Tandon Varun, Kethireddy Nikhila, Balakumaran Kathir, Kim Agnes S
Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.
Division of Cardiology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.
Eur Heart J Case Rep. 2019 Jun 1;3(2). doi: 10.1093/ehjcr/ytz029.
Cardiac tumours are typically secondary in nature, and the most common malignancies metastasizing to the heart are cancers of the lung, breast, oesophagus, melanoma, and lymphoma. We present a unique case of squamous cell carcinoma of the tongue, metastasizing to the heart and manifesting with ST elevation in the inferior-leads on electrocardiogram (ECG).
A 25-year-old woman was initially diagnosed with squamous cell carcinoma of the tongue at the age of 23 and treated with hemi-glossectomy with clear-margins. Sixteen months later, the tumour recurred in the oropharynx and the left upper lobe of the lung. She was treated with chemotherapy; however, the tumour progressed. Thus, she was initiated on immunotherapy and radiation therapy. One month later, she presented with chest pain. Electrocardiogram revealed ST elevation in the inferior-leads. Troponin-I was elevated. Transthoracic echocardiogram revealed focal areas of thickening within the left and right ventricular myocardium with associated hypokinesis. These findings suggested ECG changes were likely secondary to infiltrative metastases and not acute-coronary-syndrome. Cardiac magnetic resonance imaging showed infiltrative masses with increased T2-signal and heterogeneous enhancement on perfusion and delayed enhancement sequences. Imaging also demonstrated numerous extra-cardiac metastases. She was treated with analgesics and discharged to home hospice.
Head and neck cancers are a rare cause of cardiac metastasis. ST elevation and troponin release are thought to be due to tumour extension into the myocardium. Cardiac metastases usually present in patients with advanced widespread malignancy. In a cancer patient with cardiac symptoms or ECG changes, it is important to consider a broad differential diagnosis and entertain the possibility of cardiac metastasis.
心脏肿瘤通常为继发性，最常见转移至心脏的恶性肿瘤是肺癌、乳腺癌、食管癌、黑色素瘤和淋巴瘤。我们报告一例独特的舌鳞状细胞癌转移至心脏并在心电图（ECG）下壁导联出现ST段抬高的病例。
一名25岁女性在23岁时最初被诊断为舌鳞状细胞癌，并接受了切缘清晰的半舌切除术。16个月后，肿瘤在口咽和左肺上叶复发。她接受了化疗，但肿瘤仍进展。因此，她开始接受免疫治疗和放射治疗。1个月后，她出现胸痛。心电图显示下壁导联ST段抬高。肌钙蛋白I升高。经胸超声心动图显示左、右心室心肌内有局灶性增厚区域并伴有运动减弱。这些发现提示心电图改变可能继发于浸润性转移而非急性冠状动脉综合征。心脏磁共振成像显示浸润性肿块在T2加权像上信号增加，在灌注和延迟强化序列上呈不均匀强化。影像学检查还显示有大量心脏外转移。她接受了止痛治疗，随后出院接受居家临终关怀。
头颈部癌是心脏转移的罕见原因。ST段抬高和肌钙蛋白释放被认为是由于肿瘤延伸至心肌所致。心脏转移通常发生在晚期广泛恶性肿瘤患者中。对于有心脏症状或心电图改变的癌症患者,重要的是要进行广泛的鉴别诊断并考虑心脏转移的可能性。
