Primary Esophageal Carcinoma with Metastasis to Left Atrium

Purpose: Metastatic involvement of the heart from esophageal carcinoma is relatively uncommon. Esophageal carcinoma is responsible for about 3.6% of all metastatic lesions to the heart. Esophageal carcinoma can directly invade the heart through pericardium and rarely metastasize to the endocardium or the internal cardiac cavities. We present a case of esophageal carcinoma with direct invasion to the left atrium and review the available medical literature. A 73 year old Haitian woman with significant history of hypertension and GERD presented with 6 months of progressive dysphagia. She noted weight loss of 14 kg over the past 6 months. Dysphagia was initially to solids but 1 month prior to presentation, progressed to liquids as well. Esophagogastroduodenoscopy (EGD) revealed a large obstructing mass in the esophagus at 35 cm from the incisors. Multiple biopsies were obtained. Pathology was suggestive of moderate to poorly differentiated adenocarcinoma invading the submucosa. The patient underwent EUS for staging of the esophageal carcinoma. The mass could not be fully evaluated due to obstruction of esophageal lumen. However, the proximal margins of the mass were examined and it appeared to extend through the muscularis propria and into the wall of the left atrium. The descending aorta was not involved. Two small lymph nodes were also identified. Patient subsequently underwent a repeat EGD and an esophageal stent was successfully placed across the strictured mass. She is currently being followed at a tertiary care oncology center and is scheduled to start radiation therapy. Metastatic cardiac tumors have been reported to be 20 to 30 times more frequent than primary cardiac tumors. Klatt and Heitz reported that metastatic cardiac tumors accounted for 10.75 of 1029 autopsy cases in which a malignant neoplasm was diagnosed. However, esophageal constitutes only 3.6% to 28.7% of all cardiac metastasis. Generally, no clinical findings are present unless cardiac metastases are extensive. In that case cardiac dysfunction may occur. Rarely vascular occlusion and myocardial infarction may occur. Arrythmias have been reported. Overall the condition is surprisingly well tolerated.