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Year : 2020  |  Volume : 35  |  Issue : 3  |  Page : 258-259  

Rare case of cardiac metastasis in a patient with cutaneous squamous cell carcinoma of foot detected on 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography


1 Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
2 Department of Surgical Oncology, Tata Main Hospital, Jamshedpur, Jharkhand, India

Date of Submission15-Feb-2020
Date of Acceptance21-Mar-2020
Date of Web Publication01-Jul-2020

Correspondence Address:
Dr. Girish Kumar Parida
Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur - 831 001, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_31_20

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   Abstract 


Cutaneous squamous cell carcinoma (SCC) metastasizes most commonly to the regional lymph nodes and lungs. Metastasis to heart, although described in literature, is a very rare phenomenon. We present the 18F-fluorodeoxyglucose positron emission tomography–computed tomography findings in a 50-year-old woman who was a biopsy-proven case of SCC left foot, showing cardiac metastasis in addition to lymph nodes, lungs, and skeletal metastases.

Keywords: 18F-fluorodeoxyglucose positron emission tomography–computed tomography, cardiac metastasis, cutaneous squamous cell carcinoma


How to cite this article:
Parida GK, Kumar A, Mitra S, Suman A, Muthu GS. Rare case of cardiac metastasis in a patient with cutaneous squamous cell carcinoma of foot detected on 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography. Indian J Nucl Med 2020;35:258-9

How to cite this URL:
Parida GK, Kumar A, Mitra S, Suman A, Muthu GS. Rare case of cardiac metastasis in a patient with cutaneous squamous cell carcinoma of foot detected on 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography. Indian J Nucl Med [serial online] 2020 [cited 2020 Aug 9];35:258-9. Available from: http://www.ijnm.in/text.asp?2020/35/3/258/288459



A 50-year-old woman presented to our department with a large fungating mass lesion involving the right foot region. Contrast-enhanced magnetic resonance imaging of right foot showed ill-defined heterogeneous mass involving skin, subcutaneous tissue of the heal region with associated focal erosion of posterior-inferior cortex of right calcaneum. Computed tomography (CT) abdomen pelvis showed right inguinal lymphadenopathy, following which the patient underwent right below knee amputation. As part of restaging workup,18 F-fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) study was done, which showed FDG avid hypodense lesion involving the interventricular septum (IVS) adjacent to inferior wall of heart [Figure 1]a showing MIP with black arrow; [Figure 1]f, [Figure 1]g, [Figure 1]h, [Figure 1]i showing fused PET-CT and CT images, respectively] suggesting cardiac metastases. In addition to this, there were metastases involving right inguinal [Figure 1]b and [Figure 1]c showing PET-CT fused and CT images, respectively], right pelvic, prevascular lymph nodes [Figure 1]d and [Figure 1]e showing PET-CT fused and CT images, respectively], bilateral lungs, and left scapula. For confirmation of the cardiac metastasis and as a part of baseline cardiac evaluation, two-dimensional echocardiography was done, which showed an ill-defined echogenic lesion involving the IVS and apex, measuring approximately 3.3 cm × 3.0 cm, with normal ejection fraction of 60% and no significant regional wall motion abnormality.
Figure 1: 18F-fluorodeoxyglucose avid hypodense lesion involving the interventricular septum adjacent to inferior wall of heart, (a) showing MIP with black arrow and (f-i) showing fused positron emission tomography–computed tomographic and computed tomographic images. 18F-fluorodeoxyglucose avid metastases involving right inguinal and prevascular lymph nodes, (b-e) showing fused positron emission tomography–computed tomographic and computed tomographic images

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Cardiac metastasis is a rare finding. As the patients are often clinically silent or have nonspecific symptoms, metastases to the heart are difficult to diagnose and usually detected in the postmortem setting during an autopsy. When they present with symptoms, the manifestations include heart failure, arrhythmias, valvular disease, and cardiac tamponade. The most common primary cancers in patients with cardiac metastases include melanoma, mediastinal tumors, lung cancer, breast cancer, and leukemia.[1] Four hypotheses have been believed for cardiac metastases, those include direct extension, hematologic spread, lymphatic spread, and intracavitary diffusion via the inferior vena cava or pulmonary veins.[1],[2],[3] As to primary skin malignancies, there are several reports of metastatic malignant melanoma in the myocardium;[4] however, there are only a few published case reports of metastatic squamous cell carcinoma (SCC) to the heart.[5],[6],[7],[8] With the increasing use of PET-CT in oncology, asymptomatic cardiac metastases are now getting detected more frequently. Reports of cardiac metastases on PET/CT are seen in melanoma,[9] Ewing's sarcoma,[10] renal cell carcinoma,[11] breast cancer,[12] upper aero-digestive tract,[3] head-and-neck cancer,[13] carcinoma rectum,[14] to name a few, with no reports from cutaneous SCC. Our case is a valuable addition to the existing literature on myocardial metastases and also highlights the role of FDG PET/CT in the detection of such rare sites, especially in asymptomatic patients, which otherwise would have been undiagnosed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Bussani R, de-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol 2007; 60:27-34.  Back to cited text no. 1
    
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Puranik AD, Purandare NC, Sawant S, Agrawal A, Shah S, Jatale P, et al. Asymptomatic myocardial metastasis from cancers of upper aero-digestive tract detected on FDG PET/CT: A series of 4 cases. Cancer Imaging 2014;14:16.  Back to cited text no. 3
    
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Mackenzie KA, Simcock JW, Lainchbury JG, Currie MJ, Lynn KL. Myocardial metastasis of cutaneous squamous cell carcinoma in a renal transplant recipient. Transplant Proc 2009;41:4414-5.  Back to cited text no. 8
    
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Coccia P, Ruggiero A, Rufini V, Maurizi P, Attinà G, Marano R, et al. Cardiac metastases of Ewing sarcoma detected by 18F-FDG PET/CT. J Pediatr Hematol Oncol 2012;34:236-8.  Back to cited text no. 9
    
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Maurer AH, Burshteyn M, Adler LP, Steiner RM. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. Radiographics 2011;31:1287-305.  Back to cited text no. 10
    
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Pinnamaneni N, Muthukrishnan A. Left ventricular myocardium metastasis in a patient with primary renal cell carcinoma detected by 18F-FDG PET/CT. Clin Nucl Med 2012;37:e181-3.  Back to cited text no. 11
    
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Johnson TR, Becker CR, Wintersperger BJ, Herzog P, Lenhard MS, Reiser MF. Images in cardiovascular medicine. Detection of cardiac metastasis by positron-emission tomography-computed tomography. Circulation 2005;112:e61-2.  Back to cited text no. 12
    
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Kim JK, Sindhu K, Bakst RL. Cardiac metastasis in a patient with head and neck cancer: A case report and review of the literature. Case Rep Otolaryngol 2019;2019:9581259.  Back to cited text no. 13
    
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Tripathy S, Parida GK, Naswa N, Jha P, Reddy S, Arun Raj ST. Right ventricle metastasis from carcinoma rectum: Findings on 18 F-fluorodeoxyglucose positron emission tomography-computed tomography. Indian J Nucl Med 2020;35:78-9.  Back to cited text no. 14
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