Marreros Mark, Dulguerov Nicolas, Mermod Maxime
Maxillo-Facial Surgery Unit, Geneva University Hospital, Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland.
Head and Neck Surgery Unit, ENT Department of Geneva University Hospital, Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland.
Radiol Case Rep. 2024 Nov 25;20(2):1009-1013. doi: 10.1016/j.radcr.2024.10.139. eCollection 2025 Feb.
A 58-year-old male with squamous cell carcinoma of the floor of mouth underwent surgical planning for tumor resection and floor of mouth reconstruction. Unexpectedly, preoperative cervico-thoracic computed tomography (CT) indicated possible right ventricular intramural thrombosis, prompting initiation of unfractionated heparin. Follow-up echocardiography revealed no thrombus reduction, raising concerns of intracardiac metastasis. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose with computed tomography (F-FDG PET/CT) showed a hypermetabolic mass in the right ventricle, raising concern for a distant tumor metastasis. Under anti-coagulation, the patient experienced recurrent tumor-related hemorrhage, necessitating urgent lingual artery embolization. Due to disease progression, surgical options were dismissed in favor of palliative chemo-immunotherapy, which both led to significant regression of both primary and metastatic lesions.
一名58岁男性，患有口腔底部鳞状细胞癌，接受了肿瘤切除和口腔底部重建的手术规划。出乎意料的是，术前颈胸计算机断层扫描（CT）显示可能存在右心室壁内血栓形成，于是开始使用普通肝素。后续超声心动图显示血栓没有缩小，引发了对心脏内转移的担忧。2-脱氧-2-[氟-18]氟-D-葡萄糖正电子发射断层扫描与计算机断层扫描（F-FDG PET/CT）显示右心室有一个高代谢肿块，增加了对远处肿瘤转移的担忧。在抗凝治疗期间，患者出现复发性肿瘤相关出血，需要紧急进行舌动脉栓塞。由于疾病进展，放弃了手术选择，转而采用姑息性化学免疫疗法，该疗法使原发灶和转移灶均显著消退。
