A 59-year-old female with squamous cell lung cancer invading the left atrium developed atrial fibrillation and cardioembolic strokes, requiring anticoagulation and targeted radiation.
Case Report (n=1)
This case highlights the rare occurrence of squamous cell lung cancer invading the left atrium and interatrial septum, emphasizing the complex multidisciplinary management required to balance bleeding and embolic risks.
Abstract Introduction Squamous cell carcinoma (SCC) accounts for 30% of Non-Small Cell Lung Cancers (NSCLC). SCC is known to metastasize to brain, spine bone, adrenals, liver and in rare cases heart. However, malignant invasion into the cardiac atrium is exceedingly rare and has only been described in a handful of case reports. We present a case of lung SCC invading the left atrium complicated by atrial fibrillation with cardioembolic strokes and discuss the implications for treatment. Case Presentation A 59-year-old female with history of hypertension and 42 pack-years of tobacco-use presented with 3 weeks of progressive dyspnea, cough, and weight loss. On presentation, she was tachypneic but saturating well on room air. Other vital signs were within normal limits. Labs were notable for leukocytosis of 26.65 K/uL, hemoglobin of 6.2 g/dL, and venous blood gas of pH 7.30, partial CO2 36 mmHg, and partial O2 58 mmHg. Physical exam revealed right-sided decreased basilar breath sounds and dullness to percussion. CT imaging revealed an 11.8cm x 8.0cm x 6.0cm obstructing right lower lobe mass invading the left atrium, enlarged lymph nodes, complex pleural effusion, and mesenteric mass. Brain MRI revealed multiple micro-embolic infarcts. Invasion into the left atrial and interatrial septum was confirmed on MRI Chest and echocardiogram. The patient subsequently developed intermittent atrial fibrillation raising concerns for tumor microemboli versus hypercoagulable state of malignancy versus disruption of atrial rhythm and blood flow. CT biopsy of the lung mass showed SCC. The patient was anticoagulated after discussions with cardiology, oncology, neurology, and pulmonary consultants due to concerns for microemboli. In addition to anticoagulation, targeted radiation was emergently initiated to reduce tumor burden and risk of emboli. Discussion of Novelty and Importance Cardiac metastasis from SCC is usually limited to pericardial involvement and has a prevalence of 1.62% in patients with malignancy. Aggressive invasion through the myocardium and endocardium is incredibly rare, representing less than 1% of patients with malignancy. Often patients are initially asymptomatic, leading to advanced disease, and poor prognosis. In our case, multisystem involvement required the team to weigh the risk of gastrointestinal bleeding, hemothorax, and atrial rupture against the benefit of preventing thrombus formation and a potentially catastrophic stroke prior to anticoagulation and radiation. The complexity of our case highlights a gap in knowledge and lack of evidence to guide risk stratification and treatment approaches for patients with malignant cardiac invasion. This abstract is funded by: None
Basara et al. (Fri,) conducted a case report in Squamous cell lung cancer invading the left atrium (n=1). Anticoagulation and targeted radiation was evaluated. A 59-year-old female with squamous cell lung cancer invading the left atrium developed atrial fibrillation and cardioembolic strokes, requiring anticoagulation and targeted radiation.
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