the incidence of metastatic hepatocellular carcinoma ( hcc ) in the right heart cavity with cephalad extension through the inferior vena cava has been reported to be less than 6% in an autopsy series . however , the diagnosis of metastasis of hcc into the cardiac cavity can be overlooked , as the symptoms are neither apparent nor specific . moreover , reports of isolated intracavitary metastatic hcc of the right ventricle without right atrium and inferior vena cava involvement are very rare . here , we describe a patient with isolated metastasis of hcc into the right ventricular ( rv ) outflow tract ( rvot ) . a 79-year - old man was admitted to our hospital for chest pain , severe dyspnea ( new york heart association grades 34 ) , and orthopnea . ten years earlier , he underwent right hemi - hepatectomy for a hcc ( t3n0m0 according to the american joint committee on cancer classification ) . subsequently , he has been assessed regularly at another general hospital specializing in cancer , and he had a disease - free status for 10 years . the latest -fetoprotein level was 1.4  ng / ml ( normal range , less than 7.0  ng / ml ) . results of the laboratory test showed no significant abnormal value ; even the hepatic and cardiac enzymes were within normal range . however , the echocardiogram showed a visible , huge rv mass with partial rvot obstruction ( maximum velocity : 1.3  m / s , maximum pressure gradient : 7.5  mm hg ) and hypokinesia of the rv wall from the mid to apex ( fig . we performed contrast - enhanced computed tomography ( ct ) and magnetic resonance imaging ( mri ) to obtain more precise characteristics about the mass . the mri showed that the tumor was isointense on the t1-weighted image and had slightly high intensity on the t2-weighted image ( fig . thus , we thought the patient 's symptoms occurred owing to rvot obstruction , which decreased the pulmonary artery flow . to determine whether the tumor was malignant , and if it had metastasized to other sites , we performed f - fluorodeoxyglucose positron emission tomography ( pet ) . the pet scan showed an abnormal intake of 18-fluoro-2-deoxyglucose in the right ventricle ( fig . 4 ) . there was no tumor in the right atrium , inferior vena cava , liver , and any other site ( fig . transthoracic echocardiogram of the tumor ( 4.97  cm    3.22  cm ) . contrast - enhanced computed tomography scans ( axial view ) . a multilobulated , polypoid , isodense to hypodense cardiac magnetic resonance images using the black - blood and fat subtraction technique . the right ventricular mass with a multilobulated surface was an isointensity lesion on the t1-weighted image and a slightly high intensity lesion on the t2-weighted image ( [ a ] arrows indicate the isointensity ; [ b ] arrowheads indicate the high intensity area ) . the arrow indicates the thickened right ventricular free wall with abnormal uptake of 18-fluoro-2-deoxyglucose ( standardized uptake value , 5.5 ) . histopathological findings with hematoxylin and eosin staining demonstrated that the tumor had a trabecular pattern with central sinusoid space , and we confirmed metastatic hcc by performing hepatocyte antigen immunohistochemistry analysis ( fig . the immunochemical finding from hepatocyte antigen immunohistochemistry analysis is specific for the neoplastic or nonneoplastic hepatocyte antigen . palliative resection of the tumor was performed through right atriotomy and ventriculotomy . during the operation , a huge , yellowish , dark purple tumor with extensive involvement of the rv free wall and outflow tract extension was observed ( fig . 7 ) . postoperatively , he felt more comfortable , as the chest pain and dyspnea had been resolved . later , we found a multifocal arterial enhanced lesion suggestive of a new hcc in the left hepatic lobe on a 3-phase abdominal ct scan ( fig . 8) , as well as an increased protein induced by vitamin absence level ( 10,973  mau / ml [ normal range , less than 40  mau / ml ] ) . the arrows indicate multifocal arterial enhanced lesions suggestive of a new hepatocellular carcinoma in the left hepatic lobe . we advised the patient that his case is very rare , and there is no standard treatment . on the basis of the findings from imaging studies and the patient 's medical history , we confirmed isolated metastasis of hcc in the right ventricle . several reports have described cardiac tumor metastasis , and its incidence is approximately 10% in patients with hcc . however , such metastases usually invade the heart through the vascular system or by infiltrating the heart from neighboring organs . hcc with rv metastasis without inferior venous cava and right atrium metastasis is rarely reported , and it may be caused by the hematogenous spread of cancer cells . patients who present with right cardiac cavities with tumor invasion are difficult to be diagnosed . yet , even with a diagnosis , effective treatment has not been well established . presently , there is no standard treatment for metastatic hcc with invasion into the right ventricle . palliative resection may be necessary owing to hemodynamic compromise , but the prognosis remains very poor . after partial surgical resection , we recommended radiotherapy in our patient ; however , we were uncertain of the treatment effect , and the patient refused this treatment recommendation . until recently , only a few large - scale clinical studies of patients with hcc extending into the heart have been published . the present report describes an unusual case of isolated metastasis of hcc in the right ventricle . in similar cases , treatment should be individualized to the patient , and a multidisciplinary approach , including surgery , radiotherapy , and chemotherapy , should be used .
abstractmetastatic hepatocellular carcinoma ( hcc ) of the right ventricle is very rare and difficult to diagnosis.a 79-year - old man who underwent right hemi - hepatectomy for hcc was admitted to our hospital for chest pain , severe dyspnea , and orthopnea . 
 the echocardiogram showed a tumor located in the right ventricle . 
 a biopsy was obtained , and histopathological findings confirmed metastatic hcc . 
 palliative resection of the tumor was performed.there is no standard treatment for metastatic hcc into the right ventricle . 
 thus , treatment should be individualized to the patient , and a multidisciplinary approach should be used .