A Hepatocellular Carcinoma Intheheart With No Other Primary. Can Be? Case Report And Reviewof Literature
Tamer M. Abdalghafoor, Dina alwaheidi, Mohamad El-Kahlout, Mohd Lateef Wani, Abdulwahid Al Mulla.
Hamad Medical Corporation, Doha, Qatar.
BackgroundSecondary cardiac tumors with hepatic origin are extremely rare when it comes to clinical practice, although it has been described more commonly in postmortem autopsy studies. Its most likely due to local invasion across the vena cava to the right atrium. Giving its silent presentation, poor prognosis & complex approach; it remains an unfortunate diagnosis with limited survival.Method We are reporting a case of asymptomatic aggressive right heart mass being a hepatocellular carcinoma with no primary tumour detection.Case report A 65-year-old male patient was referred for assessment after being discovered to have a huge right heart mass. His medical history was remarkable for post hepatitis C liver cirrhosis Class A, Hypertension & DMII. He started to complain of prostatic hypertrophy and was planned for Prostatectomy. pre-prostatectomy Transthoracic echocardiogram was done for routine preoperative assessment, which revealed right atrium heterogenous mass looking like originating from the right atrium with a broad-base septal attachment, dangling across the tricuspid valve into the right ventricle, reaching to the inferior vena cava. Fig 1. Cardiac MRI confirmed the echocardiography finding. Fig 2. Positron emission tomography-computed tomography (PET-CT) was obtained, the mass showed global SUV of 7.1 uptake with no other FDG-avid lesions. Fig 3 MDT meeting with hepatobiliary team & oncology agreed to proceed for excisional biopsy of the mass for definitive diagnosis & treatment.Unfortunately, complete excision was impossible but debulking of the mass was done as much as possible & sent for histopathology examination. The patient post-operative course was unremarkable & he was discharged on the 5thHis pathology showed a hepatocellular carcinoma. Referring to oncology team decision was to start systemic chemotherapy. He received his first cycle & currently he is on follow up.ConclusionSecondary tumors to the heart might be more common than expected and occult HCC lesion could cause diagnostic dilemma. 
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