Case presentation
A thirty-three-year-old man underwent surgical resection of left
anterior superior mediastinal tumor in May 2007. Intraoperative
observations were as follows: A tumor was located in the left anterior
superior mediastinum, approximately 10 cm × 12 cm in size, and it
exhibited some capsule breakdown with a rough surface. The tumor had
extensive adhesion with the chest
wall, pericardium, and septal nerve. According to these observations, a
diagnosis of malignant tumor was made. Therefore he underwent total
tumor resection and phrenicectomy by thoracotomy. Postoperative
pathologic examination revealed mediastinal carcinoid. Recently, the
patient was admitted with complaint of chest pain at resting position
without obvious trigger. On July 15, 2018, he underwent two-dimensional
echocardiography and the following findings were revealed. High
echogenic masses, which were 83 mm × 61 mm and 45 mm × 25 mm in size in
the left ventricle (LV)(Figure 1)and LV wall epicardium(Figure 2),
respectively. The mass within the LV swung slightly and appeared to be
associated with the inferior LV wall and apex. LV dilation with LV
end-diastolic diameter of 68 mm. Reduced LV systolic function, with LVEF
of 44%. Pericardial effusion of 8 mm. PET/CT imaging also revealed
masses in the LV and at lateral posterior LV wall near the apex, with
local hypermetabolism and high SUVmax of 6.5(Figure
3).These results indicated cardiac malignant tumor without metastasis to
other sites. On July 25, 2018, he underwent LV neoplasm resection.
Intraoperative observations showed that the tumor was fragile and
located inside the LV with a wide base and connected extensively to the
ventricular septum and apex. Due to the tender texture and wide invasion
to the LV, it was difficult to remove the tumor completely. Pathologic
examination showed neuroendocrine tumor, equivalent to an atypical
carcinoid, with invasion into cardiac striated muscle tissue, which
suggested mediastinal tumor metastasis (Figure 4).He died about a month
later after the operation because of heart failure.