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Giant cardiac lesion in anaplastic thyroid cancer

Open AccessPublished:September 28, 2022DOI:https://doi.org/10.1016/j.xjtc.2022.08.030
      Figure thumbnail fx1
      Intraoperative view of the cardiac metastasis of anaplastic thyroid carcinoma.
      Cardiac metastases of ATC are rare. Benefits of cardiac surgery on early postoperative survival are very limited.
      Cardiac metastases of anaplastic thyroid carcinoma (ATC) are extremely rare and mostly documented at the time of autopsy.
      • Besic N.
      • Gazic B.
      Sites of metastases of anaplastic thyroid carcinoma: autopsy findings in 45 cases from a single institution.
      Intracavitary lesions should be removed to avoid sudden death and/or pulmonary embolism,
      • Torbicki A.
      • Galié N.
      • Covezzoli A.
      • Rossi E.
      • De Rosa M.
      • Goldhaber S.Z.
      ICOPER Study Group
      Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry.
      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,
      • Catford S.R.
      • Lee K.T.
      • Pace M.D.
      • Marasco S.F.
      • Longano A.
      • Topliss D.J.
      Cardiac metastasis from thyroid carcinoma.
      on early survival.
      • Maniakas A.
      • Dadu R.
      • Busaidy N.L.
      • Wang J.R.
      • Ferrarotto R.
      • Lu C.
      • et al.
      Evaluation of overall survival in patients with anaplastic thyroid carcinoma, 2000-2019.
      Figure thumbnail gr1
      Figure 1Intracardiac metastasis of anaplastic thyroid carcinoma. A, Echocardiographic image of the mass (length 14 cm, width 4 cm, depth 3 cm); B, Computed tomography of the chest showing the mass. C and D, Intraoperative view of the specimen: asterisk indicates the mass, the focal point of the image. a, atrial part; v, ventricular part; i, infundibular part. RV, Right ventricle; RA, right atrium.

      Supplementary Data

      References

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