When cancer reaches the heart: a case series on rare myocardial and endocardial metastases from squamous cell carcinoma
https://orcid.org/0000-0002-2473-6544
Ikram Burney
https://orcid.org/0000-0002-1825-0097
Z Al-Hashami
https://orcid.org/0000-0001-6300-7013
Marwa Ahmed
Amany Hany Mohamed Kamel
https://orcid.org/0000-0002-3562-1099
Airton Leonardo de Oliveira Manoel
https://orcid.org/0000-0002-9593-1013
Yarub Al Balushi
Waleed Dawelbeit
Abstract
Cardiac metastases are rare but devastating complications of malignancies. Squamous cell carcinoma (SCC), particularly from non-pulmonary origins, infrequently metastasizes to the heart, making its cardiac involvement an unusual and underreported phenomenon. We present a case series of four patients diagnosed with myocardial and endocardial metastases from SCC at our center over two years. Clinical presentation, imaging modalities, suspected metastatic pathways, management strategies, and outcomes were analyzed. Patients (ages 41–74, three males, one female) had primary SCC in the vulva, tongue, buccal mucosa, and lung. Symptoms varied, including dyspnea, hypotension, chest pain, and stroke. All patients had elevated troponin levels. Echocardiography was crucial for initial detection, while PET/CT confirmed metastases, with one patient undergoing cardiac MRI. Hematogenous spread was likely metastatic pathway in most cases. Treatment was primarily palliative; only one patient received chemotherapy post-diagnosis. Survival post-cardiac metastasis diagnosis ranged from a few days to six months. Myocardial and endocardial metastases from SCC are rare and often indicate advanced disease with poor prognosis. Early recognition through multimodal imaging and biomarkers such as troponin may facilitate timely palliative interventions. Increased collaboration between oncology and cardiology may improve supportive care and symptom management in these patients.
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Cardiac metastasis, Squamous cell carcinoma, vulvar SCC, oral SCC, lung SCC, troponin levels
2. Butany J, Leong SW, Carmichael K, Komeda M. A 30-year analysis of cardiac neoplasms at autopsy. Can J Cardiol. 2005 Jun;21(8):675-80. PMID: 16003450.
3. Reynen K. Frequency of primary tumors of the heart. Am J Cardiol. 1996 Jan 1;77(1):107. doi: 10.1016/s0002-9149(97)89149-7. PMID: 8540447.
4. Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007 Jan;60(1):27-34. doi: 10.1136/jcp.2005.035105. PMID: 17098886; PMCID: PMC1860601.
5. Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann Oncol. 2004 Mar;15(3):375-81. doi: 10.1093/annonc/mdh086. PMID: 14998838.
6. Young JM, Goldman IR. Tumor metastasis to the heart. Circulation. 1954 Feb;9(2):220-9. doi: 10.1161/01.cir.9.2.220. PMID: 13127183.
7. Savoia P, Fierro MT, Zaccagna A, Bernengo MG. Metastatic melanoma of the heart. J Surg Oncol. 2000 Nov;75(3):203-7. doi: 10.1002/1096-9098(200011)75:3<203::aid-jso9>3.0.co;2-x. PMID: 11088053.
8. Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 2001 Mar-Apr;21(2):439-49. doi: 10.1148/radiographics.21.2.g01mr15439. PMID: 11259706.
9. Lundberg GD. Pathology of the heart and blood vessels, Ed 3. Arch Intern Med. 1970;125(2):367-8. doi:10.1001/archinte.1970.00310020173042.
10. Onwuchekwa J, Banchs J. Early cardiac metastasis from squamous cell carcinoma of the tongue in 2 patients. Tex Heart Inst J. 2012;39(4):565-7. PMID: 22949780; PMCID: PMC3423288.
11. Browning CM, Craft JF, Renker M, Schoepf UJ, Baumann S. Squamous cell carcinoma of the tongue with metastasis to the right ventricle. Am J Med Sci. 2015 May;349(5):461-2. doi: 10.1097/MAJ.0000000000000411. PMID: 25647835.
12. Patel H, Francke M, Stahura H, El-Hajjar M, Schulman-Marcus J. Solitary cardiac metastasis from primary oral squamous cell carcinoma presenting as ST-elevation MI. BMJ Case Rep. 2018 Apr 17;2018:bcr2018224732. doi: 10.1136/bcr-2018-224732. PMID: 29666101; PMCID: PMC5905818.
13. Pattni N, Rennie A, Hall T, Norman A. Cardiac metastasis of oral squamous cell carcinoma. BMJ Case Rep. 2015 Sep 9;2015:bcr2015211275. doi: 10.1136/bcr-2015-211275. PMID: 26354838; PMCID: PMC4567762.
14. Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec. 2001 Jul-Aug;63(4):202-7. doi: 10.1159/000055740. PMID: 11408812.
15. Nagata S, Ota K, Nagata M, Shinohara M. Cardiac metastasis of head and neck squamous cell carcinoma. Int J Oral Maxillofac Surg. 2012 Dec;41(12):1458-62. doi: 10.1016/j.ijom.2012.07.017. PMID: 22921451.
16. Goldberg AD, Blankstein R, Padera RF. Tumors metastatic to the heart. Circulation. 2013 Oct 15;128(16):1790-4. doi: 10.1161/CIRCULATIONAHA.112.000790. PMID: 24126323.
17. Yusuf SW, Bathina JD, Qureshi S, Kaynak HE, Banchs J, Trent JC, Ravi V, Daher IN, Swafford J. Cardiac tumors in a tertiary care cancer hospital: clinical features, echocardiographic findings, treatment and outcomes. Heart Int. 2012 Feb 3;7(1):e4. doi: 10.4081/hi.2012.e4. PMID: 22690297; PMCID: PMC3366300.
18. Al-Mamgani A, Baartman L, Baaijens M, de Pree I, Incrocci L, Levendag PC. Cardiac metastases. Int J Clin Oncol. 2008 Aug;13(4):369-72. doi: 10.1007/s10147-007-0749-8. PMID: 18704641.
19. Murtagh G, Januzzi JL, Scherrer-Crosbie M, Neilan TG, Dent S, Ho JE, Appadurai V, McDermott R, Akhter N. Circulating Cardiovascular Biomarkers in Cancer Therapeutics-Related Cardiotoxicity: Review of Critical Challenges, Solutions, and Future Directions. J Am Heart Assoc. 2023 Nov 7;12(21):e029574. doi: 10.1161/JAHA.123.029574. PMID: 37889193; PMCID: PMC10727390.
20. Auger D, Pressacco J, Marcotte F, Tremblay A, Dore A, Ducharme A. Cardiac masses: an integrative approach using echocardiography and other imaging modalities. Heart. 2011 Jul;97(13):1101-9. doi: 10.1136/hrt.2010.196006. PMID: 21642661.
21. Basuoni AM, A WD, de Oliveira Manoel A, et al. When Chest Pain Isn’t What It Seems: A Case of Cardiac Lymphoma. Cureus 2025;17(1): e78267. doi:10.7759/cureus.78267
22. Rahbar K, Seifarth H, Schäfers M, Stegger L, Hoffmeier A, Spieker T, Tiemann K, Maintz D, Scheld HH, Schober O, Weckesser M. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med. 2012 Jun;53(6):856-63. doi: 10.2967/jnumed.111.095364. PMID: 22577239.
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