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Right atrial metastatic melanoma with unknown primaries.

Kuriakose R, Melvani R, Gangadharan V, Cowley M - Case Rep Cardiol (2015)

Bottom Line: Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery.The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch.After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation.

View Article: PubMed Central - PubMed

Affiliation: Virginia Commonwealth University, 1250 East Marshall Street, Richmond, VA 23298, USA.

ABSTRACT
A 54-year-old male with history of anemia and rheumatoid arthritis presented with a three-month history of dyspnea on exertion and lower extremity edema. Patient was referred for a transthoracic echocardiogram that revealed a large right atrial mass with reduced ejection fraction of 40% and an incidental large liver mass. Subsequent cardiac MRI revealed a lobulated right atrial mass measuring 5.4 cm × 5.3 cm with inferior vena cava compression and adjacent multiple large liver lesions confirmed to be malignant melanoma through biopsy. Interestingly, no primaries were found in the patient. PET/CT imaging displayed hypermetabolic masses within the right atrium and liver that likely represent metastases, as well as bilateral pleural effusions, most likely due to heart failure. Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery. The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. The patient is currently being administered ipilimumab for systemic therapy of metastatic melanoma.

No MeSH data available.


Related in: MedlinePlus

PET/CT scan displaying metastatic masses in right atrium and liver, as well as bilateral pleural effusion due to heart failure.
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fig1: PET/CT scan displaying metastatic masses in right atrium and liver, as well as bilateral pleural effusion due to heart failure.

Mentions: A 54-year-old male with history of anemia and rheumatoid arthritis had noted increased lower extremity edema, chronic cough, and shortness of breath for 3 months, at which point his rheumatologist treated him for pneumonia. With symptoms worsening, the patient visited a primary care physician, as his father had a history of coronary artery disease, colon cancer, and multiple basal cell skin cancers. The patient was then referred for a transthoracic echocardiogram (TTE), which revealed a large right atrial mass with reduced ejection fraction of 40% along with incidental lesions in the liver. A cardiac MRI and MRI of the abdomen/pelvis confirmed these results, revealing a lobulated right atrial mass measuring 5.4 cm × 5.3 cm with inferior vena cava (IVC) compression and adjacent multiple large liver lesions, the largest of which measured 6.6 cm × 7.0 cm × 7.3 cm. The cardiac mass appeared to extend through the right atrial wall and into the pericardium. The patient's abdominal MRI showed mass effect on the bile duct with central biliary duct dilatation as well as mass effect on the hepatic portal veins. Mass effect was also seen on the first portion of the duodenum causing gastric distention. After completion of both MRIs, subsequent ultrasound-guided liver biopsy returned the results of melanoma. Further workup revealed no cutaneous melanoma lesions. An eye examination was performed in order to exclude ocular melanoma. Based on the recent diagnosis of melanoma, the patient was scheduled to meet with his oncologist 4 weeks later in order to discuss treatment options. Three days prior to the patient's scheduled visit with his oncologist, the patient presented to the emergency department (ED) with worsening dyspnea and lower extremity edema. PET/CT imaging using F-18 fluorodeoxyglucose (FDG) was conducted for tumor anatomical localization. The scans displayed hypermetabolic masses within the right atrium and liver that are consistent with metastatic disease, as well as bilateral pleural effusions, likely secondary to resultant heart failure (Figure 1). Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery (Figure 2). The cardiac mass was surgically removed, and the right atrium was reconstructed with a pericardial patch (Figure 3). Pathologic analysis of the mass confirmed melanoma. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. Beginning one month after surgery, the patient was treated for systemic therapy with four cycles of ipilimumab, 3 mg/kg every three weeks. He subsequently developed autoimmune nephritis and a significant nephrotic syndrome as well as anasarca but recovered with pulse steroid therapy within four weeks. He had an objective response to ipilimumab in the liver and no recurrence in the heart; however, he developed progression into the peritoneal cavity, for which he is now being treated with pembrolizumab, 3 mg/kg every three weeks.


Right atrial metastatic melanoma with unknown primaries.

Kuriakose R, Melvani R, Gangadharan V, Cowley M - Case Rep Cardiol (2015)

PET/CT scan displaying metastatic masses in right atrium and liver, as well as bilateral pleural effusion due to heart failure.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352741&req=5

fig1: PET/CT scan displaying metastatic masses in right atrium and liver, as well as bilateral pleural effusion due to heart failure.
Mentions: A 54-year-old male with history of anemia and rheumatoid arthritis had noted increased lower extremity edema, chronic cough, and shortness of breath for 3 months, at which point his rheumatologist treated him for pneumonia. With symptoms worsening, the patient visited a primary care physician, as his father had a history of coronary artery disease, colon cancer, and multiple basal cell skin cancers. The patient was then referred for a transthoracic echocardiogram (TTE), which revealed a large right atrial mass with reduced ejection fraction of 40% along with incidental lesions in the liver. A cardiac MRI and MRI of the abdomen/pelvis confirmed these results, revealing a lobulated right atrial mass measuring 5.4 cm × 5.3 cm with inferior vena cava (IVC) compression and adjacent multiple large liver lesions, the largest of which measured 6.6 cm × 7.0 cm × 7.3 cm. The cardiac mass appeared to extend through the right atrial wall and into the pericardium. The patient's abdominal MRI showed mass effect on the bile duct with central biliary duct dilatation as well as mass effect on the hepatic portal veins. Mass effect was also seen on the first portion of the duodenum causing gastric distention. After completion of both MRIs, subsequent ultrasound-guided liver biopsy returned the results of melanoma. Further workup revealed no cutaneous melanoma lesions. An eye examination was performed in order to exclude ocular melanoma. Based on the recent diagnosis of melanoma, the patient was scheduled to meet with his oncologist 4 weeks later in order to discuss treatment options. Three days prior to the patient's scheduled visit with his oncologist, the patient presented to the emergency department (ED) with worsening dyspnea and lower extremity edema. PET/CT imaging using F-18 fluorodeoxyglucose (FDG) was conducted for tumor anatomical localization. The scans displayed hypermetabolic masses within the right atrium and liver that are consistent with metastatic disease, as well as bilateral pleural effusions, likely secondary to resultant heart failure (Figure 1). Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery (Figure 2). The cardiac mass was surgically removed, and the right atrium was reconstructed with a pericardial patch (Figure 3). Pathologic analysis of the mass confirmed melanoma. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. Beginning one month after surgery, the patient was treated for systemic therapy with four cycles of ipilimumab, 3 mg/kg every three weeks. He subsequently developed autoimmune nephritis and a significant nephrotic syndrome as well as anasarca but recovered with pulse steroid therapy within four weeks. He had an objective response to ipilimumab in the liver and no recurrence in the heart; however, he developed progression into the peritoneal cavity, for which he is now being treated with pembrolizumab, 3 mg/kg every three weeks.

Bottom Line: Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery.The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch.After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation.

View Article: PubMed Central - PubMed

Affiliation: Virginia Commonwealth University, 1250 East Marshall Street, Richmond, VA 23298, USA.

ABSTRACT
A 54-year-old male with history of anemia and rheumatoid arthritis presented with a three-month history of dyspnea on exertion and lower extremity edema. Patient was referred for a transthoracic echocardiogram that revealed a large right atrial mass with reduced ejection fraction of 40% and an incidental large liver mass. Subsequent cardiac MRI revealed a lobulated right atrial mass measuring 5.4 cm × 5.3 cm with inferior vena cava compression and adjacent multiple large liver lesions confirmed to be malignant melanoma through biopsy. Interestingly, no primaries were found in the patient. PET/CT imaging displayed hypermetabolic masses within the right atrium and liver that likely represent metastases, as well as bilateral pleural effusions, most likely due to heart failure. Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery. The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. The patient is currently being administered ipilimumab for systemic therapy of metastatic melanoma.

No MeSH data available.


Related in: MedlinePlus