Amelanotic melanoma, choriocarcinoma and cervix carcinoma: Course of three unusual cases with cardiac tumour manifestation

M.K. Bohlmann a, M.D., C. Sergi b, M.D., F.S. Eckstein c, M.D., E. Stauffer d, M.D., H.P. Sinn b, M.D. , and T. Strowitzki a, M.D.

a Women’s Hospital, Division of Gynecologic Endocrinology and Reproductive Medicine, b Institute of Pathology, University of Heidelberg, Germany, c Clinic for Cardiovascular Surgery, d Institute of Pathology, University Hospital Berne, Switzerland

AIM: To report rare cardiac tumour manifestations in three female patients. METHODS: Clinical findings, histology and postmortem examination were reviewed by collecting recording data and samples. RESULTS: The diagnosis was established after cardiac surgery in two of three patients. Case 1: An amelanotic melanoma without evidence of a primary extracardiac tumour manifestation was detected in a 58-year-old female. In a palliative approach, the patient was treated with Dacarbazin. She declined further treatment after one course of chemotherapy and died six weeks later. No autopsy was performed. Case 2: A postpartal disseminated choriocarcinoma was seen in a 41-year-old patient, who was suffering from severe pulmonary hypertension due to a left atrial tumor, obstructing the lower pulmonary veins. Renal, hepatic, cerebral, splenic and pulmonary metastatic locations were found. Cardiac surgery helped to control the patient’s acute symptoms of pulmonary hypertension. This patient received high dose-chemotherapy and remains in full remission in a 18 month follow-up. Case 3: Necropsy revealed the presence of isolated cardiac metastases in a 50-year-old woman affected with a squamous cell carcinoma of the cervix with lymphangiosis carcinomatosa, infiltration of the vagina, and of 1 of 12 parametrial lymphnodes (FIGO IIa). CONCLUSIONS: Cardiac surgery may be a useful approach to control acute symptoms in patients with cardiac metastatic tumor. Tumor reductive surgery followed by high-dose chemotherapy seems to be favorable in patients with metastatic choriocarcinoma and pulmonary hypertension. The cardiotropism of some cervical carcinomas supports two classes of invasive disease.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Metastasis.