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.