BACKGROUND: Endometrial adenocarcinoma of any histologic type rarely metastasizes to the heart. Only three such metastases to the myocardium and three to the pericardium have been reported antemortem in the literature. The rarity of this metastasis is likely explained by the relative avascularity of the endocardium and velocity of blood. METHODS AND RESULTS: A 62-year-old female was admitted for increasing shortness of breath over the previous month. Her past medical history was significant for a resected Stage IC endometrial adenocarcinoma endometrioid type 15 months prior. The tumor was found to be a poorly differentiated (Grade 3) endometrial adenocarcinoma invading over half the myometrium. The periaortic and pelvic lymph nodes as well as the cervix and pelvic organs were free of tumor. The patient was later treated with adjuvant external beam radiotherapy. An echocardiogram demonstrated a large right ventricular mass. Subsequent endocardial biopsy showed a poorly differentiated, Grade 3, endometrial adenocarcinoma of endometrioid histologic type. The tumor was deemed inoperable given its size and vast involvement of the myocardium so palliative care was provided and the patient expired 17 days later. CONCLUSION: Management of metastatic adenocarcinoma to the heart is not well established due to the rarity of this lesion. Previously reported cases vary in the therapeutic approach as well as the outcome. To this date the best outcome has been a survival of 6 years after treatment of the metastasis with radiotherapy and concurrent cisplatin and pegylated liposomal doxorubicin.
BACKGROUND:Endometrial adenocarcinoma of any histologic type rarely metastasizes to the heart. Only three such metastases to the myocardium and three to the pericardium have been reported antemortem in the literature. The rarity of this metastasis is likely explained by the relative avascularity of the endocardium and velocity of blood. METHODS AND RESULTS: A 62-year-old female was admitted for increasing shortness of breath over the previous month. Her past medical history was significant for a resected Stage IC endometrial adenocarcinoma endometrioid type 15 months prior. The tumor was found to be a poorly differentiated (Grade 3) endometrial adenocarcinoma invading over half the myometrium. The periaortic and pelvic lymph nodes as well as the cervix and pelvic organs were free of tumor. The patient was later treated with adjuvant external beam radiotherapy. An echocardiogram demonstrated a large right ventricular mass. Subsequent endocardial biopsy showed a poorly differentiated, Grade 3, endometrial adenocarcinoma of endometrioid histologic type. The tumor was deemed inoperable given its size and vast involvement of the myocardium so palliative care was provided and the patient expired 17 days later. CONCLUSION: Management of metastatic adenocarcinoma to the heart is not well established due to the rarity of this lesion. Previously reported cases vary in the therapeutic approach as well as the outcome. To this date the best outcome has been a survival of 6 years after treatment of the metastasis with radiotherapy and concurrent cisplatin and pegylated liposomal doxorubicin.