PMC4942513_01
(A) Apical four-chamber echocardiogram showing mass at the right ventricular apex (arrow) with small loculated pericardial effusion. (B) Echocardiogram (RVOT view) showing right ventricular mass in the right ventricular cavity. (C) Echocardiogram in short-axis view showing mass extending from the right ventricular cavity (arrow) to the right ventricular outflow tract (arrowhead). (D) Cardiac MRI oblique four -chamber view with gadolinium contrast showing obliteration of the right ventricular apex (arrow). (E) Cardiac MRI oblique five-chamber view in transverse section with horizontal long axis on gadolinium contrast showing intracavitary mass (arrow). (F) Cardiac MRI showing right ventricular (arrow) and right atrial enlargement.
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Right atrium was dilated and also showed small loculated pericardial effusion at right ventricle apex (Fig. 1A-1C). Cardiac MRI findings were most consistent with a combination of tumor and thrombus within the right ventricle (Fig. 1D-1F).
(A) PET-CT transverse image showing radiotracer uptake in right ventricular apex and right atrium at T4 level. (B) PET-CT transverse image showing radiotracer uptake in right ventricular apex (arrow) at T3 level. (C) PET-CT nuclear scan showing metastatic areas to heart, brain, bilateral paraaortic lymph nodes, and the pelvic region.
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However, there appeared to be a more focal uptake in the sub-valvular region and near the pulmonary outflow tract, in the areas of concern raised on the MRI (Fig. 2A-2B). The findings also revealed enlarged and hypermetabolic lymph nodes almost diffusely throughout the retroperitoneum and bilateral inguinal regions (Fig. 2C).
(A) Microscopic histopathology shows hypercellular neoplastic squamous cells (arrow) and normal myocardial tissue (arrowhead). (B) Gross transverse section of the heart with tumor filling right ventricle (arrow).
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The mass occupied nearly the entire rigth ventricle, invading the ventricular wall and involved the tricuspid valve with the right ventricular outflow tract; histopathology revealed metastatic poorly differentiated invasive squamous cell carcinoma, most likely originating from the uterine cervix (Fig. 3A-3B).