Myocardial Metastasis of Cutaneous Squamous Cell Carcinoma in a Burn Patient

Figures

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  Figure 1. Mass before excision. Large ulcerative fungating mass measuring about 30 × 30 cm, extending from the left back to left flank.

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  Figure 2. Patient's back after excision. After wide-margin excision of the mass, with exposed muscle. Subsequent biopsy confirmed margins were negative for malignancy.

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  Figure 3. Transthoracic echocardiography of tumor in the RVOT. Parasternal short-axis view of the RVOT reveals a large, nonobstructive mass (red arrow) occupying the RVOT caudal to the pulmonic valve.

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  Figure 4. Myocardial perfusion echocardiography using a low mechanical index, real-time harmonic imaging, and Definity contrast, before high-power flash still frames, revealing patchy perfusion and establishing vascularity of the mass (blue circle).

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  Figure 5. Myocardial perfusion echocardiography using a low mechanical index, real-time harmonic imaging, and Definity contrast, after high-power flash still frames, revealing patchy perfusion and establishing vascularity of the mass (blue circle).

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  Figure 6. Transesophageal echocardiography of tumor in the right ventricular outflow tract (RVOT) reveals tumor (red asterisk) in the RVOT, with infiltration of the anterior right ventricular free wall (blue curved line). AoV, Aortic valve; RV, right ventricle.

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  Figure 7. Transesophageal echocardiographic color Doppler still frames in systole, biplanar view, showing laminar blood flow across the RVOT, consistent with the nonobstructive nature of the mass (red star).

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  Figure 8. Intraprocedural fluoroscopic images: anteroposterior projection delineating tumor mass (asterisk) and location of biopsy site.

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  Figure 9. Intraprocedural fluoroscopic images: lateral projection delineating tumor mass (asterisk) and location of biopsy site.

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  Figure 10. Endomyocardial mass biopsy. Histopathology showing normal myocardium (black arrow) infiltrated by highly malignant neoplasm. The cells show markedly enlarged nuclei with open, hyperchromatic chromatin consistent with metastatic SCC (blue arrow), confirmed by Hematoxylin and Eosin and cytokeratin immunostaining.

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  Figure 11. Most common presenting symptoms of patients with reported metastatic SCC, adapted from supplemental data. CHF, Congestive heart failure; MI, myocardial infarction; PE, pulmonary embolism.

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  Figure 12. Primary site of malignancy in cases with cardiac metastasis of SCC, adapted from supplemental data.