7 Squamous Cell Carcinoma of the Lung-Invading Myocardium: An Autopsy Finding. (11th January 2018)

• Record Type: Journal Article
• Authors: Raza, Roshan; Mahabir, Roshan; Levi, Gabriel
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S3
• Page End: S3
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx114.006
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Lung cancer is the leading cause of cancer deaths worldwide, including more than 160, 000 deaths per year in the United States. Pleura, pericardium, mediastinal and hilar lymph nodes, great vessels, and nerves are frequently involved by lung cancers due to direct invasion; but direct cardiac invasion by lung carcinoma is uncommon. Only 8%-10% of all lung cancers present with invasion of heart. This can result in conduction abnormalities, pericarditis, arrhythmias, cardiac tamponade, congestive cardiac failure, rarely myocardial infarction, and even sudden death. We report a case of an 80-year-old man with past medical history significant for prostate cancer, a 70-year smoking history, a newly diagnosed atrial fibrillation, and squamous cell carcinoma of the lung. He presented to the emergency department a month after his new diagnosis, with black stools for 5 days, and lower extremity swelling and weakness for 3 weeks. On physical examination, he was noted to have diffuse wheezing, heart sounds, and pitting edema of bilateral knees. Chest CT showed a 7.2 x 5.2 cm mass in the anterior right upper and middle lung lobes with evidence of lymphangitic spread. He died of cardiogenic shock after a 4-day hospital stay. At autopsy, the most significant finding was a large tumor of the right lung with contiguous spread into the right side of the heart and generalized constrictive pericarditis (thickened, nodular, fibrous pericardium). Histology showed an invasive, poorly differentiated, nonkeratinizing, squamous cell carcinoma of right middle lobe of lung (7.5 cm greatest dimension) with lymphovascular invasion and areas of necrosis. In summary, this 80-year-old man with long-standing history of smoking died of cardiogenic shock due to restrictive pericarditis and arrhythmia secondary to extensive myocardial invasion of right-sided squamous cell carcinoma of the lung.