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Open Access Case report

Symptomatic cardiac metastases of breast cancer 27 years after mastectomy: a case report with literature review - pathophysiology of molecular mechanisms and metastatic pathways, clinical aspects, diagnostic procedures and treatment modalities

Darko Katalinic1*, Ranka Stern-Padovan2, Irena Ivanac3, Ivan Aleric4, Damir Tentor5, Nora Nikolac6, Fedor Santek1, Antonio Juretic1 and Stjepko Plestina1

Author Affiliations

1 Department of Oncology, University Hospital Centre (KBC Zagreb), University of Zagreb School of Medicine, Kispaticeva 12, HR-10000, Zagreb, Croatia

2 Department of Diagnostic and Interventional Radiology, University Hospital Centre (KBC Zagreb), University of Zagreb School of Medicine, Zagreb, Croatia

3 Department of Cardiovascular Diseases, University Hospital Centre (KBC Zagreb), University of Zagreb School of Medicine, Zagreb, Croatia

4 Department of Pulmonary Medicine, University Hospital Centre (KBC Zagreb), University of Zagreb School of Medicine, Zagreb, Croatia

5 Department of Pathology and Cytology, University Hospital Centre (KBC Zagreb), University of Zagreb School of Medicine, Zagreb, Croatia

6 Department of Clinical Chemistry, University Hospital Centre “Sisters of Charity”, University of Zagreb School of Medicine, Zagreb, Croatia

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World Journal of Surgical Oncology 2013, 11:14  doi:10.1186/1477-7819-11-14

Published: 23 January 2013

Abstract

Metastases to the heart and pericardium are rare but more common than primary cardiac tumours and are generally associated with a rather poor prognosis. Most cases are clinically silent and are undiagnosed in vivo until the autopsy. We present a female patient with a 27-year-old history of an operated primary breast cancer who was presented with dyspnoea, paroxysmal nocturnal dyspnoea and orthopnoea. The clinical signs and symptoms aroused suspicion of congestive heart failure. However, the cardiac metastases were detected during a routine cardiologic evaluation and confirmed with computed tomography imaging. Additionally, this paper outlines the pathophysiology of molecular and clinical mechanisms involved in the metastatic spreading, clinical presentation, diagnostic procedures and treatment of heart metastases. The present case demonstrates that a complete surgical resection and systemic chemotherapy may result in a favourable outcome for many years. However, a lifelong medical follow-up, with the purpose of a detection of metastases, is highly recommended. We strongly call the attention of clinicians to the fact that during the follow-up of all cancer patients, such heart failure may be a harbinger of the secondary heart involvement.

Keywords:
Heart metastases; Breast cancer; Pathophysiology; Symptoms; Treatment