients with metastatic tumors (41 ± 13 years vs. 57 ± 18 years, p = 0.001), with no significant gender difference. The most frequent presentations were heart failure (59%) and arrhythmia (23%). The most prevalent tumor location was the right heart chambers (71%), mostly in the right atrium (35%). 47% were submitted to tumor resection, and 29% received chemotherapy. The mortality rate was 82% with a median survival of 6.0 (interquartile range: 1.0–11.8) months after diagnosis (minimum of 12 days and maximum of 19 years). One patient with fibrosarcoma underwent heart transplantation and was still alive and well after 19 years. B: regarding metastatic cardiac invasion, the most common primary tumor sites were lung carcinomas (38%), thymomas (17%), and lymphomas (14%). Presentation with pericardial effusion was common (33%). The mortality rate was 72%, with a median survival of 3.6 (1.0–13.4) months (minimum of 7 days, maximum of 5 years). Conclusion: Diagnosis of metastatic cardiac tumors was more common than that of malignant primary tumors, both with a dismal prognosis. When radical exeresis is not possible, heart transplantation can be an option with a favorable outcome in carefully selected patients with sarcomas. [ABSTRACT FROM AUTHOR]

In the right clinical setting, ST segment elevation (STE) on electrocardiogram (ECG) is most concerning for acute injury due to transmural myocardial ischemia. This frequently points to significant epicardial coronary artery disease, mandating emergent cardiac intervention. In rare cases, cardiac metastases may cause transient STE. We present a case of a 28-year-old male patient with metastatic osteosarcoma with STE in three different ECG territories over ten months. Several transient, dynamic patterns of STE were noted: anteroseptal leads concerning for acute injury with reciprocal ST depressions in inferior leads, lateral leads, inferior leads with reciprocal ST depression in lateral leads, followed by STE again in lateral leads. Given the patient's young age, absence of cardiac history or symptoms, personal preference, bleeding risk, and cancer prognosis, cardiac catheterization was never pursued. We present this case to remind providers to include metastatic cancer in the differential diagnosis of STE on ECG, and that these changes can be dynamic. • Visualizing dynamic ST elevations in the setting of cardiac metastasis. • Maintaining a broad differential for ST segment elevations. • Weighing the benefits of intervention for STE in cancer patients. • Asymptomatic ST elevation over time. [ABSTRACT FROM AUTHOR]

A 73-year-old woman with silent cardiac metastasis underwent high anterior resection for rectal cancer 3 years ago. Follow-up computed tomography showed a tumor in the right atrium. Partial vascular resection of the superior vena cava and right atrium was performed. Early postoperative recurrence occurred, and chemotherapy was unsuccessful. The patient died 7 months after surgery.

Pancoast tumor is a rare and aggressive form of lung cancer; cardiac metastasis is very uncommon. We present a case of advanced Pancoast tumor, with extensive cardiac metastases and intracardiac thrombosis in a woman presenting with dyspnea, shoulder pain, and weight loss. A contrast-enhanced chest computed tomographic scan revealed an apical mass, metastatic thoracic nodes, and filling defects within both ventricles. Further imaging with cardiac magnetic resonance imaging revealed 2 left ventricular masses infiltrating into the myocardium suggestive of metastatic disease, and a multilobulated mass within the right ventricle suggestive of intracardiac thrombus. She was initiated on anticoagulation for intracardiac thrombosis. Surgical pathology of biopsied tissue samples was consistent with advanced metastatic lung adenocarcinoma. She was a poor candidate for surgical intervention. Given the patient's goals of care, she was ultimately transitioned to comfort care. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac metastasis (CM) is a rare lung cancer location. It often remains clinically silent but may cause life-threatening complications. Better survival rates thanks to the immunotherapy revolution and the improving performance of imaging lead to an increasing number of CM diagnosis. Case Presentation: We report a case of a 54-year-old woman who was diagnosed with a stage IIIa non-small cell lung cancer. She developed a right ventricular CM without symptoms during treatment by immunotherapy after concurrent chemoradiotherapy. Cardiac magnetic resonance imaging confirmed the presence of an endocavitary lesion in the right ventricle apex. Complete surgical resection through a right ventriculotomy was performed. Conclusion: The diagnosis of similar cases has become more frequent due to immunotherapy and more advanced imaging technology. Our case report also highlights the fact that CM surgery has to be considered as a successful therapeutic option in those oligo-progression situations. Guidelines on the management and treatment of lung cancer CM are needed as well as larger studies to evaluate the survival benefit from surgical treatment. [ABSTRACT FROM AUTHOR]

Cardiac cancers are exceedingly rare, mainly appearing as secondary cancers in patients with numerous systemic metastases, and are often detected by autopsies. Right ventricle (RV) metastasis from metastatic colorectal cancer (mCRC) is rarely reported in the literature. We report a 24-year-old man's case of mCRC, who developed positional variation in pulse rate while receiving the second cycle of chemotherapy. The echocardiography and chest computed tomography (CT) scan showed RV mass. The tumor was rightsided, and Kirsten rat sarcoma (KRAS) mutated based on that. He was treated with FOLFOX chemotherapy protocol plus bevacizumab and enoxaparin with an initial reduction in mass size. However, follow-up CT 9 months later demonstrated disease progression. For that, the chemotherapy was stopped, and the patient received palliative care. In conclusion, this case provides evidence that mCRC and RV location of metastasis can and do occur. In such a case, therapeutic intervention should be determined by weighing the benefits and risks. [ABSTRACT FROM AUTHOR]

Cardiac metastasis of squamous cell carcinoma (SCC) of the tongue is rare. This report presents a known case of SCC of the tongue in a patient who was admitted with an initial diagnosis of pneumonia and endocarditis and had received wide spectrum antibiotics. Due to the lack of an appropriate response, surgical valve replacement was initially considered, but further evaluation by cardiac MRI revealed multiple cardiac, lung and paravertebral metastases, most probably from the previous SCC and as such the patient was managed conservatively. This case report highlights the importance of cardiac MRI for evaluating head and neck tumors and choosing optimal treatment plans. Mouth cancer (also known as oral squamous cell carcinoma can spread to other areas of the body, including the heart – this is referred to as cardiac metastases. Although cardiac metastases is rare, it can change the surgical plan and prognosis of the disease. A young woman with a prior history of tongue squamous cell carcinoma was admitted with what was believed to be an infection of the inner surface of the heart, this is also known as infective endocarditis. However, a technique used to assess the function and structure of the cardiovascular system inside the heart called cardiac MRI, showed that the cancer had spread to multiple areas of the heart. With this knowledge the patient was managed conservatively but passed away 1 month later. [ABSTRACT FROM AUTHOR]

Uterine neoplasm metastases to heart is infrequent, especially from uterine cancer, although it is possible because leiomyosarcoma is very invasive. We present a case of a 33 years old woman with 9 months evolution of this neoplasm. By cardiac and brain symptomatology, this patient was diagnosed with cardiac and brain tumors in imaging studies. The patient underwent tumors resection by cardiac surgery and stereotaxic procedure and subsequent chemo and radiotherapy, without neurological and cardiac symptoms in her evolution.

Abstract Background Cardiac metastases are rare and frequently remain undiagnosed due to the absence of clinical signs in the majority of cases. Malignancies found to most commonly metastasise to the heart include lung carcinoma, breast carcinoma and lymphoma, while urothelial carcinoma is a rare cause of cardiac metastasis. The patient presented with pyrexia, a rare presentation of metastatic cardiac involvement. Single metastatic lesions are mainly reported in the literature, while multiple metastatic deposits such as in this case are less common. Case presentation A 74-year-old gentleman presented with frequent febrile spikes, a month after undergoing a nephroureterectomy for poorly differentiated urothelial carcinoma. No febrile source was identified, and a computed tomography identified two cardiac lesions. A transthoracic echocardiogram could not detect the cardiac lesions; therefore, cardiac magnetic resonance (CMR) imaging was performed. Three spherical intramyocardial masses were noted at the basal septum, LV apex and the anteromedial papillary muscle. The lesions demonstrated signal characteristics suggestive of cardiac metastases (high fluid content, absence of fat, presence of a surrounding rim of increased extravascular space, absence of deformation within the masses) from the previously resected urothelial carcinoma. The patient was palliated, and he shortly succumbed to his condition. Conclusions Urothelial carcinoma is an exceedingly rare cause of cardiac metastasis. CMR is an important imaging modality for localisation and characterisation of suspicious cardiac lesions, aiding in the diagnosis of cardiac metastasis.

Purpose: Cardiac metastasis is a rare fatal event. An intracavitary right tumor mainly in the ventricle is difficult to manage. Literature reports suggest that cardiac surgery in oligometastatic patients could offer median survival of 1 year. We investigated salvage treatment comprising transcoronary tumor embolization followed 15 days later by cardiac radiotherapy (40.5 Gy/15 fractions). Cases: We report two cases of severe right cardiac metastasis with a history of abdominal cancer managed by this salvage treatment following residual cardiac mass after previous cardiac surgery. Conclusion: Both symptomatic patients improved progressively and were locally controlled for at least 1 year without toxicity.

IntroductionThe manifestations of cardiac metastases are extremely variable depending on their location and extension.Case presentationA 62-year-old man was admitted to the cardiac emergency department presenting with chest pain, worsening shortness of breath and palpitations. He had a history of esophageal squamous cell carcinoma treated with chemoradiotherapy, and he was not diagnosed with cardiovascular disease before. The electrocardiogram showed significant ST-segment elevations in leads II, III, and aVF. Initially, the patient was diagnosed with ST-segment elevation myocardial infarction. A cardiac point-of-care ultrasound was performed immediately revealing two large heterogeneous masses in the left ventricular wall and the apex, which changed the diagnosis and the management strategy. There was no significant change in serial cardiac biomarkers in the setting of persistent STE. Thoracic computed tomography and cardiac magnetic resonance confirmed that the patient was suffering from cardiac and lung metastases.ConclusionECG findings of localized and prolonged STE without Q waves or changes in biomarkers may suggest myocardial tumor invasion, especially in the cancer setting. Cardiac point-of-care ultrasound is an effective, convenient, noninvasive imaging modality to guide real-time clinical decision-making.

Patients with secondary cardiac cancer occasionally show ST segment elevation that mimics acute coronary syndrome despite the absence of coronary artery occlusion. We herein describe a rare case of secondary cardiac cancer that presented with ST-segment elevation. An 82-year-old Chinese man was admitted to the hospital with chest discomfort. Electrocardiography (ECG) showed ST segment elevation in the precordial leads and low-voltage QRS complexes in limb leads without the development of Q waves. Unexpectedly, emergency coronary angiography showed no significant stenosis of the coronary arteries. However, fortunately, transthoracic echocardiography (TTE) revealed massive pericardial effusion and a mass at the apex of the ventricular myocardium. Coincidentally, contrast-enhanced chest computed tomography showed primary lung cancer in the left lower lobe, pericardial effusion, and myocardial metastasis at the ventricular apex. The pericardiac fluid contained blood with significantly increased CEA levels and exfoliated tumor cells. The lung histopathological report suggested squamous cell carcinoma. Two months later, the patient died. These findings suggested that the persistent ST-segment without the development of Q waves was associated with ventricular invasion by primary lung cancer and may indicate a poor prognosis. In conclusion, physicians should be aware of persistent ST-segment elevation mimicking myocardial infarction due to cardiac metastasis with a poor prognosis.

We present a case of bladder cancer with a singular cardiac metastasis. A 51-year-old female patient was referred to our department for painless macrohematuria. We confirmed the diagnosis of muscle-invasive urothelial carcinoma of the urinary bladder with partial squamous cell differentiation. Computed tomography (CT) staging demonstrated a singular cardiac metastasis. Two months after receiving six cycles of chemotherapy control CT scan revealed massive tumour progression. The singular cardiac metastasis size increased to approximately two thirds of right ventricle size. Singular cardiac metastases of urothelial carcinoma are extremely rare and show rapid progression, hence introduction to therapy should not be delayed.

A 63-year-old man with a history of right plantar malignant melanoma (T3bN0M0, IIb) developed multiple metastases in bilateral lungs 19 months after surgery. Subsequent 18F-FDG PET/CT revealed multiple pulmonary metastases with intense FDG uptake and detected a hypermetabolic lesion in the lateral wall of the left ventricle, which was considered to be a cardiac metastasis of malignant melanoma. This lesion was later confirmed in the dynamic myocardial perfusion MR. This case demonstrates the effectiveness of 18F-FDG PET/CT in detecting occult cardiac metastases of malignant melanoma. [ABSTRACT FROM AUTHOR]

Simple Summary: Approximately 20% of patients with Merkel cell carcinoma (MCC) will develop distant metastasis. Rarely, MCC metastases may involve the heart; there are limited data on management and prognosis of cardiac metastasis of MCC. Among a prospective registry of 582 patients with metastatic MCC (mMCC), we identified 9 patients (1.5%) with cardiac involvement. We found that cardiac mMCC most commonly involves the right heart (8 of 9; 89%) and occurs relatively late in the disease process (median 925 days from the initial diagnosis to cardiac involvement). In our cohort, cardiac mMCC frequently responds to immunotherapy and cardiac radiotherapy, which can both be delivered with minimal cardiac toxicity. Cardiac involvement was not associated with worse survival compared to MCC patients with non-cardiac distant disease. These results are timely as cardiac mMCC may be increasingly encountered in the era of immunotherapy as patients with metastatic MCC live longer. Merkel cell carcinoma (MCC), an aggressive neuroendocrine skin cancer, has a high rate (20%) of distant metastasis. Within a prospective registry of 582 patients with metastatic MCC (mMCC) diagnosed between 2003–2021, we identified 9 (1.5%) patients who developed cardiac metastatic MCC (mMCC). We compared overall survival (OS) between patients with cardiac and non-cardiac metastases in a matched case–control study. Cardiac metastasis was a late event (median 925 days from initial MCC diagnosis). The right heart was predominantly involved (8 of 9; 89%). Among 7 patients treated with immunotherapy, 6 achieved a complete or partial response of the cardiac lesion. Among these 6 responders, 5 received concurrent cardiac radiotherapy (median 20 Gray) with immunotherapy; 4 of 5 did not have local disease progression or recurrence in the treated cardiac lesion. One-year OS was 44%, which was not significantly different from non-cardiac mMCC patients (45%, p = 0.96). Though it occurs relatively late in the disease course, cardiac mMCC responded to immunotherapy and/or radiotherapy and was not associated with worse prognosis compared to mMCC at other anatomic sites. These results are timely as cardiac mMCC may be increasingly encountered in the era of immunotherapy as patients with metastatic MCC live longer. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features of patients with cardiac metastases from digestive system tumors. Methods This retrospective study collected and analyzed the medical records of patients with cardiac metastases from digestive system tumors who received treatments in the Cancer Hospital, Chinese Academy of Medical Sciences between January 1999 and January 2021. Kaplan-Meier method was used for survival analysis. Results A total of 19 patients were identified. The primary tumors were esophageal squamous cell carcinoma ( n = 7), gastric or gastroesophageal junction adenocarcinoma (n = 6), hepatobiliary cancers ( n = 3 ) and colorectal cancers ( n = 3 ). 16 patients had pericardial metastases, 2 patients had right atrium metastases, and 1 patient had left ventricle metastasis. The most common symptom was dyspnea, which was present in 8 cases. 7 patients received locoregional treatment, while 11 patients underwent systemic therapies. The median overall survival from diagnosis of primary cancer was 31.4 months, and the median overall survival time from diagnosis of cardiac metastasis was 4.7 months. Conclusion Cardiac metastasis from digestive system tumors is associated with low incidence and a poor prognosis. Systemic treatment remains the cornerstone of management, while novel anti-tumor drugs may improve therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Background: Lung adenosquamous carcinoma is a relatively rare pathological type in lung cancer. The incidence of gene mutation is lower than that of lung adenocarcinoma. However, the cases of pathological transformation after targeted treatment of EGFR gene mutation are more rare. Case introduction: A 55 year old female was diagnosed with lung cancer and underwent surgical treatment. The pathology suggested adenosquamous cell carcinoma. Genetic test was EGFR-L858R. After surgery, she was treated with gefitinib targeted therapy. After 2 years of surgery, she developed brain metastasis. surgery was performed again. The pathology suggested squamous cell carcinoma. She continued to take gefitinib targeted therapy orally. After one month later since brain metastasis, she was found to have heart cavity metastasis and surgery was performed for the third time. Besides, the pathology suggested adenosquamous cell carcinoma. Genetic test was EGFRp E746_ A750del, T790M (-), and we replaced with the second-generation EGFR-TKI afatinib targeted therapy. Up to now, no recurrence or metastasis has been found. Conclusion: We now report a rare case of lung adenosquamous carcinoma with pathological transformation during targeted therapy, which is intended to provide therapeutic ideas for the treatment of lung adenosquamous carcinoma in clinical practice. In addition, we reviewed previously reported tumor heterogeneity in the literature. [ABSTRACT FROM AUTHOR]

It is very rare for colorectal neoplasms to metastasize to the heart in the worldwide medical literature; only a single case of well-documented colorectal cancer metastasis to the left atrium was found. The case of a 66-year-old man is explained in this paper, who was suffering from metastatic adenocarcinoma of the colon that included the left atrium. In transthoracic and transesophageal echocardiography, a large multilobulated mass was present in the left atrium. An accidental pulmonary mass was also seen in a lung spiral CT scan. The cardiac mass was taken out, and a biopsy was obtained from the pulmonary mass. Adenocarcinoma was seen in histological assessment. Immunohistochemical staining was carried out to examine the expression of cytokeratin 7, cytokeratin 20, and caudal-related homeobox transcription factor 2 (CDX2) to determine the origin of the adenocarcinoma. In addition, the expression of these proteins was linked to the attributes of the patient and tumor. Post-surgical transesophageal echocardiography showed normal left ventricle and right ventricle function with no evidence of left atrium mass. Therefore, we suggest that asymptomatic cancer patients with a history of colorectal cancer and who have developed cardiac symptoms should be immediately examined for potential cardiac metastasis. [ABSTRACT FROM AUTHOR]

Tumor metastasis is a phenomenon in which tumor cells grow in distant organs far from their primary site and is the final and most lethal manifestation of cancer. Most patients with cancer succumb to metastatic disease, not primary tumors. The occurrence of cardiac metastases is rare, but any primary tumor can potentially metastasize to the heart. The present report describes a 71-year-old male with stage IV lung squamous cell carcinoma who was diagnosed with cardiac metastases. These were identified as pedicled structures in the left atrium and left ventricle via echocardiography and positron emission tomography/computed tomography (PET/CT) prior to curative therapy. PET/CT imaging confirmed increased uptake of the tracer in these regions, indicating malignancy. Given the high expression of programmed cell death-ligand 1, the patient was treated with sintilimab immunotherapy. Despite a transient increase in liver function markers during treatment, the patient completed eight cycles of immunotherapy. Notably, both the primary lung tumor and cardiac metastases were markedly reduced in size, indicating a positive therapeutic response. The present case underscores the potential efficacy of immunotherapy in the management of cardiac metastases originating from lung cancer., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Shen et al.)

A 58-year-old male with squamous cell carcinoma of the floor of mouth underwent surgical planning for tumor resection and floor of mouth reconstruction. Unexpectedly, preoperative cervico-thoracic computed tomography (CT) indicated possible right ventricular intramural thrombosis, prompting initiation of unfractionated heparin. Follow-up echocardiography revealed no thrombus reduction, raising concerns of intracardiac metastasis. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose with computed tomography ( 18 F-FDG PET/CT) showed a hypermetabolic mass in the right ventricle, raising concern for a distant tumor metastasis. Under anti-coagulation, the patient experienced recurrent tumor-related hemorrhage, necessitating urgent lingual artery embolization. Due to disease progression, surgical options were dismissed in favor of palliative chemo-immunotherapy, which both led to significant regression of both primary and metastatic lesions., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Neuroendocrine tumor (NET) metastases to the heart are found in 1%-4% of NET patients and have been reported primarily in the form of individual cases. We investigated the prevalence, clinical characteristics, imaging features, and outcomes of NET patients with cardiac metastases on 68 Ga-DOTATATE PET/CT. Methods: 68 Ga-DOTATATE PET/CT of 490 consecutive patients from a single institution were retrospectively reviewed for sites of metastases. The cumulative cardiovascular event rate and overall survival of patients with cardiac NET metastases (CNMs) were compared with those of a control group of metastatic NET patients without cardiac metastases. In patients with CNMs, the cardiac SUV max with and without normalization to the myocardial background uptake was compared with a separate cohort of 11 patients with active cardiac sarcoidosis who underwent 68 Ga-DOTATATE PET/CT for research purposes. Results: In total, 270 patients with metastatic NETs were identified, 9 (3.3%) of whom had CNMs. All 9 patients had grade 1-2 gastroenteropancreatic NETs, most commonly from the small intestine (7 patients). The control group consisted of 140 patients with metastatic grade 1-2 gastroenteropancreatic NETs. On Kaplan-Meier analysis, there was no significant difference in the risk of cardiovascular adverse events ( P = 0.91 on log-rank test) or mortality ( P = 0.83) between the metastatic NET patients with and without cardiac metastases. The degree of cardiac DOTATATE uptake was significantly higher in CNMs than in patients with cardiac sarcoidosis without overlap, in terms of both cardiac SUV max ( P = 0.027) and SUV max -to-myocardial background ratio ( P = 0.021). Conclusion: Routine 68 Ga-DOTATATE PET/CT can be used to identify CNMs in 3% of patients with metastatic NETs. CNMs do not confer added cardiovascular or mortality risk. A distinguishing feature of CNMs is their high degree of DOTATATE uptake compared with focal myocardial inflammation., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)