Mark-Adjeli Princess, Cirrone Joseph, Gupta Ravi, Nawaz Shahid
Department of Medicine, Long Island Community Hospital, Patchogue, NY, USA.
Department of Radiation Oncology, New York Cancer and Blood Specialists, Patchogue, NY, USA.
J Community Hosp Intern Med Perspect. 2019 Dec 14;9(6):524-528. doi: 10.1080/20009666.2019.1701311. eCollection 2019.
Tonsillar carcinoma metastasis to the myocardium is undermined with detection rate often occurring at autopsy or advance stage. A 60-year-old male with a 1-month history of right-sided facial pain and failed antibiotics therapy underwent head and neck CT scan that revealed a tonsillar mass. Tonsillar biopsy revealed squamous cell carcinoma, HPV-16 positive. PET-CT scan showed a significant activity in the right tonsillar mass along with prominent right level 2 lymph nodes and no distant disease. Definite surgery was deferred and he underwent 7 weeks of radiation therapy with concurrent weekly Cisplatin. PET scan 8 weeks later showed significant improvement in large right palatine tonsil mass; however, a new FDG-avid cardiac mass of right ventricle. An echocardiogram showed an ejection fraction of 59% and a large mass in the apical portion of the right ventricle. Cardiac MRI confirmed a 9 cm right ventricular mass. Complete resection of the cardiac mass was unsuccessful; a partial tumor debulking provided adequate sample for pathologic examination, which was consistent with metastatic squamous cell cancer, p16+, clinical-stage T4aN1M1. Surgical intervention was not performed; instead, he received a palliative radiation therapy to his right-sided cardiac mass with concurrent Keytruda immunotherapy. Unfortunately, the evening of successfully completing his last therapy, he was found unresponsive and subsequently expired. Although tonsillar carcinoma metastasis to the myocardium is rarely coupled with its atypical presentations, clinicians should consider early echocardiogram evaluation for possible metastatic disease so as to provide early interventions.
扁桃体癌转移至心肌的情况常难以被发现，其检出率通常在尸检时或疾病晚期才出现。一名60岁男性，有1个月右侧面部疼痛病史且抗生素治疗无效，接受了头颈部CT扫描，结果显示扁桃体有肿物。扁桃体活检显示为鳞状细胞癌，HPV - 16阳性。PET - CT扫描显示右侧扁桃体肿物有明显活性，同时右侧2区淋巴结肿大，无远处转移。原定手术推迟，他接受了7周的放疗，并同时每周使用顺铂。8周后的PET扫描显示右侧腭扁桃体大肿物有显著改善；然而，右心室出现了一个新的FDG摄取阳性的心脏肿物。超声心动图显示射血分数为59%，右心室心尖部有一个大肿物。心脏MRI证实右心室有一个9厘米的肿物。完整切除心脏肿物未成功；部分肿瘤减瘤术提供了足够的样本进行病理检查，结果与转移性鳞状细胞癌相符，p16阳性，临床分期为T4aN1M1。未进行手术干预；相反，他接受了针对右侧心脏肿物的姑息性放疗，并同时使用可瑞达免疫治疗。不幸的是，在成功完成最后一次治疗的当晚，他被发现无反应，随后死亡。尽管扁桃体癌转移至心肌很少见且表现不典型，但临床医生应考虑早期进行超声心动图评估以排查可能的转移性疾病，从而提供早期干预措施。
