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Metastatic cardiac squamous cell carcinoma arising in the left ventricle
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A 71 year old man was diagnosed with lingual squamous cell carcinoma (T2 N0 M0) and was subjected to partial lingualectomy in June, 1997. Ten months after the operation, local signs of recurrences, such as ulceration in the oral cavity and multiple metastatic lesions, were found. Surprisingly, an ECG showed ST elevation in I, aVL, and V5–6, and ST depression in II, III, aVF, and V1–3 without any symptoms. Transthoracic echocardiography revealed multiple high echoic masses only in the left ventricular posterior wall and left ventricular lateral wall (top right, LV, left ventricle, LA, left atrium, Ao, aorta). Although he received radiotherapy and chemotherapy, the patient died in March 1998. Pathological dissection of the heart revealed a cardiac tumour that occupied mainly the posterior and lateral walls of the left ventricle and almost extended over the left ventricle (bottom right). Interestingly, the cardiac tumour corresponded with the ST changes. Microscopic examination of haematoxylin and eosin stained tissue preparations revealed that the cardiac tumour was a squamous cell carcinoma, suggesting that it was a metastasis of the lingual cancer. Other metastases were found in the right lung, right and left adrenal glands, right and left kidney, right upper arm, and right forearm.  Almost all metastatic cardiac tumours have been reported to arise in the right side of the heart. There have been few reports about electrocardiographic changes induced by metastatic cardiac tumours. In this patient, the metastatic tumour occupied a large part of the left ventricular wall, which explains the ECG findings. This case indicates that a left ventricular mass accompanied with ST changes might indicate the presence of a metastatic tumour.