2022 Volume 86 Issue 5 Pages 878-
An 88-year-old woman was referred for heart failure symptoms (i.e., dyspnea and lower extremity edema). Her N-terminal-pro-B-type natriuretic peptide levels were markedly elevated. Echocardiography revealed a giant left atrial (LA) tumor extending from the right pulmonary vein (Figure A, Supplementary Movie). Chest computed tomography revealed pleural effusion and a tumor with irregular margins and spicules in the upper lobe of the right lung, suggesting malignancy (Figure B). Because of the distance between the tumors, the causal relationship was unclear. Considering her advanced age and general condition, we performed conservative heart failure management using diuretics. Unfortunately, she died 21 days after admission due to worsening heart failure. Gross findings on postmortem examination revealed that the LA tumor was connected to the right lung tumor via the right pulmonary vein (Figure C). Based on the pathological examination, the tumor was diagnosed as a pleomorphic carcinoma with a squamous cell carcinoma composed of spindle and atypical giant cells. Moreover, the histological types of both the tumors were identical (Figure D,E). Thus, we concluded that the giant LA tumor was a transvenous cardiac metastasis from the pleomorphic lung carcinoma.
(A) Echocardiogram. (B) Computed tomography. (C) Gross findings on postmortem examination. (D,E) Pathological examinations. H.E., hematoxylin-eosin; LA, left atrium; LV, left ventricle.
Because this disease is rare, its precise diagnosis is often overlooked. Therefore, when a mass lesion is detected in the LA cavity, its spread should be investigated with an expanded field of an echocardiographic view. Furthermore, if mass lesions are also found in the lung, metastasis of lung cancer through the pulmonary vein should be considered.
The authors declare no conflicts of interest.
None.
Supplementary Movie. Left atrial tumor.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-21-0946
