FROM INCIDENTAL CARDIAC MASS TO METASTATIC NEUROENDOCRINE TUMOR: A DIAGNOSTIC JOURNEY

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

5 hydroxyindoleacetic acid, chromogranin, chromogranin A, gallium dotatate ga 68, octreotide, synaptophysin, cancer screening, cardiovascular magnetic resonance, case report, chronic obstructive lung disease, clinical article, conference abstract, coronary artery bypass graft, coronary artery disease, diagnosis, echocardiography, heart catheterization, heart left ventricle filling, heart metastasis, heart ventricle function, heart weight, human, hypertension, immunofluorescence, immunohistochemistry, interventricular septum, left liver lobe, left ventricular apex, male, mesentery, metastasis, multimodal imaging, neuroendocrine tumor, positron emission tomography, positron emission tomography-computed tomography, terminal ileum

Abstract

Background: Cardiac metastasis of neuroendocrine tumors (NET) is rare with incidence less than 5%. They are mostly asymptomatic and detected incidentally. Case A 73-year-old man with past medical history of Coronary artery disease, hypertension, COPD underwent a CT chest for lung cancer screening, it showed a small isodense mass in the right ventricle in relation to interventricular septum near cardiac apex . Further workup included a transthoracic echocardiogram showing a normal ventricular function, EF of 65% and normal valves. Heart catherization showed a severe right and circumflex disease with moderate LAD disease. Cardiac MRI showed an enhancing lesion at the right ventricular apex attached to the RV and septum. PET scan showed mildly hypermetabolic cardiac apical region mass measuring about 2.1 x 1.5 cm. He underwent a CABG with right ventricular mass excision at the Cleveland Clinic. Pathology showed the tumor cells to be diffusely and strongly positive with synaptophysin and no reactivity with ACTH. Movat stain showed pseudocapsule around the tumor and focal moderate interstitial fibrosis of the myocardium. The mass was deemed to be a NET. Followed by a Ga-68 dotatate scan showed masslike thickening in the terminal ileum. Metastatic lesions in the left hepatic lobe and mesentery were seen as well. CT chest/abdomen/pelvis showed 2.5 x 2 cm mass in the ileocolic mesentery in proximity to the ileocolonic junction containing coarse calcifications. He was diagnosed with stage IV neuroendocrine cancer. Lab work showed a chromogranin A level of 160 ng/ml (reference range 0 - 160 ng/mL) and 5HIAA level of 13.5 mg (reference range < 10 mg/24h). Eventhough the patient was asymptomatic he was started on octreotide injections monthly in the setting of visceral and cardiac metastasis. A repeat echocardiogram showed EF in the range of 65 - 70% and normal pattern of LV diastolic filling. Decision-making The echocardiography, Cardiac MRI, dotatate scan, and PET/CT guided the diagnosis and management. Mass resection and immunostaining confirmed diagnosis. Conclusion As the cardiac NET are mostly asymptomatic, multimodal imaging plays an important role in early detection and management is patient-specific.

Volume

85

Issue

12

First Page

3982

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