Metastatic Cardiac Tumor from Primary Tongue Cancer: A Case Report

原發性舌癌伴隨心臟轉移：病例報告及文獻探討

王慈慧(Tzu-Hwei Wang) ； 劉文山(Wen-Shan Liu)

《放射治療與腫瘤學》 12卷3期 (2005/09) Pp. 241-246

https://doi.org/10.6316/TRO/200512(3)241

摘要

目的：原發性舌癌伴隨心臟轉移的病例非常罕見，我們報告一病患以心包膜填塞為表現的病例，經開刀後證實是轉移性鱗狀上皮癌。
病例報告：一位年紀67歲的男性患者，在2004年3月時被確定診斷出左側鱗狀上皮舌癌，當時癌症分期為T2N0M0。病人在外院接受了局部舌切除後，無佐以其他輔助治療。不幸的，在2004年10月時，左側下頷骨淋巴節復發，病人自行轉診至本院，經檢查後確定無遠處轉移。病人在10月時接受了同步化學治療及放射治療，從2004年10月至2004年12月，總共接受了6次化學治療及79.8 Gy記38次的放射線治療。治療期間，除了有WHO Grade Ⅱ的黏膜反應外，治療堪稱平順。然而不幸的，2005年2月病人有頑固性心包膜滲液產生並導致心包膜填塞。心臟超音波及胸部斷層掃瞄均發現在右心室有一腫瘤及心包膜滲液；由於持續性心臟功能惡化，為了改善心臟功能，心臟外科醫師在2月24日施行腫瘤摘除手術，從右心室取出一個3.3×2.7×2.0公分大小的腫瘤。經病理確定診斷為轉移性鱗狀上皮癌。
結果：術後我們施予加強性支持療法，然而病人仍於2005年3月7日因心衰竭逝世。
結論：雖然轉移性心臟腫瘤的病例極為少見，但在頭頸部腫瘤中，舌癌算是較常見的。由於腫瘤心臟轉移時並無特定表現的病徵；且轉移後，病人通常處於危急狀態，所以臨床要診斷轉移性心臟腫瘤很困難。我們必須注意的是，舌癌患者，一旦出現新的心臟疾病，心臟轉移的診斷不可被忽略。

關鍵字

舌癌 ； 心臟轉移 ； 心包膜填塞

並列摘要

Purpose: To report a case of cardiac metastasis from primary squamous cell carcinoma of tongue presented as malignant pericardial effusion causing cardiac tamponade. This case was proven by pathologic evidence.
Case report: This 67 years old male patient was diagnosed of left tongue carcinoma with initial staging of T2N0M0 and received local excision in March 2004 in another hospital. However, left submandibular lymph node recurrence occurred in October 2004. Restaging work-up was arranged and no evidence of distant metastasis was found. Then he received salvage treatment of concurrent chemo-radiotherapy (CCRT) since October 28, 2004. For radiotherapy, the total dose to recurrent LN and primary tumor bed with whole lymphatic chain were 79.8 Gy and 62.4 Gy, respectively. The regimen of chemotherapy was taxotere (12 mg/m2) plus cisplatin (30 mg/m2) weekly for 6 cycles. The total treatment course was completed smoothly on December 24, 2004 except for WHO Grade Ⅱ mucositis that developed during treatment period. Unfortunately, pericardiac effusion occurred as diagnosed by cardiac echography in February 2005. Refractory pericardiac effusion caused cardiac tamponade was still persistent despite of repeated pericardiocentesis. Chest computed tomography (CT) showed that a mass within the right ventricle and massive pericardiac effusion. Surgery was performed owing to progressive degradation of cardiac function on February 24, 2005.
Result: The myocardiac tumor biopsy proved metastatic squamous cell carcinoma. Unfortunately, this patient died of heart failure even after intensive supportive treatment,
12 days after surgery.
Conclusion: Although primary tongue cancer is frequent in head and neck tumor, metastatic cardiac cancer is a rare occurrence. The diagnosis of metastasis to heart is difficult because of various cardiac symptoms. Most importantly, the diagnosis of cardiac metastasis should be kept in mind if a new onset of cardiac disease occurred in cancer patient.

並列關鍵字

Tongue cancer ； Cardiac metastasis ； Cardiac tamponade