Introduction/Background*Literature on cardiac metastases from endometrial cancer (EC) is scarce. We report a unique case of a 65-years-old woman diagnosed endometrioid EC, G3, FIGO stage IIIC, treated with surgery and adjuvant chemo-radiation in 2018. In April 2020, while she was undergoing chemotherapy (CHT) with Carboplatin-Paclitaxel because of abdominal and oropharyngeal recurrence, a F18 FDG-PET/CT showed a partial response of the known lesions, but highlighted high glucose uptake in the right atrium, deserving timely diagnostic investigation.
Methodology A multidisciplinary discussion was undertaken to choose the best management: gynecologists, cardiologists, cardiac surgeons, pathologists, oncologists and cardiovascular anesthesiologists were involved. A complete trans-thoracic echocardiogram was performed, showing an isoechoic, mobile, adherent to the tricuspid ring, 22 x 50 mm mass with non-smooth margins, resulting in obstruction of the right ventricular filling (gradient 7 mmHg). Cardiac magnetic resonance imaging (MRI) demonstrated a 41x35 mm, polylobed mass, adhered to the tricuspid ring on the inferior-posterior side, which incorporated the posterior and septal flaps of the tricuspid valve, extensively emerging in the ventricular cavity in the diastolic phase. The mass obstructed the right ventricular filling and its most caudal portion partially occupied, in the systolic phase, the outlet of the inferior vena cava in the atrium. Because of the life-threatening obstruction, the mass was removed by cardiac surgeons with sternotomy in extracorporeal circulation. During surgery, the mass was analyzed by pathologist, confirming the endometrial origin. Postoperatively, radiotherapy (RT) on the heart was performed, followed by second line CHT with Liposomal Doxorubicin till February 2021.
Result(s)*In February 2021 cardiac MRI was performed, showing no evidence of disease. Complete response of the oropharyngeal and abdominal recurrences was also detected. But the woman presented with neurological symptoms, as partial paralysis of the legs. Encephalic MRI was performed showing brain metastases. The woman underwent pan-encephalic RT with subsequent reduction of those lesions.
In June 2021, the woman is still alive without neurological nor other symptoms.
Conclusion*A multidisciplinary approach is essential to treat rare EC metastases. Reference centers for the treatment of EC must have specialists from other disciplines available, to ensure the best clinical practice.
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