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      Diagnostic and Therapeutic Challenges Associated with the Rare Cardiac Metastasis Complicating Rectal Adenocarcinoma

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          Abstract

          Colorectal cancer (CRC) is one of the most common malignancies in the world. It typically metastasizes to the lymph nodes, liver or lungs. Cardiac involvement is considered the least likely metastatic complication of malignant tumors including CRC. We report a rare case of metastatic rectal cancer to the liver, ovaries, lungs and peritoneum that presented initially with a 1-week history of rectal bleeding. Her hospital course was complicated by progressive dyspnea and palpitations secondary to right atrial metastasis based on imaging studies including cardiac MRI with contrast. The patient was not fit for chemotherapy or any surgical intervention given her poor prognosis and functional status in the setting of advanced stage of her disease. After discussion with the patient and her family, a decision was made to change her code status to DNR (do not resuscitate) and focus on palliative treatment of her disease. She expired about 2 weeks following her discharge date. Based on this case report, we recommend a high index of suspicion for cardiac metastasis when dealing with cardiac or respiratory complaints in cases of CRC that need careful evaluation with echocardiography and MRI.

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          Most cited references 17

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          Metastatic involvement of the heart and pericardium: CT and MR imaging.

          Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma. Tumor may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. Impairment of cardiac function occurs in approximately 30% of patients and is usually attributable to pericardial effusion. The clinical presentation includes shortness of breath, which may be out of proportion to radiographic findings in patients with pericardial effusion or may be the result of associated pleural effusion. Patients may also present with cough, anterior thoracic pain, pleuritic chest pain, or peripheral edema. The differential diagnosis of pericardial effusion in a patient with known malignancy includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis. Any disease process that causes thickening or nodularity of the pericardium or myocardium or masses within the cardiac chambers can mimic metastatic disease.
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            Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

            This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.
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              Cardiac metastases.

              Tumours metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic. Although primary cardiac tumours are extremely uncommon (various postmortem studies report rates between 0.001% and 0.28%), secondary tumours are not, and at least in theory, the heart can be metastasised by any malignant neoplasm able to spread to distant sites. In general, cardiac metastases are considered to be rare; however, when sought for, the incidence seems to be not as low as expected, ranging from 2.3% and 18.3%. Although no malignant tumours are known that diffuse preferentially to the heart, some do involve the heart more often than others--for example, melanoma and mediastinal primary tumours. This paper attempts to review the pathophysiology of cardiac metastatic disease, epidemiology and clinical presentation of cardiac metastases, and pathological characterisation of the lesions.
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                Author and article information

                Journal
                Case Rep Oncol
                Case Rep Oncol
                CRO
                Case Reports in Oncology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1662-6575
                Sep-Dec 2020
                7 December 2020
                7 December 2020
                : 13
                : 3
                : 1441-1445
                Affiliations
                aDepartment of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
                bCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
                Author notes
                *Mohammad Alrehaili, Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Muzdalifah Road, PO Box 57657, Makkah 24246 (Saudi Arabia), dr.rehaili@ 123456hotmail.com
                Article
                cro-0013-1441
                10.1159/000511600
                7772863
                Copyright © 2020 by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                Page count
                Figures: 3, References: 15, Pages: 5
                Categories
                Case Report

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