Department of Internal Medicine, Yekatit 12 Hospital Medical College, Sidist Kilo Square, P. O. Box 257, Addis Ababa, Ethiopia.
Department of Oncology, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
J Med Case Rep. 2024 Nov 4;18(1):520. doi: 10.1186/s13256-024-04875-8.
Heart failure is a rare manifestation of metastatic disease of the carcinoma of an unknown primary, malignancy that requires extensive work-up to identify the primary site. Initial consideration of rare etiologies in patients presented with a common clinical syndrome is challenging.
A 35-year-old Black woman presented with shortness of breath at rest, orthopnea, paroxysmal nocturnal dyspnea, chest pain, a blood-tinged productive cough, and fever for 2 weeks. She also had progressive body swelling, easy fatigability, loss of appetite, and abdominal pain during the same week's duration. Body imaging revealed large pleural and pericardial effusions, metastatic liver lesions, and bilateral pulmonary vascular segmental and subsegmental filling defects. Pericardial and pleural fluid cytology suggest malignant effusion. Liver lesions and core needle biopsy indicated adenocarcinoma of unknown origin, and the carcinoembryonic antigen level also increased significantly.
Carcinoma of unknown primary origin commonly presents in an advanced stage and is often accompanied by clinical features of site metastasis. This case highlights heart failure as an unusual first manifestation of adenocarcinoma with an unknown primary origin.
心力衰竭是一种罕见的癌转移疾病的表现，这种癌症需要广泛的检查来确定原发部位。在患者出现常见临床综合征时，最初考虑罕见病因具有挑战性。
一名 35 岁的黑人女性因静息时呼吸困难、端坐呼吸、阵发性夜间呼吸困难、胸痛、血性痰和发热 2 周而就诊。在同一周内，她还出现了进行性身体肿胀、易疲劳、食欲不振和腹痛。身体影像学显示大量胸腔和心包积液、转移性肝病变以及双侧肺血管节段和亚节段充盈缺损。心包和胸腔积液细胞学检查提示恶性积液。肝病变和芯针活检提示腺癌，癌胚抗原水平也显著升高。
原发灶不明的癌通常在晚期出现，并且常伴有局部转移的临床特征。本病例突出了心力衰竭作为一种不常见的首发表现的腺癌，原发灶不明。
