Occult Metastatic Melanoma Presenting as an Acute Coronary Syndrome (original) (raw)
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Cardiac metastases of melanoma as first manifestation of the disease
Journal of Radiology Case Reports, 2014
Cardiac metastases are rare, but more common than primary cardiac tumours, and metastatic melanoma involves heart or pericardium in greater than 50% of the cases, although cardiac metastasis are rarely diagnosed ante mortem because of the lack of symptoms. A multimodality approach may help to obtain a more timely diagnosis and in some cases a quicker and better diagnosis can enable a surgical resection to prevent cardiac failure or to reduce the tumour before chemotherapy. We present a case of a patient with cardiac metastasis as first evidence of a malignant melanoma: in this case the patient underwent echocardiography, cardiac magnetic resonance and computed tomography. This case underlines the importance of advanced diagnostic techniques, such as cardiac magnetic resonance, not only for the detection of cardiac masses, but also for a better anatomic definition and tissue characterization, to enable a quick and accurate diagnosis which can be followed by appropriate treatment.
Cardiac metastases from malignant melanoma
Cancer, 1999
BACKGROUND. Cardiac metastases are uncommon, with the exception of malignant melanoma. More cases of cardiac involvement are being diagnosed in association with the rising incidence and increasing survival of patients with melanoma.
Cardiac metastasis of malignant melanoma: a case report
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2014
The heart is regularly involved in metastatic neoplasms with cardiac metastases being found in up to 20 % of autopsies. We present a case about a 42-year-old Caucasian female with a fatal metastatic melanoma to the heart. The five- year survival rate for stage IV melanoma (melanoma with metastases to other organs) is 15 to 20 %. If patients with malignant melanoma present with new onset of cardiac symptoms, clinicians should always be aware of the possibility of cardiac metastases and perform further investigations.
Metastatic melanoma of the heart
Journal of Surgical Oncology, 2000
Background: Malignant melanoma has an unpredictable biologic behavior and is the neoplasm with the greatest propensity for cardiac involvement. Although relatively frequent at autopsy, cardiac metastases are rarely identified antemortem. Methods: We reviewed 2,810 patients with histologically confirmed malignant melanoma, who were diagnosed and followed up by our clinic. Clinical, histological, and imaging data are presented. Results: Five cases of metastatic melanoma of the heart were identified out of 314 melanoma patients with visceral involvement. One case of a 53-year-old woman, who died unexpectedly during her first chemotherapy course, is described in detail. Postmortem examination determined the cause of death to be the presence of multiple melanoma metastases in the heart, even though the patient had shown no signs of cardiac involvement. Conclusions: The unpredictable biologic behavior of melanoma may lead to unusual metastatic sites, and, therefore, the heart also should be included in routine examinations.
Over a five-year period, we encountered two cases of malignant melanoma with metastasis to the heart and pericardium. Both patients had a relevant medical history, showing their previous involvement by this tumor. A high index of suspicion, simply provided by a precise clinical history, together with histopathological and cytological studies can be used to diagnose such patients in due course. The preliminary diagnosis is made by echocardiography, by which the tumoral masses are seen in different parts of the heart. Nevertheless, their primary or secondary origin as well as the histogenesis can only be ascertained by pathological studies. Routine staining methods are useful in the demonstration of malignant cells in the tissue or pericardial fluid samples
Metastatic melanoma to the heart
European Journal of Nuclear Medicine and Molecular Imaging, 2005
Melanoma is a common neoplasm with a propensity to metastasize to the heart. Although cardiac metastasis is rarely diagnosed ante mortem, using a multimodality approach, several imaging findings may be seen. Echocardiography is often the initial imaging method used to detect cardiac metastases and their complications. On computed tomography, intraluminal filling defects and myocardial/ pericardial nodules may be seen. On magnetic resonance imaging, metastatic melanoma is classically hyperintense on T1 images and hypointense on T2 images, a result of the T1 shortening of melanin; however, this is seen in a minority of cases. As melanoma metastases are fluorine-18-fluorodeoxyglucose avid, fluorine-18-fluorodeoxyglucose positron emission tomography may also be used to detect cardiac metastases.
Heart Dissemination: A Clinical Case of Melanoma
Case Reports in Medicine, 2021
Introduction. Primitive malignant heart tumours are rare, specific cases. The presence of cardiac metastases, often in the pericardium, besides indicating disseminated oncological disease, represents a diagnostic challenge since they tend to be asymptomatic. Malignant cutaneous melanoma (MCM) is the neoplasm that most often affects the heart. Patients and Methods. The authors describe a case report of a 59-year-old female patient with a history of non-insulin-treated diabetes mellitus, arterial hypertension, dyslipidemia, and remitting cutaneous malignant melanoma who underwent skin excision, lymphadenectomy, and adjuvant chemotherapy in 1996. In April 2014, she resorted to emergency service due to epigastric pain and progressive tiredness. Due to the persistence of the complaints, abdominal ultrasound was performed, which showed a large pericardial effusion, corroborated later by teleradiography and echocardiography. The patient underwent pericardiocentesis, which isolated neoplast...
Atypical Cardiac Location of Melanoma of Unknown Origin
Medicina, 2021
The subject was a 66-year-old woman, suffering from the chest pain evoked by physical activity. Transthoracic echocardiography (TTE) revealed an abnormal structure, 41 × 29 mm. In MSCT, a hypodensic mobile tissue lesion that was infiltrating the whole thickness of left ventricle was confirmed. PET excluded the existence of other remote lesions. After surgical tumor removal, histopathological differential diagnosis revealed melanoma, myoepithelial cancer, and MPNST “high–grade” sarcoma. A control TTE detected a tumor that was 14 × 10 mm. After immunohistochemical results, immunotherapy with pembrolizumab was used, which resulted in complete tumor resolution. Presently, surgical resection and neoadjuvant targeted immunochemotherapy remain the treatment of choice for clinical stage III/IV melanoma.
Cardiac Metastatic Melanoma Investigated by Magnetic Resonance Imaging
Magnetic Resonance Imaging, 1998
There is a high rate of cardiac involvement in malignant melanoma (MM), but such cardiac metastases are usually diagnosed late. This report describes four cases with different clinical presentations of MM cardiac involvement that were investigated by magnetic resonance imaging (MRI). The MM cardiac involvement was asymptomatic in one case, detected because of a superior vena cava syndrome in a second, and because a tamponade in the remaining two cases. MRI permitted the diagnosis of cardiac metastases of MM, which was not made by echocardiography in one case. By precisely detecting the extent of the tumors, MRI was a great help in management, especially when an isolated cardiac metastasis was suitable for surgical ablation (two cases). Because both clinical signs and transthoracic echocardiogram are not very sensitive for diagnosing MM myocardial involvement, MRI can help provide such a diagnosis and ensure better treatment-monitored decisions.
Current diagnosis and management of cardiac melanoma: a case series and review
Journal of Cancer Metastasis and Treatment, 2023
Malignant melanoma is believed to have the highest rate of cardiac metastasis of any cancer based on autopsy studies, but descriptions of clinical findings, diagnosis, and treatment remain lacking. In particular, the use of immunotherapy has been only sparingly described. We present eight cases of malignant melanoma treated at our institution. Four patients displayed symptoms, three were diagnosed on routine surveillance imaging, and one was diagnosed postmortem. Locations of cardiac tumors varied with all four chambers and septum involved between the cases. Six patients underwent genetic profiling: two patients had a CDKN2A variant detected in their cardiac tumor, one patient had a BRAF mutation, and one patient had an NRAS mutation. Six patients underwent immunotherapy with either anti-PD-1 and/or anti-CTLA-4 therapy. This report highlights the importance of considering cardiac melanoma in surveillance imaging and the use of immunotherapy for management.