Isolated cardiac metastasis of urethral carcinoma

Introduction: Primary urethral cancer is rare and tends to invade locally and metastasizes to adjacent soft tissues. We present the first description of urethral carcinoma with isolated cardiac metastasis without recurrence of the primary tumor. Case report: A forty-seven-year old man was referred to our hospital with angina pectoris on exertion and an episode of syncope during exercise. A year previously he had undergone transurethral resection of a papillous tumor of the urethra and was given adjuvant radio-chemotherapy. Echocardiogram showed a 60×57×54mm sized mass in the right ventricle. On computed tomography the ventricular mass was seen infiltrating myocardial walls. He underwent excision of the mass with reconstruction of the tricuspid valve under cardiopulmonary bypass. Histopathology of the resected tissue revealed metastatic squamous cell carcinoma of the urethra. Discussion: Altough metastases of the heart are more common than primary cardiac tumors, the overall incidence is relatively low. Currently there are two main treatment options. Either chemotherapy or surgery. In our case presented the decision towards surgery was affected by the presentation of the clinical course, as there was no recurrence of the primary tumor observed and the intracardial lesion was found the only site of metastasis. The 3D-reconstruction of preoperative computed tomography scan provided excellent information of size, localization and invasion of the intracardial mass.