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A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma

Hürthle cell carcinoma (HCC) is a variant of a follicular carcinoma with a tendency to higher frequency of metastases and a lower survival rate. However, intracavitary cardiac metastases from thyroid HCC are extremely rare. We describe the case of a 57-year-old female with thyroid HCC, 5 years after...

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Autores principales: Luo, Hongxiu, Tulpule, Sunil, Alam, Mahmood, Patel, Reema, Sen, Shuvendu, Yousif, Abdalla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463785/
https://www.ncbi.nlm.nih.gov/pubmed/26078743
http://dx.doi.org/10.1159/000430948
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author Luo, Hongxiu
Tulpule, Sunil
Alam, Mahmood
Patel, Reema
Sen, Shuvendu
Yousif, Abdalla
author_facet Luo, Hongxiu
Tulpule, Sunil
Alam, Mahmood
Patel, Reema
Sen, Shuvendu
Yousif, Abdalla
author_sort Luo, Hongxiu
collection PubMed
description Hürthle cell carcinoma (HCC) is a variant of a follicular carcinoma with a tendency to higher frequency of metastases and a lower survival rate. However, intracavitary cardiac metastases from thyroid HCC are extremely rare. We describe the case of a 57-year-old female with thyroid HCC, 5 years after total thyroidectomy, who presented with dyspnea associated with hypoxia and hypotension. The computed tomography angiogram showed extensive pulmonary embolism and a 6-cm right atrial mass while the lower-extremity deep vein thrombosis studies were negative. This patient received a cardiac thrombectomy using cardiopulmonary bypass support. However, intraoperatively, we found out that the mass was from the mediastinum, directly extending into the heart and clearly unresectable since it effaced at least 1/3 of the right atrial wall. The core biopsy of the mass confirmed that it was metastatic poorly differentiated HCC of thyroidal origin. The patient eventually died of respiratory failure due to a massive pulmonary embolism. For cancer patients with unexplained dyspnea, cardiac metastases should be considered regardless of anticoagulation prophylaxis, especially when there is no deep vein thrombosis in the lower limbs. Early recognition of intracavitary cardiac metastases may help in providing prompt treatment and improving the prognosis.
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spelling pubmed-44637852015-06-15 A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma Luo, Hongxiu Tulpule, Sunil Alam, Mahmood Patel, Reema Sen, Shuvendu Yousif, Abdalla Case Rep Oncol Published online: May, 2015 Hürthle cell carcinoma (HCC) is a variant of a follicular carcinoma with a tendency to higher frequency of metastases and a lower survival rate. However, intracavitary cardiac metastases from thyroid HCC are extremely rare. We describe the case of a 57-year-old female with thyroid HCC, 5 years after total thyroidectomy, who presented with dyspnea associated with hypoxia and hypotension. The computed tomography angiogram showed extensive pulmonary embolism and a 6-cm right atrial mass while the lower-extremity deep vein thrombosis studies were negative. This patient received a cardiac thrombectomy using cardiopulmonary bypass support. However, intraoperatively, we found out that the mass was from the mediastinum, directly extending into the heart and clearly unresectable since it effaced at least 1/3 of the right atrial wall. The core biopsy of the mass confirmed that it was metastatic poorly differentiated HCC of thyroidal origin. The patient eventually died of respiratory failure due to a massive pulmonary embolism. For cancer patients with unexplained dyspnea, cardiac metastases should be considered regardless of anticoagulation prophylaxis, especially when there is no deep vein thrombosis in the lower limbs. Early recognition of intracavitary cardiac metastases may help in providing prompt treatment and improving the prognosis. S. Karger AG 2015-05-13 /pmc/articles/PMC4463785/ /pubmed/26078743 http://dx.doi.org/10.1159/000430948 Text en Copyright © 2015 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.
spellingShingle Published online: May, 2015
Luo, Hongxiu
Tulpule, Sunil
Alam, Mahmood
Patel, Reema
Sen, Shuvendu
Yousif, Abdalla
A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma
title A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma
title_full A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma
title_fullStr A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma
title_full_unstemmed A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma
title_short A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma
title_sort rare silent killer: right atrial metastasis of thyroid hürthle cell carcinoma
topic Published online: May, 2015
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463785/
https://www.ncbi.nlm.nih.gov/pubmed/26078743
http://dx.doi.org/10.1159/000430948
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