Antemortem Diagnosis of Cardiac Metastasis Available in a Patient with Primary Tongue Carcinoma

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, and depressed 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, the tongue carcinoma had invaded the myocardium. With the uncommon ECG and cardiacechographic findings, we could clinically make an antemortem diagnosis for the present patient. The paucity of antemortem diagnosis of cardiac metastasis in the literature emphasizes the uniqueness.