Introduction: Esophageal adenocarcinoma with subsequent metastasis is a commonly diagnosed condition.
Case Description/Methods: We report a case of a 72 year old Caucasian man with a history of atrial fibrillation and hypertension who presented with complaints of dysphagia, belching and unexplained weight loss. Upper endoscopy revealed a mass in the distal esophagus extending from 38-42 cm and histopathology then confirmed an adenocarcinoma. A CT chest showed a probable 3.8 cm thrombus in the right atrium. The patient did not present with any cardiopulmonary signs or symptoms. A trans-esophageal echocardiogram was performed which showed a 4.5 x 4.1 cm right atrial mass, rather than a thrombus, which was successfully excised by thoracic surgery. The mass was consistent with metastatic adenocarcinoma, positive for cytokeratin 7/20 and CDX-2 and negative for TTF-1, HER2/neu and PD-L1 negative and felt to be of esophageal origin. No other evidence of distant metastasis were noted.
Oncology initiated systemic chemotherapy with Oxaliplatin, Leucovorin, 5-FU and Opdivo for which he received six cycles. The patient initially did well but ultimately succumbed to his disease state several months later.
Discussion: This case highlights a rare case of esophageal adenocarcinoma with a large metastasis to the right atrium. The overall incidence of cardiac metastases from an esophageal primary is extremely rare and not well documented in the literature. Most cases are found post-mortem, with the histologic presentation being a squamous cell carcinoma in the vast majority. Our case was diagnosed ante-mortem, without cardiac symptoms on presentation, and was an adenocarcinoma. This is an extremely rare and infrequently documented condition.
.jpg "Diana Lei S. Dy, RN, BSN photo")