Cardiac Metastasis in a Patient with Head and Neck Cancer: A Case Report and Review of the Literature

Table 1

Literature review of cardiac metastasis in head and neck cancer detected ante-mortem.

Patient	Study	Year of publication	Primary site	Primary treatment	Location of metastasis	Signs/symptoms	ECG findings	Biopsy proven cardiac metastasis	Treatment for cardiac metastasis	Initial imaging modality to detect cardiac metastasis	PET scan used?
1	Werbel et al. [18]	1985	Base of tongue	Hemiglossectomy	Mediastinal mass compressing right ventricular outflow tract and encasing the ascending aorta, right atrium mass	Intermittent positional chest pain, dysphagia, weight loss	New ST depression with T-wave inversions anteriorly	Yes	Surgical exploration via modified right-sided Chamberlain procedure, but deemed unresectable. Planned to proceed with radiotherapy, but patient expired before initiation	2D Echocardiogram	No
2	Rivkin et al. [19]	1999	Right base of tongue	Local excision and adjuvant radiotherapy to primary site and bilateral neck	Right ventricle	Chest pain, lower extremity edema	Mild ST elevation in V4 and V5, atrial fibrillation with ST elevation in V2 to V6 and Q waves in V2 and III	Yes	Chemotherapy with cisplatin, 5-FU, bleomycin, and methotrexate	Chest X-ray and Echocardiogram	No
3	Schwender et al. [20]	2002	Right buccal mucosa	Chemotherapy with cisplatin and radiotherapy	Pericardial effusion	Weakness, lightheadedness, dyspnea	Atrial fibrillation with rapid ventricular response	Yes	None	Chest X-ray, CT Chest	No
4	Zemann et al. [13]	2007	Oral cavity	Right mandibulectomy, right hemiglossectomy, right radical neck dissection, and left supraomohyoid dissection with immediate microvascular flap reconstruction followed by adjuvant radiotherapy to right lower jaw and right neck to 60 Gy/50Gy	Right ventricle	Respiratory distress	Normal findings	No	None	CT Chest	No
5	Hans et al. [21]	2008	Base of tongue	Induction chemotherapy (5-FU/cisplatin), glossectomy and left radical neck dissection and adjuvant radiotherapy to primary site and neck to 60 Gy/46 Gy	Right ventricle extending into the pulmonary infundibulum	Dyspnea, lower extremity edema, hemoptysis	Right bundle branch block	No	None	CT Chest	No
6	Tsai et al. [22]	2010	Left retromolar trigone	Segmental mandibulectomy and ipsilateral modified radical neck dissection followed by adjuvant radiotherapy to primary site and whole neck to 64 Gy	Pericardial effusion, mediastinal mass	Progressive dyspnea, tachycardia, pulsus paradoxus	Low QRS voltage	Yes	Chest tube insertion and drainage, emergency thoracotomy, palliative chemotherapy with cisplatin and cetuximab	2D Echocardiogram	Yes
7	Nagata et al. [1]	2012	Right lingual	Preoperative concurrent chemoradiation therapy to 30 Gy followed by partial glossectomy and right radical neck dissection and rectus abdominis musculocutaneous flap reconstruction followed by adjuvant chemotherapy	Left atrium to the left pulmonary vein, Pericardial effusion	Fever	—	Yes	Resection of cardiac mass	Chest CT and Echocardiogram	Yes
8			Left soft palate	Preoperative concurrent chemoradiation therapy to 40 Gy followed by partial maxillectomy and radical neck dissection followed by adjuvant chemotherapy	Right atrium and right ventricle, pericardial effusion	—	Right bundle branch block and borderline Q wave	No	None	Chest CT	Yes
9	Onwuchekwa and Banchs [23]	2012	Right oral tongue	Right partial glossectomy and extensive neck dissection	Right ventricle invading interventricular septum and left ventricle	Syncope, mild dyspnea	Sinus rhythm	No	None	CT angiogram and 2D echocardiogram	No
10			Left oral tongue	Concurrent chemoradiotherapy, left partial glossectomy, left neck dissection	Anteroseptal wall of the left ventricle extending toward the right ventricular outflow tract, pericardial effusion	Palpitations, dyspnea	Sinus rhythm with ST elevation in the anterolateral leads	No	Radiotherapy and chemotherapy	Chest X-Ray and 2D echocardiogram	No
11	Yadav et al. [16]	2014	Right piriform sinus	Chemotherapy with cisplatin and radiotherapy	Right and left ventricular apex and distal interventricular septum	None	Inferior and anterolateral ST elevation	Yes	Pemetrexed and gemcitabine	PET/CT	Yes
12			Oral tongue	Partial glossectomy	Left and right ventricle with extension to chordae tendinae	Presented with pneumonia	New anterolateral myocardial infarction (ST elevation)	No	None	Chest X-Ray and Echocardiogram	No
13	Puranik et al. [4]	2014	Left buccal mucosa	Concurrent chemoradiotherapy	Left ventricular myocardium	Weight loss	—	No	Palliative chemotherapy	PET/CT	Yes
14			Right lateral oral tongue	Wide excision and right lateral neck dissection	Left ventricular myocardium	Swelling over ala of nose	—	No	Palliative chemotherapy	PET/CT	Yes
15			Right Vallecula	Chemoradiotherapy	Right ventricular myocardium	—	—	—	Palliative chemotherapy	PET/CT	Yes
16	Pattni et al. [5]	2015	Left retromolar trigone	Began radiotherapy, but then elected to pursue surgery with curative intent-Cardiac metastasis was detected and surgery was cancelled	Apex of right ventricle extending to the tricuspid valve	Central chest “heaviness,” tachycardia, irregularly irregular pulse	ST-segment elevation	No	None	Transthoracic echocardiogram	No
17	Browning et al. [14]	2015	Base of tongue	Radiotherapy	Anterior wall of right ventricle	—	—	No	None	PET/CT	Yes
18	Martell et al. [24]	2016	Right retromolar trigone	Pharyngotomy and segmental mandibular resection, right selective neck dissection, free fibular flap reconstruction followed by adjuvant concurrent chemoradiotherapy to 60 Gy with cisplatin	Right ventricle, prevascular lymph node, pericardial effusion	Acute dyspnea, palpitations	Rapid atrial fibrillation	Yes	Planned for palliative radiotherapy to 20 Gy in 5 fractions, but patient expired prior to treatment	Echocardiogram and CT Chest	No
19	Vaduganathan et al. [25]	2016	Larynx	Unknown	Left ventricle	Arrhythmia	Stable ventricular tachycardia	No	Permanent pacemaker placement and systemic chemotherapy	Transthoracic echocardiogram	No
20	Malekzadeh et al. [3]	2017	Oral tongue	Right hemiglossectomy and adjuvant radiotherapy	Right ventricle	Acute chest pain	Slight ST elevation inV3 and V4	No	Palliative chemotherapy with cetuximab, carboplatin, and 5-FU	CT Chest	Yes
21	Chua et al. [26]	2017	Tongue	Resection and reconstruction	Right ventricle, minor pericardial effusion	Progressive dyspnea	—	—	Concurrent chemoradiotherapy	Transthoracic echocardiogram	No
22	Cho et al. [15]	2018	Oral Cavity	Induction chemotherapy (doxetaxel/cisplatin/5-FU) followed by concurrent chemoradiotherapy to 66 Gy with cisplatin followed by complete surgical excision	Interventricular septum protruding into right ventricle	Dizziness	Complete AV block	No	Permanent pacemaker placement and palliative chemotherapy	CT Chest and Echocardiogram	Yes
23	Present Study	2018	Left lateral tongue	T-wave inversion in the inferior and V3-V6 leads.	Left ventricle	Chest pressure, dizziness, dyspnea	T-wave inversion	No	Nivolumab	CT Chest	Yes