Myocardial metastasis from ZEB1- and TWIST-positive spindle cell carcinoma of the esophagus: A case report

BACKGROUND

Metastatic cardiac tumors are known to occur more frequently than primary cardiac tumors, however, they often remain asymptomatic and are commonly discovered on autopsy. Malignant tumors with a relatively high frequency of cardiac metastasis include mesothelioma, melanoma, lung cancer, and breast cancer, whereas reports of esophageal cancer with cardiac metastasis are rare.

CASE SUMMARY

The case of a 60-year-old man who complained of dysphagia is presented. Upper gastrointestinal endoscopy showed a submucosal tumor-like elevated lesion in the esophagus causing stenosis. Contrast-enhanced computed tomography showed left atrial compression due to the esophageal tumor, multiple liver and lung metastases, and a left pleural effusion. Pathological examination of a biopsy specimen from the esophageal tumor showed spindle-shaped cells, raising suspicion of esophageal sarcoma. The disease progressed rapidly, and systemic chemotherapy was deemed necessary, however, due to his poor general condition, administration of cytotoxic agents was considered difficult. Given his high Combined Positive Score, nivolumab was administered, however, the patient soon died from the disease. The autopsy confirmed spindle cell carcinoma (SCC) of the esophagus and cardiac metastasis with similar histological features. Cancer stem cell markers, ZEB1 and TWIST, were positive in both the primary tumor and the cardiac metastasis.

CONCLUSION

To the best of our knowledge, there have been no prior reports of cardiac metastasis of esophageal SCC. This case highlights our experience with a patient with esophageal SCC who progressed rapidly and died from the disease, with the autopsy examination showing cardiac metastasis.

Myocardial metastasis within lipomatous hypertrophy of the interatrial septum

A 74-year-old lady with lipomatous hypertrophy of the interatrial septum presented with symptomatic anemia. Imaging revealed a new diagnosis of metastatic cancer of presumed lung origin, with a new soft tissue myocardial lesion adjacent to the right atrium within the region of lipomatous hypertrophy. This was favored to represent a myocardial metastasis within concurrent lipomatous hypertrophy of the interatrial septum.

Primary Squamous Cell Lung Cancer With Frequent Episodes of Sustained Ventricular Tachycardia due to Myocardial Metastasis

Myocardial metastasis from lung cancer rarely occurs. We encountered a patient with squamous cell lung cancer who was diagnosed with myocardial metastasis before death and sustained ventricular tachycardia during the course of the disease. The patient was a 56-year-old woman. A tumor was noted in the apex area of the left lung and was diagnosed as stage IVA of squamous cell lung cancer after a detailed examination. She underwent concurrent chemoradiotherapy with weekly treatment of carboplatin + paclitaxel. A 12-lead electrocardiogram performed upon admission for additional chemotherapy showed negative T waves in leads III, aVF, and V1-4. Transthoracic echocardiography and computed tomography showed a tumor lesion in the right ventricular wall, which was diagnosed as myocardial metastasis from lung cancer. During the course of the disease, the patient had frequent episodes of sustained ventricular tachycardia, which were refractory to treatment with antiarrhythmic drugs. However, the sinus rhythm was restored with cardioversion. Subsequently, the patient received palliative treatment and eventually died 4 months after the diagnosis of cardiac metastasis and 3 weeks after the diagnosis of ventricular tachycardia. Myocardial metastasis might reflect poor prognosis due to serious arrhythmia or some other complications. Therefore, the early diagnosis and appropriate treatment of cardiac metastasis by chemotherapy, cardiac radiotherapy, or surgery, are necessary prior to the development of symptoms in tolerant cases.

Solitary myocardial metastasis from neuroendocrine tumor: surgical resection as curative surgery

We present the case of a 70-year-old man with intramyocardial solitary metastasis from a carcinoid bowel tumor. One year previously, he had undergone distal ileum resection for a neuroendocrine tumor. Asymptomatic recurrence was diagnosed with the combination of elevated chromogranin A serum level and somatostatin receptor scintigraphy. The tumor was located on the right ventricle free wall, without obstruction of the right ventricular outflow tract and absence of carcinoid syndrome or liver involvement. Complete resection was obtained under cardiopulmonary bypass. The patient is currently alive without disease 2 years after surgery. Oncologists should be aware of the heart as a possible site of neuroendocrine metastatic disease. This case highlights the value of positron emission tomography with somatostatin analogs for earlier and more frequent metastasis detection. Persistent remission can be obtained with complete surgical resection when the metastatic tumor is localized in the right ventricle without evidence of carcinoid heart disease.