Isolated Cardiac Metastasis in Carcinoma Cervix: A Rare Case Report

Cardiac metastasis in a known case of squamous cell carcinoma of cervix is rare. Majority are diagnosed at autopsy. Incidence is <1.23% on autopsy. Metastatic sites in heart include epicardium, myocardium, endocardium and intraventricular tumor formation. [2] Cardiac metastasis should be suspected in patients with recurrent pulmonary emboli without any evidence of deep vein thrombosis, inexplicable heart failure especially in patients with extensive pelvic lymph node metastasis. Early diagnosis may improve prognosis. e report a case of carcinoma cervix International Federation of Gynecology and Obstetrics (FIGO) Stage IIIB treated with external beam radiotherapy 50 Gray in 25 fractions, 5 fractions per week with concurrent weekly five cycles of carboplatin followed by two fractions of intracavitary brachytherapy 7.5 Gray per fraction. Patient was on regular follow up and asymptomatic for four months post treatment. There was no evidence of local disease on examination and imaging. She complained of fatigue, weakness and shortness of breath. Total leucocyte count was elevated. Chest radiograph showed mild cardiomegaly. Patient was treated symptomatically. Cardiology opinion was sought. 2D echocardiography showed mild mitral stenosis, tricuspid stenosis, aortic stenosis, 42 cm thrombus in right ventricular outlet, clot in right ventricle apex. Patient was admitted under cardiology and actively managed for pulmonary emboli, but patient developed brain infarct and was kept on anticoagulants. However, patient's condition could not be stabilized even after two weeks of active management and she ultimately died of cardiac failure. On review of literature, we found 40 case reports of the same. Average survival after diagnosis was 12-23 months after the diagnosis.