Yonago Acta medica 2001;44:131–136

Antemortem Diagnosis of Cardiac Metastasis Available in a Patient withPrimary Tongue Carcinoma
Katsuyuki Kawamoto, Aya Nosaka and Hiromi Takeuchi
Department of Oto-Rhino-Laryngology, Tottori University Faculty of Medicine, Yonago 6830826 Japan
We report a rare case of a patient suffering from cardiac metastasis with tongue
carcinoma. A 71-year-old Japanese man was admitted to our clinic at Tottori University
Hospital in June 1997. We diagnosed his disease as stage T2 N2 M0 squamous cell
carcinoma of the tongue, and performed a partial resection of the tongue and a rightside radical neck dissection. The postoperative course was uneventful, and follow-up
was continued. In March 1998, he visited us complaining of anorexia and constipation.
On electrocardiogram (ECG), ST waves were elevated in leads I, aVL, V5 and V6, anddepressed in lead aVF. Cardiac echogram revealed a shadow-like tumor in the lower
portion at the lateral wall of the left ventricle. He had a sudden and serious arrhythmic
attack on 12 March, and he died of cardiac insufficiency by arrhythmia on 22 March
1998. An autopsy showed that a cardiac tumor had invaded mainly into the anterior
and lateral wall of the left ventricle, and had reached the septum. Microscopically, thetongue carcinoma had invaded the myocardium. With the uncommon ECG and cardiacechographic findings, we could clinically make an antemortem diagnosis for the presentpatient. The paucity of antemortem diagnosis of cardiac metastasis in the literatureemphasizes the uniqueness.
Key words: cardiac echography; cardiac metastasis; tongue carcinoma

Cardiac metastasis with tongue carcinoma is
comparatively rare. Most reports on cardiac
metastases have presented cases of invasion
into the right atrium or ventricle, and metastasis
to the left ventricle is quite uncommon. It isdifficult to find a metastatic cardiac tumor inantemortem examinations because there are nocharacteristic findings in clinic or on electrocardiogram (ECG). The disease has been discovered at autopsy in most cases. When an antemortem diagnosis of cardiac metastasis of a malignant tumor is made, it is often difficult to apply
a curative therapy because most cardiac metastases are spread by a systematic route, causinga critical status in general. But, if the cardiac
metastasis is discovered early by ECG or cardiac echogram, apothanasia with chemotherapy
or radiation therapy would be possible. There-fore, antemortem diagnosis of cardiac metastasis is significant. We report a rare case of a patient with tongue carcinoma with cardiac metastasis in the left ventricle, in which antemortem
diagnosis was available by ECG and echocardiography.

Patient Report
In June 1997, a 71-year-old Japanese man wasadmitted to our hospital with a swallowing disturbance due to an oral pain which had lasted for
2 months. In the right margin of the tongue, atumor 25 mm in diameter was found, which we/highly suspected to be tongue carcinoma. Twoelastic hard masses 15 mm in diameter wereidentified by palpation in the right side of theAbbreviations: CT, computed tomography; ECG, electrocardiogram/-graphy131

K. Kawamoto et al.

Table 1. Laboratory findings upon second admission
Laboratory findings

Measured values Normal values

White blood cell count (× 103/mm3)

18.6
3.20
10.6
476
7.1
3.1
1.00.9140
3.2
11.8
15.21

Red blood cell count (× 106/mm3)
Hemoglobin(g/dL)
Platelet count(× 103/mm3)
Total protein(g/dL)
Albumin(g/dL)
Total bilirubin(mg/dL)
Serum creatinine(mg/dL)
Serum sodium(mEq/L)
Serum potassium(mEq/L)
Serum calcium(mEq/L)C-reacting protein
mEq/L, milliequivalent/literneck. Pathology of the biopsy specimen of the
tongue tumor revealed a low or moderately differentiated squamous cell carcinoma. By echography and computed tomography (CT), the 2neck masses were suspected of being metastaticfrom the tongue carcinoma. Distant metastases
into the chest, abdomen, pelvic cavity and limbs
were not identified by CT and gadolinium scintigraphy. Diagnosed as stage T2 N2 M0 tongue

3.3 – 8.8
4.00 – 5.70
12.0 – 17.0
125 – 343
6.0 – 8.0
3.5 – 5.0
0.2 – 1.2
0.7 – 1.7
137 – 147
3.6 – 5.0
8.6 – 11.0
< 0.2

carcinoma, radiation therapy was applied byirradiating a 30-Gy dose, and then a partial resection of the tongue and a right-side radical
neck dissection were performed in August 1997.
Histological examination of the right margin ofthe tongue showed no cancer cells. The postoperative course was uneventful, and follow-up
was carried out through periodical ambulatory
examinations.

Fig.1. ECGs showing ST elevations in leads I, aVL, V5 and V6, and a ST depression in lead aVF.

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