Giant cardiac lesion in anaplastic thyroid cancer

Cardiac metastases of anaplastic thyroid carcinoma (ATC) are extremely rare and mostly documented at the time of autopsy. Intracavitary lesions should be removed to avoid sudden death and/or pulmonary embolism, but the poor outcomes associated with ATC yield surgical indications controversial. With his informed consent, we describe the case of a 53-year-old man who underwent thyroidectomy (through left-lateral cervicotomy) and, 2 months later, cardiac surgery to remove an intracardiac metastasis, occupying almost entirely the right heart (Video 1). Thrombosis of the left jugular, subclavian and innominate veins was also demonstrated (Figure 1, A and B). At surgery, left femoral vein and ascending aorta were cannulated to establish extracorporeal circulation. Under cardioplegic arrest, right atriotomy allowed total exeresis of the mass, which appeared completely capsulated (Figure 1, C and D). Histology revealed undifferentiated neoplastic cells within thrombotic organized tissue. Although an early postoperative echocardiogram confirmed cardiac chambers' clearness, the patient underwent resternotomy after 5 days for pericardial (nonthrombotic) effusion and, 15 days later, computed tomography showed the reorganization of the intravascular thrombosis. Despite surgery, his prognosis was deemed ominous, and no other procedures were performed. Noncardiac-related death occurred 2 months later, underlying the very limited value of this intervention, although suggested in other reports, on early survival.