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DOI: 10.1055/s-0030-1269031
A huge right atrial tumor as primary manifestation of hepatocellular carcinoma
Introduction: A 61-year-old patient with a history of hepatocirrhosis, esophageal varices, alcoholism and pelvis vein thrombosis developed a hepatic mass. Biopsies revealed only micronodual cirrhosis without further information. Abdominal ultrasound showed a massive congestion with ascites and edema. Echokardiography revealed a huge tumor of the right atrium with extension into the inferior vena cava and prolapsing into the right ventricle causing a severe tricuspid valve stenosis. The patient was transferred to our center for diagnosis and resection of the intraatrial mass.
Aims: Additional diagnostic procedures were performed. PET-CT-scan suggested a cardiac angiosarcoma with secondary occlusion of the hepatic veins and the inferior vena cava and additionally showed intrapulmonary metastasis. Cardiac surgery was performed using standard extracorporeal circulation with cardioplegic arrest. On opening of the right atrium a 10×12cm yellowish mass was prolapsing out of the atrium and was excised without difficulties out of the tricuspid valve, the atrium and the inferior vena cava thereby restoring flow to the right atrium. The histologic examination revealed a hepatocellular carcinoma. The patient was transferred to an oncology clinic on postoperative day 6 for multimodal oncotherapy and died on postoperative day 45 of liver failure.
Discussion: Hepatocellular carcinoma is the most common primary tumor of the liver, but cardiac involvement is rare. Patients in this condition are in an advanced stage of cancer with a poor long-term survival. Although cardiac surgery and the short-term follow-up of our patient were uneventful, the resection of the cardiac metastasis did not improve survival.