Isolated metastases of hepatocellular carcinoma in the right atrium: Case report and review of the literature

Kawakami,Manri; Koda,Masahiko; Mandai,Mari; Hosho,Keiko; Murawaki,Yoshikazu; Oda,Wakako; Hayashi,Kazuhiko

doi:10.3892/ol.2013.1240

Isolated metastases of hepatocellular carcinoma in the right atrium: Case report and review of the literature

Authors:
- Manri Kawakami
- Masahiko Koda
- Mari Mandai
- Keiko Hosho
- Yoshikazu Murawaki
- Wakako Oda
- Kazuhiko Hayashi
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Affiliations: Department of Multidisciplinary Internal Medicine, Division of Medicine and Clinical Science, School of Medicine, Tottori University, Yonago 683‑8504, Japan, Division of Molecular Pathology, Tottori University, Yonago 683‑8504, Japan
Published online on: March 8, 2013 https://doi.org/10.3892/ol.2013.1240
Pages: 1505-1508

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Abstract

The aim of this study was to clarify the clinical features of patients with isolated HCC metastases to the heart. A 66‑year‑old female hospitalized with a hepatocellular carcinoma (HCC) ranging from the right to the left lobe and with a tumor thrombus in the main portal vein, was treated with intraarterial cisplatin, 5‑fluouracil, adriamycin and mitomycin. Computed tomography (CT) one month later revealed that the HCC had progressed with multiple lung metastases and moderate ascites. The patient had no symptoms. Magnetic resonance imaging (MRI) and echocardiography revealed a round, movable tumor with a diameter of 2 cm in the right atrium (RA). The patient succumbed to HCC five months later. An autopsy revealed HCC with portal tumor thrombi and metastases to the lungs, inferior vena cava (IVC) and RA. The metastases in the RA and IVC were not continous with the intrahepatic tumor and were histologically attached to the endocardium and endothelium, respectively. An isolated metastasis of a HCC of the RA and IVC is extremely rare. In conclusion, although the majority of isolated metastases of HCC to the heart were diagnosed by echocardiography and were treated with mainly surgery, they had poor prognosis. The echocardiography should be performed for patients with advanced HCC. A novel treatment including molecular targeted drugs is required.

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1	Kojiro M, Nakahara H, Sugihara S, Murakami T, Nakashima T and Kawasaki H: Hepatocellular carcinoma with intra-atrial tumor growth. A clinicopathologic study of 18 autopsy cases. Arch Pathol Lab Med. 108:989–992. 1984.PubMed/NCBI
2	MacDonald RA: Primary carcinoma of the liver; a clinicopathologic study of one hundred eight cases. AMA Arch Intern Med. 99:266–279. 1957. View Article : Google Scholar : PubMed/NCBI
3	Kato Y, Kurosaki M, Kobayashi K, Sugimoto T and Takada A: Liver cancer associated with a large spheric thrombus caused by tumor in the right atrium of the heart. Naika. 28:349–353. 1971.(In Japanese).
4	Takigami S, Komai Y, Lai Y-S, et al: An autopsy case of minute hepatoma accompanied by a large intraatrial tumor embolus. Acta Hepat Jap. 21:478–486. 1980.(In Japanese).
5	Yoshioka K, Izuchi M, Okayama M, et al: An autopsied case of hepatocellular carcinoma with metastases to the heart and spleen. Acta Hepat Jap. 24:909–913. 1983.(In Japanese).
6	Miura Y, Kondo K, Watanabe T, et al: An autopsy case of hepatocellular carcinoma with tumor thrombus in the right atrium. Nihon Shokakibyo Gakkai Zasshi. 86:2460–2463. 1989.PubMed/NCBI
7	Lei MH, Ko YL, Kuan P, Lien WP and Chen DS: Metastases of hepatocellular carcinoma to the heart: unusual patterns in three cases with antemortem diagnosis. J Formos Med Assoc. 91:457–461. 1992.PubMed/NCBI
8	Kimitsuki H, Nagasaki Y, Yamashita Y, Kurohiji T, Kakegawa T and Nakashima T: An autopsied case of hepatocellular carcinoma with cardiac metastasis. Acta Hepat Jap. 35:629–632. 1994.(In Japanese).
9	Shiota S, Konishi I, Sato N, et al: A case of hepatocellular carcinoma with metastases to the right ventricle of the heart. Jpn J Clin Surg. 61:1542–1546. 2000.(In Japanese).
10	Murakawa T, Takamoto S, Ezure M, Ono M, Kawauchi M and Tanaka O: Metastatic hepatocellular carcinoma obstructing the right ventricular outflow tract. Jpn J Thorac Cardiovasc Surg. 48:516–519. 2000. View Article : Google Scholar : PubMed/NCBI
11	Kotani E, Kiuchi K, Takayama M, et al: Effectiveness of trans-coronary chemoembolization for metastatic right ventricular tumor derived from hepatocellular carcinoma. Chest. 117:287–289. 2000. View Article : Google Scholar : PubMed/NCBI
12	Longo R, Mocini D, Santini M, et al: Unusual sites of meta-static malignancy: case 1. Cardiac metastasis in hepatocellular carcinoma. J Clin Oncol. 22:5012–5014. 2004. View Article : Google Scholar : PubMed/NCBI
13	Lin TY, Chiu KM, Chien CY, Ming C, Wang MJ and Chu SH: Case 1: Right ventricular outflow obstruction caused by metastatic hepatocellular carcinoma. J Clin Oncol. 22:1152–1153. 2004. View Article : Google Scholar : PubMed/NCBI
14	Chieng SH, Lin CH, Lu MJ and Hung CR: Intracavitary meta-static hepatocellular carcinoma of the right ventricle. Thorac Cardiovasc Surg. 53:123–125. 2005. View Article : Google Scholar : PubMed/NCBI
15	Liu YC, Hung CS, Chan SY, Chen YW, Shun CT and Lai LP: Asymptomatic metastasis of hepatocellular carcinoma into the right ventricular cavity presenting with electrocardiographic changes. Acta Cardiol Sin. 22:180–183. 2006.
16	Sekine Y, Kitano M, Akimoto T and Matsuda K: Isolated intracavitary metastatic hepatocellular carcinoma of the right atrium without inferior vena cava involvement: report of a case. Kyobu Geka. 60:504–507. 2007.(In Japanese).
17	Kan CB, Chang RY and Chen CK: Isolated right ventricular intracavitary metastasis of hepatocellular carcinoma in a 74-year-old woman. J Clin Med Assoc. 71:318–320. 2008.PubMed/NCBI
18	Sung AD, Cheng S, Moslehi J, Scully EP, Prior JM and Loscalzo J: Hepatocellular carcinoma with intracavitary cardiac involvement: a case report and review of the literature. Am J Cardiol. 102:643–645. 2008. View Article : Google Scholar : PubMed/NCBI
19	Kanematsu M, Imaeda T, Minowa H, et al: Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium. Abdom Imaging. 19:13–316. 1994. View Article : Google Scholar : PubMed/NCBI
20	Yoshitomi Y, Kojima S, Sugi T, et al: Echocardiography of a right atrial mass in hepatocellular carcinoma. Heart Vessels. 13:45–48. 1998. View Article : Google Scholar : PubMed/NCBI
21	Van Camp G, Abdulsater J, Cosyns B, Liebens I and Vandenbossche JL: Transesophageal echocardiography of right atrial metastasis of a hepatocellular carcinoma. Chest. 105:945–947. 1994.PubMed/NCBI
22	Yoshidome H, Takeuchi D, Kimura F, et al: Treatment strategy for hepatocellular carcinoma with major portal vein or inferior vena cava invasion: a single institution experience. J Am Coll Surg. 212:796–803. 2011. View Article : Google Scholar : PubMed/NCBI
23	Mizuno S, Kato H, Azumi Y, et al: Total vascular hepatic exclusion for tumor resection: a new approach to the intrathoracic inferior vena cava through the abdominal cavity by cutting the diaphragm vertically without cutting the pericardium. J Hepatobiliary Pancreat Sci. 17:197–202. 2010. View Article : Google Scholar
24	Murakami E, Aikata H, Miyaki D, et al: Hepatic arterial infusion chemotherapy using 5-fluorouracil and systemic interferon-α for advanced hepatocellular carcinoma in combination with or without three-dimensional conformal radiotherapy to venous tumor thrombosis in hepatic vein or inferior vena cava. Hepatol Res. 42:442–453. 2012.
25	Komatsu S, Fukumoto T, Demizu Y, et al: The effectiveness of particle radiotherapy for hepatocellular carcinoma associated with inferior vena cava tumor thrombus. J Gastroenterol. 46:913–920. 2011. View Article : Google Scholar : PubMed/NCBI
26	Chang JY, Ka WS, Chao TY, Liu TW, Chuang TR and Chen LT: Hepatocellular carcinoma with intra-atrial tumor thrombi. A report of three cases responsive to thalidomide treatment and literature review. Oncology. 67:320–326. 2004. View Article : Google Scholar : PubMed/NCBI
27	Llovet JM, Ricci S, Mazzaferro V, et al SHARP Investigators Study Group: Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 359:378–390. 2008. View Article : Google Scholar : PubMed/NCBI