Right ventricle metastasis from carcinoma rectum: Findings on¹⁸F-fluorodeoxyglucose positron emission tomography–computed tomography

Background/Aim: Right ventricular cardiac metastasis from colorectal cancer (CRC) is rare and clinically silent. There is no standardised treatment. To date, only twelve cases have been reported in the literature. This is a case report and literature review of right ventricular cardiac metastasis from CRC. Case Report: A 75-year-old woman with a history of CRC treated with sigmoidectomy followed by liver and lung metastasectomy presented with a right ventricle tumour. Biopsy showed metastatic adenocarcinoma not suitable for resection because multiple lung metastases coexisted. The metastases were controlled for a prolonged duration by chemotherapy with capecitabine plus bevacizumab. According to the review of 13 cases, the median age of metastatic CRC that involves the right ventricle is 71 years and the primary site is half the colon and rectum. Half of cases have non-cardiac metastases at cardiac metastasis diagnosis. Chemotherapy is more suitable than resection in cases with metastases other than heart because resection of the right ventricle has a high risk. Conclusion: Cardiac right ventricular metastasis from CRC can be controlled by capecitabine plus bevacizumab.Metastases from colorectal cancer (CRC) can occur either by lymphatic or hematogenous spreading, and the sites most commonly involved are the lymph nodes, liver, and lung.Cardiac metastasis from CRC is an extremely rare event and the incidence is probably underestimated. A large autopsy series reported that colon carcinoma metastases to the heart account for 1.2%, with a prevalence of 2%, of all metastatic neoplasms (1). The reasons for the limited number of reported cases are that cardiac tumours are usually asymptomatic and do not present themselves. A progressive metastatic mass of the heart occasionally causes acute heart failure or superior vena cava syndrome, resulting in sudden death (2, 3). Such masses are often associated with non-specific symptoms, including those of right-sided heart failure, dyspnoea, arrhythmias, pulmonary thromboembolism, and tumour thrombus (4). With regard to the frequency of cardiac metastases from any malignancy, the epicardium (75.5%), followed by the myocardium (38.2%) and endocardium (15.5%) has been reported to be involved (5). In this report, cardiac metastasis refers to the involvement of parts other than the epicardium. Herein, we present a case of a patient with right ventricular cardiac metastasis from adenocarcinoma of the sigmoid colon who was effectively treated with chemotherapy and review reports to date regarding CRC metastases to the right ventricle of the heart, their diagnosis, treatments, and prognosis.

Cutaneous squamous cell carcinoma (SCC) metastasizes most commonly to the regional lymph nodes and lungs. Metastasis to heart, although described in literature, is a very rare phenomenon. We present the 18 F-fluorodeoxyglucose positron emission tomography–computed tomography findings in a 50-year-old woman who was a biopsy-proven case of SCC left foot, showing cardiac metastasis in addition to lymph nodes, lungs, and skeletal metastases.