Hohmann Christopher, Bunck Alexander C, Pfister David, Michels Guido
Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany.
Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany.
Eur Heart J Case Rep. 2019 Jan 9;3(1):yty167. doi: 10.1093/ehjcr/yty167. eCollection 2019 Mar.
The incidence of intracardiac masses is generally low. In most cases, the formation of a thrombus represents the principal diagnosis in clinical practice. The differential diagnosis mainly includes primary tumours of the heart as well as intracardiac metastases. Testicular cancer is a rare malignancy, accounting for approximately 1% of all male tumours. Cardiac metastasis of a seminoma is extremely rare.
A 30-year-old man with a history of a classic seminoma of the right testis was referred to our university hospital from an outside clinic. Transthoracic echocardiography showed a large space-occupying mass in the right ventricle (4.0 cm × 4.5 cm × 5.5 cm) attached to the apex and septum. Cardiac magnetic resonance imaging confirmed the finding of a 5.5 cm × 3.5 cm lesion without freely movable appendage or obstruction of the right ventricular outflow tract. Tissue characterization by T1- and T2-weighted black blood imaging revealed a signal behaviour comparable to pulmonary metastases. Additionally, positron emission tomography (PET) with 250 MBq induced 18-fluorodeoxyglucose (F-FDG) as part of a re-staging showed significant FDG-uptake. Thus, the final diagnosis of an intracardiac metastasis of the testicular seminoma was made, and the patient was treated with cisplatin, etoposide, and bleomycin chemotherapy according to the current guidelines. A repeat trans-thoracic echocardiogram (TTE) performed 2 weeks later already demonstrated a significant reduction of the metastasis with a diameter of 3.3 cm × 3.0 cm.
In the past few years, multimodality imaging has become essential in the diagnostic evaluation of cardiac disease. In order to improve the diagnostic accuracy, a modern approach should preferably contain the integration of different imaging modalities. Cardiac magnetic resonance imaging as well as F-FDG-PET/computed tomography helped us reach the aetiological diagnosis of an intracardiac metastasis and to initiate prompt treatment.
心内肿物的发生率通常较低。在大多数情况下，血栓形成是临床实践中的主要诊断。鉴别诊断主要包括原发性心脏肿瘤以及心内转移瘤。睾丸癌是一种罕见的恶性肿瘤，约占所有男性肿瘤的1%。精原细胞瘤的心脏转移极为罕见。
一名有右侧睾丸经典精原细胞瘤病史的30岁男性从外院转诊至我院。经胸超声心动图显示右心室有一个大的占位性肿物（4.0 cm×4.5 cm×5.5 cm），附着于心尖和室间隔。心脏磁共振成像证实发现一个5.5 cm×3.5 cm的病变，无游离活动的附属物，也无右心室流出道梗阻。T1加权和T2加权黑血成像的组织特征显示信号表现与肺转移瘤相似。此外，作为再分期的一部分，使用250 MBq的18氟脱氧葡萄糖（F-FDG）进行正电子发射断层扫描（PET）显示有明显的FDG摄取。因此，最终诊断为睾丸精原细胞瘤的心内转移，患者根据当前指南接受顺铂、依托泊苷和博来霉素化疗。2周后进行的重复经胸超声心动图（TTE）显示转移瘤明显缩小，直径为3.3 cm×3.0 cm。
在过去几年中，多模态成像在心脏病的诊断评估中变得至关重要。为了提高诊断准确性，现代方法最好应包含不同成像模态的整合。心脏磁共振成像以及F-FDG-PET/计算机断层扫描帮助我们做出心内转移的病因诊断并启动及时治疗。
