Abstract 14138: A Rare Encounter With Unusual Metastasis: Metastatic Right Ventricular Tumor Secondary to Cervical Cancer

Background: Metastasis of cervical carcinoma to the heart is a rare and uncommon phenomenon. Cervical cancer most commonly metastasizes to the lungs, liver, bones, and lymph nodes in four ways: 1) hematogenous spread, 2) lymphatic spread, 3) transvenous extension, and 4) direct extension. We present a case of a patient with cardiac metastasis from cervical cancer who initially suffered nonspecific symptoms thought to be secondary to a pulmonary embolism.

Case presentation: A 41-year-old African American woman with a history of stage IIIB squamous cell carcinoma (SCC) of the cervix was being evaluated in the hospital for exertional dyspnea and chest pain. She was tachycardic and lung auscultation revealed decreased breath sounds bilaterally. Laboratory results were unremarkable. Initially, there was concern for pulmonary embolism (PE), computed tomography angiography with contrast demonstrated no evidence of PE but a hypoenhancing defect within the right ventricle (RV) with multiple diffuse bilateral pulmonary nodules. Echocardiography revealed RV mass vs thrombus. A cardiac MRI revealed a large infiltrative irregular mass. These findings favored evidence of a tumor rather than a thrombus. Imaging findings are illustrated in Figure 1. The patient subsequently underwent a biopsy of the right lower lobe lung nodule. The biopsy revealed metastatic SCC positive for p16, p40, and PD-L1. The patient was being treated but the prognosis was poor.

Conclusion: Metastasis from cardiac tumors with primary cervical cancer is uncommon with a poor prognosis and average life expectancy of less than 6 months when diagnosed. Only 4% of cases of cardiac metastasis from cervical cancer are diagnosed as antemortem. A multimodality approach with prompt diagnosis is necessary for improving prognosis.