Surgical treatment for metastatic cardiac tumor originating from tongue cancer

Abstract

Metastasis of malignant tumors to the heart is rare and often diagnosed posthumously. A 70-year-old man, who had undergone partial tongue resection and neck dissection for tongue cancer a year prior, was found to have bilateral lung metastases. Bilateral lung resections were planned for stage II disease. After the second lung surgery, he developed frequent ventricular arrhythmias. Echocardiography revealed a 60 mm tumor on the lateral wall of the left ventricle, diagnosed as cardiac metastasis. Given the relatively good general condition and potential for long-term survival with chemotherapy, surgery was performed to prevent embolic events. Intraoperatively, tumor invasion into the papillary muscle and chordae tendineae necessitated tumor excision and mitral valve replacement. The postoperative course was favorable, with challenges in managing pleural effusions, but no recurrence of arrhythmias. The patient was discharged on postoperative day 15 and continued systemic chemotherapy and palliative care. Pathology confirmed squamous cell carcinoma, consistent with distant metastasis of tongue cancer.

Learning objective

Cardiac tumors are extremely rare and are often discovered only after death. Even when detected during the patient's lifetime, the prognosis is generally poor. This case involved a metastatic tumor to the heart from tongue cancer, but salvage surgery was considered as a potential option to improve the outcome.