PMC6854178_01
(a, b) Chest computed tomography with contrast shows a mass in the apex of the left ventricle (arrows).
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Another surveillance CT scan in December 2016 showed a cardiac lesion in the left ventricular (LV) apex (Figure 1).
Electrocardiogram shows ST elevations in the anterior and lateral leads.
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In the clinic, the patient's physical examination was unremarkable but his electrocardiogram (ECG) showed ST elevations in the anterior and lateral leads suggestive of myocardial injury (Figure 2).
(a) Transthoracic echocardiogram shows a 4.6 x 2.8 cm mass (arrows) infiltrating the apical, antero-septal-lateral wall segments. (b) Transthoracic echocardiogram shows interval progression of the mass (arrows).
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He underwent a comprehensive transthoracic echocardiogram, which showed a 4.6 x 2.8 cm mass infiltrating the apical anteroseptal and anterolateral wall segments (Figure 3).
(a) Cardiac magnetic resonance imaging (MRI) demonstrates a 3.3 x 4.2 cm infiltrating lesion (arrows) within the apex of the left ventricle without early or delayed enhancement. (b) Cardiac MRI shows interval progression of the mass (arrows). (c) Cardiac MRI shows the infiltrative tumor mass involving the left ventricular myocardium with features suggesting central necrosis (arrows).
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The patient underwent a cardiac magnetic resonance imaging (MRI) scan, which demonstrated a 3.3 x 4.2 cm infiltrating lesion within the apex of the LV without early or delayed enhancement (Figure 4(a)). A follow-up cardiac MRI done 2 months later showed a substantial increase in the size of the mass as well as extension into the right ventricular apex (Figure 4(b)). However, a cardiac MRI done in December 2017 showed interval progression of the infiltrative tumor mass involving the LV myocardium, with features suggesting central necrosis (Figure 4(c)). An echocardiogram showed interval progression of metastasis to the left and right ventricular cavities (Figure 4(c)).
Pathology slide of right ventricular myocardial tissue shows pleomorphic malignant tumor cells (yellow arrows) and cardiac myocytes (white arrows).
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The pathology immunohistochemical stains (p40 and CK5/6) were consistent with myocardial involvement by metastatic SCC (Figure 5).
(a) Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) shows development of widespread hypermetabolic metastases (arrows). (b) FDG PET/CT shows more widespread metastasis involving the right lung and adrenal glands (arrows).
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A repeat PET scan done in March 2017 showed widespread metastasis (Figure 6(a)). A follow-up PET scan showed multiple new metastatic lesions (Figure 6(b)).