Isolated cardiac metastasis after comprehensive treatment with hepatocellular carcinoma: a case report and literature review.

Abstract

Background: Cardiac metastasis of hepatocellular carcinoma (HCC) is extremely rare, especially when it presents as isolated metastasis of HCC in the right ventricle without involving the right atrium or inferior vena cava. The cardiac metastasis of HCC may develop insidiously and lack specific clinical manifestations, which hinders early detection of cardiac metastasis. The prognosis for patients with cardiac metastasis of HCC is not satisfactory.

Methods: We present a 61-year-old male patient diagnosed with BCLC-B stage HCC, who underwent liver tumor resection surgery and, following tumor recurrence, received immunotherapy checkpoint inhibitors and multiple radiofrequency ablation (RFA) treatments. In the third year after surgery, relevant examinations revealed a mass in the patient's right ventricle, ultimately leading to a diagnosis of isolated cardiac metastasis of HCC. In addition, we reviewed the research on cardiac metastasis of HCC over the past decade and summarized the relevant findings.

Results: During follow-up, the patient found a cardiac mass. Based on imaging, isolated cardiac metastasis of HCC was diagnosed, ruling out intrahepatic recurrence and considering alpha-fetoprotein (AFP) persistent rise. Treated with lenvatinib and sintilimab, the patient died of suspected cardiac rupture two weeks later, with no definitive effect observed.

Conclusion: Although cardiac metastasis of HCC is rare, patients who have experienced multiple recurrences and undergone repeated RFA for liver tumors should be wary of extrahepatic metastasis, including heart metastasis, especially when intrahepatic recurrence has been ruled out and AFP levels persistently rise. Treatment should adopt an individualized multimodal approach.