Jafri Syed Imran Mustafa, Ali Naveed, Farhat Salman, Malik Faizan, Shahin Mark
Abington-Jefferson Health, Department of Internal Medicine, 1200 Old York Road, Abington, PA 19001, USA.
Abington-Jefferson Health, Hanjani Institute for Gynecologic Oncology, 1200 Old York Road, Abington, PA 19001, USA.
Gynecol Oncol Rep. 2017 Jun 3;21:20-23. doi: 10.1016/j.gore.2017.06.004. eCollection 2017 Aug.
A 50-year-old female was diagnosed with vulvar cancer treated with left partial vulvectomy and bilateral lymphadenectomy. Ten months after her surgery, she presented with increased labial swelling, pain and discharge. Biopsy confirmed recurrence of squamous cell vulvar carcinoma. Incidentally, on restaging radiographic scans, she was found to have a large right ventricular mass which, after surgical debulking, was shown to be a squamous cell cancer of vulvar origin. She was commenced on chemotherapy with carboplatin and paclitaxel along with concurrent radiation therapy. Restaging PET scan showed persistent metastatic disease. She was switched to Cisplatin/Taxol after having hypersensitivity reaction to Carboplatin. She received 5 cycles with progression of disease in the follow up scans. She then received Nivolumab for 2 cycles. The patient then opted for comfort directed care given worsening functional status and progression of disease on repeat imaging. Secondary cardiac tumors are very rare and not extensively studied in oncology. Therefore, optimal management is not entirely clear. It is extremely rare for vulvar cancer to metastasize to the heart and only two cases have been reported in the literature. However, vulvar cancer metastasizing to the right ventricular cavity and endocardium has not been described before. We believe that this is the first ever such reported case.
一名50岁女性被诊断为外阴癌，接受了左侧部分外阴切除术和双侧淋巴结清扫术。术后10个月，她出现阴唇肿胀、疼痛和分泌物增多。活检证实为鳞状细胞外阴癌复发。偶然的是，在重新分期的影像学检查中，发现她右心室有一个大肿块，手术切除后显示为起源于外阴的鳞状细胞癌。她开始接受卡铂和紫杉醇化疗并同时进行放射治疗。重新分期的PET扫描显示仍有转移性疾病。在对卡铂出现过敏反应后，她改用顺铂/紫杉醇。她接受了5个周期的治疗，后续扫描显示疾病进展。然后她接受了2个周期的纳武单抗治疗。鉴于功能状态恶化和重复成像显示疾病进展，患者随后选择了姑息治疗。继发性心脏肿瘤非常罕见，肿瘤学领域对此研究不多。因此，最佳治疗方案尚不完全明确。外阴癌转移至心脏极为罕见，文献中仅报道过两例。然而，此前尚未有外阴癌转移至右心室腔和心内膜的描述。我们认为这是首例此类报道病例。
