Palliative therapies for a 67-year-old woman with stage IV lung adenocarcinoma extending into the left atrium were unsuccessful, leading to a transition to strictly comfort-focused care.
Case Report (n=1)
This case highlights the rarity of direct left atrial invasion by lung cancer and emphasizes the importance of multimodal imaging and multidisciplinary palliative management in such advanced cases.
Abstract Introduction Lung cancer is the leading cause of cancer-related death worldwide, with adenocarcinoma as the most common subtype. Cardiac metastases occur in up to 25 percent of patients, but direct invasion of the left atrium (LA) through the pulmonary veins is rare. This extension, typically classified as T4 disease, is often inoperable and may cause serious complications, including systemic embolization, arrhythmia, or cardiac tamponade. Mediastinal involvement carries an unfavorable prognosis, and such cases are often considered surgically inoperable. We report a rare case of stage IV lung adenocarcinoma extending from the superior pulmonary vein into the LA with brain metastases, emphasizing the role of imaging and multidisciplinary management. Case Presentation A 67-year-old woman with chronic obstructive pulmonary disease, remote tobacco use, and deep vein thrombosis presented with two months of hemoptysis, fatigue, orthopnea, and weight loss. She was initially placed on 2 L for supplemental oxygen, with other vital signs unremarkable. CT chest showed a right upper lobe mass with hilar involvement and a filling defect in the LA via the right superior pulmonary vein (Figure 1). CT abdomen, pelvis, and brain MRI revealed metastases, including three small brain lesions and mediastinal lymphadenopathy. Transthoracic echocardiography showed no thrombus, and transesophageal echo was deferred as unlikely to change management. Endobronchial ultrasound-guided biopsy confirmed adenocarcinoma positive for TTF-1 and Napsin-A. As she wasn’t a surgical candidate, she underwent palliative thoracentesis and thoracic radiation, with a port placed for planned systemic therapy with carboplatin, pemetrexed, and possible immunotherapy. However, her condition worsened, and the patient and family eventually chose strictly comfort-focused care. Discussion Direct invasion of the LA by lung cancer is rare, occurring in fewer than 1% of surgical cases. Extension usually occurs through the pulmonary veins. Surgical resection remains the preferred option in selected cases but carries significant perioperative risk, with mortality up to 18% and five-year survival of 0-22%. For inoperable or metastatic disease, combined chemotherapy and radiotherapy or stereotactic radiotherapy may offer palliative benefit and symptom control. Reported survival in such cases typically ranges from 4 to 17 months. Given the rarity of LA invasion, management should be individualized through a multidisciplinary approach. Multimodal imaging with CT, MRI, and echocardiography is essential for assessing tumor extent and guiding therapy. In this case, extensive left atrial invasion with brain metastases made surgery unsuitable, and the patient received palliative systemic therapy focused on symptom control and quality of life. This abstract is funded by: None
Kumari et al. (Fri,) conducted a case report in Stage IV lung adenocarcinoma with left atrial invasion (n=1). Palliative thoracentesis, thoracic radiation, and planned systemic therapy was evaluated. Palliative therapies for a 67-year-old woman with stage IV lung adenocarcinoma extending into the left atrium were unsuccessful, leading to a transition to strictly comfort-focused care.