Myocardial metastasis after treatment for synchronous simultaneous quadruple malignancies, including bilateral lung cancer, diagnosed before death and confirmed at Autopsy

Abstract

Background. Myocardial metastasis from various malignancies, including primary lung cancer, is rarely diagnosed before death. Case. A 75-year-old woman was diagnosed as having synchronous simultaneous quadruple malignancies, including bilateral primary lung cancer, malignant lymphoma and rectal cancer. After receiving chemotherapy for the lymphoma, she underwent bilateral pulmonary resection and postoperative adjuvant chemotherapy in addition to low anterior resection of the rectum. One year later, the right lung cancer recurred in the right hilar lymph node. The patient therefore received radiation therapy to the recurrent lesion, followed by supportive care alone. She subsequently visited our outpatient clinic with a complaint of dyspnea. A chest radiograph showed cardiac dilatation, electrocardiography showed ST-T elevation in V2-V3 and cardiac ultrasonography showed multiple hypoechoic areas throughout the anterior to lateral wall of the left ventricle, resulting in a diagnosis of myocardial metastasis. The patient was hospitalized and treated with diuretics and digitalis; however, she died five days after hospitalization. An autopsy showed tumor infiltration into the myocardium at multiple sites; the location of these lesions coincided with that of the hypoechoic areas previously observed on ultrasonography. The pathological examination revealed the intramural cardiac lesions to be metastases of the right lung adenocarcinoma. Conclusions. We herein reported an uncommon case of myocardial metastasis in a patient with quadruple malignancies diagnosed on electrocardiography and echocardiography before death and confirmed at autopsy.