ABC | Volume 112, Nº1, January 2019

Image A Large Cardiac Metastasis of a Parathyroid Tumour Presenting with Ventricular Tachycardia Rita Ilhão Moreira, 1 Sílvia Aguiar Rosa, 1 Ana Galrinho, 1 Nuno Jalles Tavares, 2 Rui Cruz Ferreira 1 Hospital Santa Marta - Centro Hospitalar Lisboa Central – Cardiologia, 1 Lisboa – Portugal Hospital CUF Infante Santo – Imagem, 2 Lisboa – Portugal Mailing Address: Rita Ilhão Moreira • Hospital Santa Marta - Cardiologia - Rua de Santa Marta, 1169-024 Lisboa – Portugal E-mail: ritailhaomoreira@gmail.com Manuscript received July 18, 2018, revised manuscript September 10, 2018, accepted October 01, 2018 Keywords Carcinoma, Squamous Cell; Neoplasms Metastasis; ParathyroidNeoplasms; Arrhythmias, Cardiac;Diagnosis, Imaging; Echocardiography/methods; Neoplasms Metastasis/therapy. DOI: 10.5935/abc.20180255 Figure 1 – Twelve-lead electrocardiogram: Ventricular tachycardia with left bundle branch block morphology and superior and leftward axis consistent with a right ventricular origination of a tumour. A-81-years old woman was admitted after an episode of ventricular tachycardia with hemodynamic instability converted after electrical cardioversion (Figure 1). Past medical history was significant for poorly differentiated squamous cell carcinoma of left parathyroid, diabetes and hypertension. Echocardiogram revealed a large mass in the right ventricle prolapsing into the right atrium and a moderate pericardial effusion (Figure 2, Video 1). Cardiac magnetic resonance demonstrated a large infiltrative mass occupying almost the entire right ventricle cavity, slightly hypointense in T1 weighted images (image not available), hyperintense in T2 weighted images, with heterogeneous early and late gadolinium enhancement (Figure 3). These findings suggested cardiac sarcoma or metastasis. On histopathological investigation performed with catheter biopsy, there were malignant cells positive for CK5/6 and p63 and negative for oestrogens consistent with a cardiac metastasis from a squamous cell carcinoma. The primary malignancies most commonly metastasizing to the heart are breast cancer, lung cancer, leukaemia, and melanoma. 1 Distant metastasis of head and neck tumours are highly unusual, especially of parathyroid. 2 Generally, patients with distant metastases are considered to be inoperable, and only palliative treatments, such as chemotherapy or irradiation of a tumour, are indicated. 3 Although infrequently, ventricular arrhythmia can be the initial presentation of a cardiac metastasis. 4,5 We report a rare case of cardiac metastasis from a poorly differentiated squamous cell carcinoma of parathyroid presenting with ventricular arrhythmia. Author contributions Acquisition of data and analysis and interpretation of the data: Moreira RI, Rosa SA, Galrinho A, Tavares NJ; writing of the manuscript: Moreira RI, Rosa AS; critical revision of the manuscript for intellectual content: Ferreira RC. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. 113