Diagnosis of a solitary cardiac metastasis from ocular melanoma

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Presentation transcript:

Diagnosis of a solitary cardiac metastasis from ocular melanoma Gabriel T. Chong, BS, Raymond J. Kim, MD, Srivani R. Ambati, MD, Terence Z. Wong, MD, PhD, Louis R. Dibernardo, MD, Elmar M. Merkle, MD, Thomas Ryan, MD, Michael A. Morse, MD The Journal of Thoracic and Cardiovascular Surgery Volume 130, Issue 6, Pages 1727-1728 (December 2005) DOI: 10.1016/j.jtcvs.2005.07.058 Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Combined axial contrast-enhanced computed tomography (CT) and corresponding fluorodeoxyglucose positron emission tomography (FDG-PET) image shows a 3.2 cm × 3.1 cm mass in the region of the cardiac apex, which is isodense to muscle tissue during the arterial contrast phase. This mass involves the left ventricle and cardiac septum. B, FDG-PET in March 2005 (B: coronal) revealed a new hypermetabolic soft tissue mass in the myocardium of the apex of the left ventricle measuring 24 × 35 mm. There was no other evidence of metabolically active disease. C, Apical 4-chamber echocardiogram revealed an apparent extracardiac mass (arrows) adjacent to the LV apex. The dimensions of the mass were 4.3 × 2.6 cm. D, Cardiac magnetic resonance imaging (MRI) showing a mass measuring 4 × 2.5 × 2 cm, which is described as heterogenous but overall bright in image intensity on true-FISP imaging (fast imaging with steady-state precession) before contrast administration, and it did not appear to involve the pericardium. Delayed enhancement imaging demonstrated hyperenhancement of the mass, and perfusion imaging revealed that the mass had a very short TI even before administration of gadolinium contrast, suggestive of metastatic melanoma. LA, Left atrium; RA, right atrium; RV, right ventricle; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1727-1728DOI: (10.1016/j.jtcvs.2005.07.058) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Hematoxylin-eosin stain, 2.5×: Resected specimen: 25 g, 5.4 × 3.5 × 3.3 cm fragment of tan muscle tissue. Sectioning revealed a 4.9 × 3.2 × 2.2 cm soft, black mass throughout the muscle tissue and extending to the epicardium. B, Hematoxylin-eosin stain, 50×: Microscopically, large amounts of pigment present throughout the tumor; nuclei are large and pleomorphic with large areas of tumor necrosis. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1727-1728DOI: (10.1016/j.jtcvs.2005.07.058) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions