Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT: A case report and literature review

Our plain-English summary of Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT: A case report and literature review, by P. Delabie, D. Evrard, I. Zouhry, et al (Medicine, 2021).

The study

• Authors: P. Delabie, D. Evrard, I. Zouhry, P. Ou, F. Rouzet, K. Benali, E. Piekarski
• Journal: Medicine
• Published: 2021;100(15):e25529
• Type of article: Case report, Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: The most common malignancies metastasizing to the heart are cancers of the lung, breast, mesothelioma, melanoma, leukemia, and lymphoma. Cardiac metastasis from a tongue cancer is a rare finding and only a few cases have been reported previously in the literature. In this case report and literature review, we discuss the main clinical features of patients with cardiac metastases secondary to a tongue cancer and imaging modalities performed, especially the 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT).

Patient Concerns: This is a case of a 39-year-old woman who in April 2018 was diagnosed with an invasive well differentiated squamous cell carcinoma of the movable tongue. She underwent a left hemiglossectomy followed by a revision of hemiglossectomy and ipsilateral selective neck lymph nodes dissection levels II to III because of pathological margins. An early inoperable clinical recurrence was diagnosed and she received radiochemotherapy with good clinical and metabolic response. She remained asymptomatic thereafter.

Diagnosis: In January 2020, a pre-scheduled 18F-FDG PET/CT showed a diffuse cardiac involvement. In February 2020, a biopsy of the lesion revealed a metastatic squamous cell carcinoma.

Interventions: She was deemed to not be a cardiac surgical candidate and treated by palliative chemotherapy: taxol-carboplatin associated with cetuximab then cetuximab alone because of adverse effects. A re-evaluation imaging performed in April 2020 evidenced a progression of the cardiac involvement, which led to switch chemotherapy by immunotherapy with nivolumab.

Outcomes: This patient had a very poor prognosis and succumbed to major heart failure 4 months after the diagnosis of cardiac metastasis.

Conclusion: In this case report, 18F-FDG PET/CT proved to be useful in detecting cardiac metastasis and changed the therapeutic management of the patient. It suggests that patients with tongue malignancies in a context of poor initial prognosis should be followed-up early by 18F-FDG PET/CT with HFLC diet to facilitate detection of recurrence.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

In plain English

This article was a case report with a literature review from Bichat University Hospital in Paris. It did not study asbestos. The patient was a 39-year-old woman with a 3 pack-year smoking history, diagnosed in April 2018 with squamous cell carcinoma of the movable tongue. After surgery the cancer returned early and was treated with chemotherapy and radiochemotherapy. In January 2020 a planned 18F-FDG PET/CT scan showed an intensely active area in the wall of the right ventricle of the heart and a thickened pericardium. A cardiac CT scan showed a mass of 4.6 by 3.5 cm. A pericardial biopsy in February 2020 showed metastatic squamous cell carcinoma. Surgery was not possible, so chemotherapy and then nivolumab were given, and the patient died in May 2020. The authors also reviewed 16 earlier published cases from 1985 to October 2019. Counting this case, PET/CT was the first imaging test to reveal the heart metastasis in 24% of patients. The authors concluded that PET/CT was useful in detecting the cardiac metastasis and changed this patient's treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report with literature review
• Who was studied: One 39-year-old woman with squamous cell carcinoma of the tongue, diagnosed April 2018 and treated at Bichat University Hospital, Paris. The literature review covered 16 other published cases of tongue squamous cell carcinoma with cardiac metastasis, 1985 to October 2019.
• Exposure: No asbestos or fiber exposure was studied. The article reports the patient's 3 pack-year smoking history.
• Main results:
  • In this patient, a January 2020 18F-FDG PET/CT showed an intensely hypermetabolic myocardial focus (SUVmax 7.1) in the basal posterolateral wall of the right ventricle, with hypermetabolic pericardial thickening (SUVmax 5.6).
  • In this patient, cardiac CT showed a mass of 4.6 by 3.5 cm infiltrating the basal posterolateral wall of the right ventricle and extending to the right atrium.
  • In this patient, a February 2020 pericardial biopsy showed metastatic squamous cell carcinoma.
  • After disease progression in April 2020, the patient received nivolumab and died in early May 2020 after 2 cycles of treatment.
  • Across the reviewed cases plus this one, 18F-FDG PET/CT was the initial imaging modality revealing the cardiac metastasis in 24% of patients.
  • In the literature review, pericardial involvement was seen in 29% of patients and left atrial involvement in one case.
  • In the literature review, 47% of cases with squamous cell carcinoma of the tongue were women.
• The authors' conclusion: The authors concluded that 18F-FDG PET/CT was useful in detecting the cardiac metastasis and changed this patient's treatment. They suggested that patients with tongue cancers and a poor initial prognosis be followed early with 18F-FDG PET/CT using a high-fat, low-carbohydrate diet preparation.

Topics

Medical terms in this study, explained in our Lexicon: Squamous Cell Carcinoma, Metastasis, Mesothelioma, Biopsy, Palliative Care, Chemotherapy, Carboplatin, Cetuximab (Erbitux).

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• Metastatic pleural mesothelioma presenting with solitary involvement of the tongue: report of a new case and review of the literature — F. Zanconati, A. DelConte, et al. (2003)
• Tongue metastasis from a malignant diffuse mesothelioma of the pleura: report of a case — A. Piattelli, M. Fioroni, et al. (1999)
• Whole-Body MRI: Comparison of Its Capability for TNM Staging of Malignant Pleural Mesothelioma With That of Coregistered PET/MRI, Integrated FDG PET/CT, and Conventional Imaging — Y. Ohno, M. Yui, et al. (2019)
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