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| LETTER TO EDITOR |
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| Year : 2011 | Volume
: 48
| Issue : 2 | Page : 266-267 |
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An unusual case of squamous cell carcinoma of lung with metastases to the heart
A Mehta1, S Gupta1, S Muhammad2
1 Department of Internal Medicine, Providence Hospital, Washington, DC, USA
2 Department of Critical Care and Sleep Medicine, Providence Hospital, Washington, DC, USA
| Date of Web Publication | 11-Jul-2011 |
Correspondence Address:
S Gupta
Department of Internal Medicine, Providence Hospital, Washington, DC
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-509X.82892
How to cite this article:
Mehta A, Gupta S, Muhammad S. An unusual case of squamous cell carcinoma of lung with metastases to the heart. Indian J Cancer 2011;48:266-7 |
Sir,
Advanced lung cancers can metastasize to the heart in approximately 36% of cases. Four different pathways of cardiac involvement in various primaries are: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. [1] Although involvement of left side is less common than right side of heart, it carries an increased risk of distant metastasis, stroke by embolization and sudden death. [2],[3],[4] We report a rare case of squamous cell carcinoma of lung metastasizing into the left atrium as an intracavitatory pedunculated mass through right inferior pulmonary vein.
A 62-year-old African-American male, active smoker (30 pack years) with no significant past medical history presented with fever, productive cough with hemoptysis, exertional dyspnea, right sided chest pain with weight loss of 7 kg over the past 2 months. On examination, he was found to be cachectic, hypoxic (PaO 2 − 55 mmHg and hemoglobin saturation of 80% on room air), tachypnoeic (23/min), tachycardic (133/min) and febrile with temperature of 101.8 °F. Abnormal laboratory data included leukocytosis (24400 cells/μl), hypercalcemia (10.7 mg/dl), and hyponatremia (132 meq/l). EKG showed atrial fibrillation. Chest X-ray showed right lower lobe consolidation with effusion, which was normal 1 year ago. CT chest showed nearly 8 cm cavitatory mass in right lower bronchus [Figure 1]a. Transthoracic echocardiography showed metastatic involvement of left atrium as an intracavitatory pedunculated mass through the right inferior pulmonary vein [Figure 1]b. He was immediately taken for surgery because of imminent risk of embolization. Intraoperatively, the tumor was inoperable which on biopsy showed squamous cell carcinoma of lung [Figure 1]c. He was treated with six cycles of concomitant radiation therapy with cisplatin and then eight cycles of taxotere and carboplatin. The latest PET/CT scan showed that he has a large lytic lesion in the right sacrum with lucent lesions in iliac wings and his condition has worsened. He has been out of chemotherapy for one year and on supportive treatment with ECOG performance status of 2−3.  | Figure 1: (a) CT scan of the chest showing huge right sided pleural effusion with collapse of the most of the underlying lung. Within the collapsed lung is a large low density mass measuring 7.8 cm in maximum diameter and that has a multilobular configuration. (b) Two-dimensional ECHO shows an oblong ECHO-dense structure measuring about 2.5 cm in width and extending from the mitral valve inlet to almost pulmonary vein. In different views this structure seems to be intermittently filling up the mitral valve and seems to be emanating from the pulmonary vein. (c) Histopathologic slide of the tissue(×40 magnification) obtained from the cardiac lesion showing many atypical squamous cells and apoptotic debris suggesting neoplasia of squamous cell origin
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It is very rare case of squamous cell carcinoma of lung to involve the left side of the heart. Echocardiogram, especially transesophageal is considered the investigation of choice for diagnosis and presurgical evaluation in highly suspected cases. [3] Surgical removal of tumor is usually indicated to avoid catastrophic complications from embolization. [5] Though extremely rare, squamous cell carcinoma of the lung can metastasize to the left side of the heart and utilization of echocardiography as a diagnostic modality can help in establishing the diagnosis.
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