INTERESTING IMAGE
An Unusual Right Ventricle Metastasis From Mandible Squamous Cell Carcinoma Detected On FDG PET/CT Yang Lu, MD, PhD Abstract: A patient with history of mandible squamous cell carcinoma underwent an FDG PET/CT scan. A focal hypermetabolic right ventricle lesion was noted and suggestive of metastasis. A cardiac MRI verified the right ventricle wall mass. Further endomyocardial biopsy confirmed the diagnosis of metastatic squamous cell carcinoma. Key Words: cardiac metastasis, FDG PET/CT, head and neck cancer (Clin Nucl Med 2015;40: 330–331)
Received for publication May 21, 2014; revision accepted November 17, 2014. From the Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL. Conflicts of interest and sources of funding: none declared. Reprints: Yang Lu, MD, PhD, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St MC 931, Chicago, IL 60612. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4004–0330
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REFERENCES 1. Bussani R, De-Giorgio F, Abbate A, et al. Cardiac metastases. J Clin Pathol. 2007; 60:27–34. 2. Reynen K, Kockeritz U, Strasser RH. Metastases to the heart. Ann Oncol. 2004;15: 375–381. 3. Lu Y, Ulaner G. FDG PET/CT demonstration of right atrium metastasis overlooked on contrast-enhanced CT. Clin Nucl Med. 2011;36:405–406. 4. Youn HJ, Jung SE, Chung WS, et al. Obstruction of right ventricular outflow tract by extended cardiac metastasis from esophageal cancer. J Am Soc Echocardiogr. 2002;15:1541–1544. 5. Neragi-Miandoab S, Kim J, Vlahakes GJ. Malignant tumours of the heart: a review of tumour type, diagnosis and therapy. Clin Oncol (R Coll Radiol). 2007; 19:748–756. 6. Alhakeem M, Arabi A, Arab L, et al. Unusual sites of metastatic involvement: intracardiac metastasis from laryngeal carcinoma. Eur J Echocardiogr. 2008;9: 323–325. 7. Renders F, Vanderheyden M, Andries E. Secondary cardiac tumour originating from laryngeal carcinoma: case report and review of the literature. Acta Cardiol. 2005;60:57–60. 8. Butany J, Nair V, Naseemuddin A, et al. Cardiac tumours: diagnosis and management. Lancet Oncol. 2005;6:219–228.
Clinical Nuclear Medicine • Volume 40, Number 4, April 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 4, April 2015
Ventricle Metastasis From Squamous Cell Carcinoma
FIGURE 1. A 65-year-old man with mandible squamous cell carcinoma underwent an FDG PET/CT scan. A focal cardiac uptake of FDG was incidentally found (arrows, SUV of 7.2; A, MIP PET of the thorax; B, PET; C, CT; D, fused PET/CT). In view of the patient's clinical history, the hypermetabolic cardiac mass was interpreted as a metastasis from his mandible squamous cell carcinoma or, to a lesser extent, a separate rare cardiac primary malignancy.
FIGURE 2. A cardiac MRI was obtained 10 days after FDG PET/CT. The fast imaging employing steady-state acquisition (FIESTA) MRI of the heart showed a mass in the inferoapical wall of right ventricle (arrows, A, axial FIESTA MRI; B, coronal FIESTA MRI), which correlates with the hypermetabolic lesion found on PET/CT. Subsequent endomyocardial biopsies demonstrated metastatic squamous cell carcinoma. Metastatic cardiac tumors are with an at least 100 times higher incidence than primary tumors, occurring in 18% of patients with metastatic disease.1,2 In general, endocardial metastasis occurs through hematogenous dissemination, whereas pericardial invasion results from lymphatic propagation.1 The most common cardiac metastases are from melanoma, carcinomas of the lung, breast, esophagus, and urinary tract tumors.2–5 Cardiac metastasis of head and neck cancers is uncommon, only with few cases reported.6,7 Cardiac tumors are generally asymptomatic; some may present with nonspecific electrocardiogram changes and symptoms resulting from large pericardial effusion, heart failure, or obstruction of cardiac chambers. Thus cardiac tumors are usually detected incidentally in the workup of an unrelated problem or in staging of a recently diagnosed primary tumor,8 such as in this case. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
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An Unusual Right Ventricle Metastasis From Mandible Squamous Cell Carcinoma Detected On FDG PET/CT Yang Lu, MD, PhD Abstract: A patient with history of mandible squamous cell carcinoma underwent an FDG PET/CT scan. A focal hypermetabolic right ventricle lesion was noted and suggestive of metastasis. A cardiac MRI verified the right ventricle wall mass. Further endomyocardial biopsy confirmed the diagnosis of metastatic squamous cell carcinoma. Key Words: cardiac metastasis, FDG PET/CT, head and neck cancer (Clin Nucl Med 2015;40: 330–331)
Received for publication May 21, 2014; revision accepted November 17, 2014. From the Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL. Conflicts of interest and sources of funding: none declared. Reprints: Yang Lu, MD, PhD, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 W Taylor St MC 931, Chicago, IL 60612. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4004–0330
330
www.nuclearmed.com
REFERENCES 1. Bussani R, De-Giorgio F, Abbate A, et al. Cardiac metastases. J Clin Pathol. 2007; 60:27–34. 2. Reynen K, Kockeritz U, Strasser RH. Metastases to the heart. Ann Oncol. 2004;15: 375–381. 3. Lu Y, Ulaner G. FDG PET/CT demonstration of right atrium metastasis overlooked on contrast-enhanced CT. Clin Nucl Med. 2011;36:405–406. 4. Youn HJ, Jung SE, Chung WS, et al. Obstruction of right ventricular outflow tract by extended cardiac metastasis from esophageal cancer. J Am Soc Echocardiogr. 2002;15:1541–1544. 5. Neragi-Miandoab S, Kim J, Vlahakes GJ. Malignant tumours of the heart: a review of tumour type, diagnosis and therapy. Clin Oncol (R Coll Radiol). 2007; 19:748–756. 6. Alhakeem M, Arabi A, Arab L, et al. Unusual sites of metastatic involvement: intracardiac metastasis from laryngeal carcinoma. Eur J Echocardiogr. 2008;9: 323–325. 7. Renders F, Vanderheyden M, Andries E. Secondary cardiac tumour originating from laryngeal carcinoma: case report and review of the literature. Acta Cardiol. 2005;60:57–60. 8. Butany J, Nair V, Naseemuddin A, et al. Cardiac tumours: diagnosis and management. Lancet Oncol. 2005;6:219–228.
Clinical Nuclear Medicine • Volume 40, Number 4, April 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 4, April 2015
Ventricle Metastasis From Squamous Cell Carcinoma
FIGURE 1. A 65-year-old man with mandible squamous cell carcinoma underwent an FDG PET/CT scan. A focal cardiac uptake of FDG was incidentally found (arrows, SUV of 7.2; A, MIP PET of the thorax; B, PET; C, CT; D, fused PET/CT). In view of the patient's clinical history, the hypermetabolic cardiac mass was interpreted as a metastasis from his mandible squamous cell carcinoma or, to a lesser extent, a separate rare cardiac primary malignancy.
FIGURE 2. A cardiac MRI was obtained 10 days after FDG PET/CT. The fast imaging employing steady-state acquisition (FIESTA) MRI of the heart showed a mass in the inferoapical wall of right ventricle (arrows, A, axial FIESTA MRI; B, coronal FIESTA MRI), which correlates with the hypermetabolic lesion found on PET/CT. Subsequent endomyocardial biopsies demonstrated metastatic squamous cell carcinoma. Metastatic cardiac tumors are with an at least 100 times higher incidence than primary tumors, occurring in 18% of patients with metastatic disease.1,2 In general, endocardial metastasis occurs through hematogenous dissemination, whereas pericardial invasion results from lymphatic propagation.1 The most common cardiac metastases are from melanoma, carcinomas of the lung, breast, esophagus, and urinary tract tumors.2–5 Cardiac metastasis of head and neck cancers is uncommon, only with few cases reported.6,7 Cardiac tumors are generally asymptomatic; some may present with nonspecific electrocardiogram changes and symptoms resulting from large pericardial effusion, heart failure, or obstruction of cardiac chambers. Thus cardiac tumors are usually detected incidentally in the workup of an unrelated problem or in staging of a recently diagnosed primary tumor,8 such as in this case. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
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