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Cardiac Metastasis likely secondary to Anal Squamous Cell Carcinoma
Cardiac Metastasis likely secondary to Anal Squamous Cell Carcinoma
Submitted on 06 Oct 2017

Dr M Madigan, Dr E Hoey, Dr R Watkin
Heart of England NHS Foundation Trust, Birmingham UK
This poster was presented at BIR Annual Congress 2017
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Poster Abstract
Tumours of the heart are uncommon, with a frequency of 0.02% for primary lesions and 0.7-3.5% for metastatic neoplasms[1,2]. Metastatic spread can occur by direct extension or via the haematogenous or lymphatic system[3]. Cardiac metastases are more frequently found with melanoma, lung, breast and haematological malignancies[4].
Case Description
A 57 year old man presented with temporary memory loss and a background of treated anal squamous cell carcinoma. A CT Head found a hyperdense ringed lesion; further evaluation with an MRI gave the impression of an incidental left frontotemporal cavernoma. Upon discharge he was referred for a transthoracic echocardiogram as an ECG showed non-specific changes compared to a previous. This demonstrated a left ventricular apical mural thrombus and mass, and the patient was admitted from clinic. A cardiac MRI described a focal fibroma-like myocardial lesion involving the lateral wall. Considering the history of malignancy, a staging CT was carried out. A cavitating lesion within the right upper lobe of the lung was found and a large necrotic nodal mass within the right groin also. The groin mass was aspirated and histology confirmed metastasis from the anal squamous cell carcinoma. He was subsequently started on palliative chemotherapy. Four months later he presented with shortness of breath; he deteriorated rapidly and died on the Intensive Care Unit.
A history of cancer should always be considered with all images that have malignancy as a differential. Cardiac tumours should be investigated further for a primary as they are more likely to be a metastasis.

[1] Reynen K. Frequency of primary tumors of the heart. Am J Cardiol. 1996 Jan 1;77(1):107
[2] Goldberg AD, Blankstein R, Padera RF. Tumors Metastatic to the Heart. Circulation. 2013;128:1790-1794
[3] Bussani R, De‐Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007 Jan; 60(1): 27–34.
[4] Amano J, Nakayama J, Yoshimura Y, Ikeda U. Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences. Gen Thorac Cardiovasc Surg. 2013; 61(8): 435–447.
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