Isolated Right Atrial Mass in a Candidate of Coronary Bypass Grafting
AbstractHepatocellular carcinoma (HCC) is not uncommon neoplasm, and its occurrences with coronary artery disease (CAD) is more confronted by cardiac surgeon today. In most cases, when the HCC is detected, it has invaded to regional or distant sites. The most frequent location of HCC metastasis includes pulmonary system, musculoskeletal, lymphatic system, and central nervous system. Indeed, intra-atrial metastasis is a rare phenomenon and associated with poor outcome. We report a case of CAD with known HCC that referred for CABG before scheduling for hepatic tumor management. His severe typical chest pain, aggravated by mild activity so his abdominal pain is shadowed by chest pain. The abdominal ultrasound revealed a large mass in the left hepatic lobe. Chest x-ray was unremarkable. Routine preoperative transthoracic echocardiography (TEE) exhibits a large sessile mass in the right atrium. The patient underwent combined resection of right atrial mass and off-pump coronary artery bypass grafting. The most of HCC patients with RA involvement usually presenting with lengthy thrombus that continues from vascular invasion site to RA, however, as in our patient, isolated and sole metastasis to RA is an exceptional phenomenon in HCC. The clinical postoperative course was uneventful, and the patient discharged on the 10th day of operation. The six-month follow-up revealed no recurrence of right atrial mass when the patient completed his treatment by hepatic lobectomy and combined adjuvant chemotherapy.
Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol 1997;1;80:671-82.
Cheng HY, Wang XY, Zhao GL, Chen D. Imaging findings and transcatheter arterial chemoembolization of hepatic malignancy with right atrial embolus in 46 patients. World J Gastroenterol 2008;14:3563-8.
International Agency for Research on Cancer. World Health Organization. (Accessed April 2017, 25, at https://www.iarc.fr/).
Yusuf SW, Bathina JD, Qureshi S, Kaynak HE, Banchs J, Trent JC, et al. Cardiac tumors in a tertiary care cancer hospital: clinical features, echocardiographic findings, treatment and outcomes. Heart Int 2012;7:e4.
Thun MJ, DeLancey JO, Center MM, Jemal A, Ward EM. The global burden of cancer: priorities for prevention. Carcinogenesis 2010;31:100-10.
Hong SS, Kim TK, Sung KB, Kim PN, Ha HK, Kim AY, et al. Extrahepatic spread of hepatocellular carcinoma: a pictorial review. Eur Radiol 2003;13:874-82.
Yu K, Liu Y, Wang H, Hu S, Long C. Epidemiological and pathological characteristics of cardiac tumors: a clinical study of 242 cases. Interact Cardiovasc Thorac Surg 2007;6:636-9.
Anthony PP. Hepatocellular carcinoma: an overview. Histopathology 2001;39:109-18.
Anwar A.M., Nosir Y.F, Chamsi-Pasha M.A, Ajam A, Chamsi-Pasha H. Right atrial metastasis mimicking myxoma in advanced hepatocellular carcinoma. Echocardiography 2010 ;27:80-3.
Gane EJ. The Roadmap concept: using early on-treatment virologic responses to optimize long-term outcomes for patients with chronic hepatitis B. Hepatol Int 2008;2:304-7.
Jennifer Ng, Jennifer Wu. Hepatitis B- and hepatitis C- related hepatocellular carcinomas in the United States: similarities and differences. Hepat Mon 2012;12:e7635.
Natsuizaka M, Omura T, Akaike T, Kuwata Y, Yamazaki K, Sato T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol 2005;20:1781-7.
Pawarode A, Voravud N, Sriuranpong V, Kullavanijaya P, Patt Y.Z. Natural history of untreated primary hepatocellular carci- noma: a retrospective study of 157 patients. Am J Clin Oncol 1998;21:386-91.
Chang JY, Ka WS, Chao TY, Liu TW, Chuang TR, Chen LT. Hepatocellular carcinoma with intra-atrial tumor thrombi. A report of three cases responsive to thalidomide treatment and literature review. Oncology 2004;67:320-6.