CARDIAC METASTASIS DUE TO ORAL CAVITY CANCER PRESENTING AS HEART FAILURE

Cardiac metastasis from head and neck cancer is rarely seen, while a lung primary would be the most common original anatomic site of cardiac metastasis. A 50-year-old man with the underlying disease of Child C liver cirrhosis underwent a liver transplantation on February 19, 2014 and took tacrolimus for prevention of graft rejection. However, a mass over right tongue border was found by the patient himself at the end of February, 2014. The patient then underwent total glossectomy and right modified radical neck dissection on June 26, 2014. Pathology report showed squamous cell carcinoma of oral tongue, pT4aN2cM0, stage IVA. Postoperative radiation therapy was started on July 22, 2014. However, the patient developed shortness of breath, cold sweating and tachycardia on August 8, 2014 after a cumulative radiation dose of 26 Gy. Coronary arteriogram showed patent coronary arteries. However, echocardiogram found a tumor mass on the right ventricle of the heart with partial cardiac flow obstruction. Chest computer tomography (CT) also showed a necrotic soft tissue mass on right ventricle of the heart, the symptom exacerbated in following two weeks. He was finally transferred for hospice care on August 25, 2014. The patient passed away on August 27, 2014. The immuno-suppressive drugs for rejection prevention may be associated with the occurrence of rare cardiac metastasis.

關鍵字

Cardiac metastasis ； Oral cavity cancer ； Immuno-suppression therapy

並列摘要

惡性腫瘤出現心臟轉移是相當罕見的，儘管過去曾有頭頸癌轉移到心臟之報導，但仍以肺癌造成心臟轉移最為常見。此病例報告為 50 歲男性因肝硬化接受親屬活體肝臟移植，並於肝臟移植後接受免疫抑制劑 tacrolimus 以預防器官排斥反應。患者後續發現罹患舌癌，於接受全舌切除及雙頸淋巴擴清手術後，開始輔助性放射治療。當放射治療劑量為26 Gy 時，患者出現呼吸急促、冷汗及心悸等症狀。心臟冠狀動脈血管攝影顯示冠狀動脈通暢，但心臟超音波發現右心室出現腫塊伴隨血流阻滯，胸部電腦斷層也顯示右心室出現壞死性腫塊。我們針對服用免疫抑制劑與癌症發生進行文獻探討，此病例報告顯示服用免疫抑制劑之癌症病患可能造成罕見之心臟轉移。

並列關鍵字

心臟轉移；口腔癌；免疫抑制治療

國際替代計量

CARDIAC METASTASIS DUE TO ORAL CAVITY CANCER PRESENTING AS HEART FAILURE

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