Korean J Leg Med.  2012 May;36(1):115-118. 10.7580/KoreanJLegMed.2012.36.1.115.

Death due to Cardiac Metastasis after Treatment of Oral Squamous Cell Carcinoma: An Autopsy Case

• Kim HJ
• Jeon SH
• Seo JS

• KMID: 2250328
• DOI: http://doi.org/10.7580/KoreanJLegMed.2012.36.1.115

Abstract

A 60-year-old man presented with electrocardiographic abnormalities after treatment for oral squamous cell carcinoma with surgical resection and radiation therapy 7 months ago. The patient died within 2 h without response to CPR after sudden arrest. Electrocardiographic changes 9 h before death included low QRS voltage and sinus tachycardia. Autopsy revealed cardiac metastasis with chronic active fibrinoid pericarditis accompanied by tumor cell infiltration. Although the frequency of cardiac metastasis in patients with oral cancer is reportedly low, clinicians should be aware that cardiac metastasis may exist if there are electrocardiographic changes in patients receiving follow-up care for primary malignancy. We report a rare medicolegal case of cardiac metastasis-related sudden death.

Keyword

oral squamous cell carcinoma; cardiac metastasis; electrocardiographic abnormalities; sudden death

MeSH Terms

Autopsy
Carcinoma, Squamous Cell
Cardiopulmonary Resuscitation
Death, Sudden
Electrocardiography
Follow-Up Studies
Humans
Middle Aged
Mouth Neoplasms
Neoplasm Metastasis
Pericarditis
Tachycardia, Sinus

Figure

• 

  Fig. 1 The deceased's ECG at the time of diagnosis primary oral squamous cell carcinoma showed normal sinus rhythm.

• 

  Fig. 2 After treatment of primary oral cancer for 7 months, the deceased presented ECG abnormalities as sinus tachycardia and low voltage QRSs.

• 

  Fig. 3 The pericardium typically has the feature of chronic constrictive pericarditis with hemorrhage and fibrinoid exudation (a and b). The metastatic tumor mass bulges in and out the right atrial wall (c and d).

• 

  Fig. 4 The metastatic tumor mass with a central necrosis is formed along the right atrioventricular groove, encircling the proximal portion of the right coronary artery.

• 

  Fig. 5 Histologically, the tumor mass is consistent with well differentiated squamous cell carcinoma (A). Tumor cells infiltrate deep to the endothelium of the right coronary artery, making a focal thrombosis (B). Tumor emboli are found in the anterior right atrial branch of the right coronary artery and a few small vessels near the nodal tissues (C). The pericardium is infiltrated with squamous cell carcinoma cells and accompanies fibronoid exudation and inflammation (D).

Reference

1. Oliveira SM, Goncalves A, Cruz C, et al. Cardiac metastasis from epidermoid esophageal cancer mimicking anterior myocardial infactrion. Rev Port Cardiol. 2011. doi:10.1016/j.repc.2011.12.011.

2. Karwinski B, Svendsen E. Trends in cardiac metastasis. APMIS. 1989. 97:1018–1024.

3. Abraham KP, Reddy V, Gattuso P. Neoplasms metastatic to the heart: review of 3314 consecutive autopsies. Am J Cardiovasc Pathol. 1990. 3:195–198.

4. Al-Mamgani A, Baartman L, Baaijens M, de Pree I, Incrocci L, Levendag PC. Cardiac metastases. Int J Clin Oncol. 2008. 13:369–372.

5. Ito T, Ishikawa N, Negishi T, Ohno K. Cardiac metastasis of tongue cancer may cause sudden death. Auris Nasus Larynx. 2008. 35:423–425.

6. Astorri E, Bonetti A, Fiorina P. ECG mimicking acute myocardial infarction during heart involvement by lung neoplasm. Int J Cardiol. 2000. 74:225–226.