Document Type : Case Reports


1 Student Committee Research, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran

2 Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran

3 Cellular and Molecular Biology Research Center, Health Research Institute, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran


It is very rare for colorectal neoplasms to metastasize to the heart in the worldwide medical literature; only a single case of well-documented colorectal cancer metastasis to the left atrium was found. The case of a 66-year-old man is explained in this paper, who was suffering from metastatic adenocarcinoma of the colon that included the left atrium. In transthoracic and transesophageal echocardiography, a large multilobulated mass was present in the left atrium. An accidental pulmonary mass was also seen in a lung spiral CT scan. The cardiac mass was taken out, and a biopsy was obtained from the pulmonary mass. Adenocarcinoma was seen in histological assessment. Immunohistochemical staining was carried out to examine the expression of cytokeratin 7, cytokeratin 20, and caudal-related homeobox transcription factor 2 (CDX2) to determine the origin of the adenocarcinoma. In addition, the expression of these proteins was linked to the attributes of the patient and tumor. Post-surgery transesophageal echocardiography showed normal left ventricle and right ventricle function with no evidence of left atrium mass. Therefore, we suggest that asymptomatic cancer patients with a history of colorectal cancer and who have developed cardiac symptoms should be immediately examined for potential cardiac metastasis.


Main Subjects

  1. Lo EKK, Lee JC-Y, Turner PC, El-Nezami HJSr. Low dose of zearalenone elevated colon cancer cell growth through G protein-coupled estrogenic receptor. 2021;11(1):1-13. [PMID] [PMCID] [DOI:10.1038/s41598-021-86788-w]
  1. Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. 2018;68(1):31-54. [DOI:10.3322/caac.21440] [PMID]
  2. Bigot P, Goodman C, Hamy A, Teyssedou C, Arnaud J-PJJoGS. Isolated splenic metastasis from colorectal cancer: report of a case. 2008;12(5):981-2. [DOI:10.1007/s11605-007-0326-5] [PMID]
  3. Shah SA, Haddad R, Al-Sukhni W, Kim RD, Greig PD, Grant DR, et al. Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. 2006;202(3):468-75. [PMID] [DOI:10.1016/j.jamcollsurg.2005.11.008]
  4. Choi PW, Kim CN, Kim HS, Lee JM, Heo TG, Park JH, et al. Skeletal Muscle Metastasis from Colorectal Cancer: Report of a Case. 2008;24 (6):492-6. [DOI:10.3393/jksc.2008.24.6.492]
  5. Phillips J, Lishman S, Jani PJTJol, otology. Colonic carcinoma metastasis to the thyroid: a case of skip metastasis. 2005;119(10):834. [DOI:10.1258/002221505774481273] [PMID]
  6. Patel SA, Herfel BM, Nolan MAJTHIJ. Metastatic colon cancer involving the right atrium. 2012;39(1):79.
  7. Bussani R, De-Giorgio F, Abbate A, Silvestri FJDI. Cardiac metastases. J ClinPathol. 2007; 60 (1): 27-34. 2005(035105.). [PMID] [PMCID] [DOI:10.1136/jcp.2005.035105]
  8. Tsujii Y, Hayashi Y, Maekawa A, Fujinaga T, Nagai K, Yoshii S, et al. Cardiac metastasis from colon cancer effectively treated with 5-fluorouracil, leucovorin, and oxaliplatin (modified FOLFOX6) plus panitumumab: a case report. 2017;17(1):1-5. [DOI:10.1186/s12885-017-3147-2] [PMID] [PMCID]
  9. Pizzicannella J, Ricci V, Gorla R, Spinapolice E, Esposito AJCrim. Isolated cardiac metastasis from colorectal cancer in a 35-year-old man. 2012;2012. [DOI:10.1155/2012/751761] [PMID] [PMCID]
  10. Al-Mamgani A, Baartman L, Baaijens M, de Pree I, Incrocci L, Levendag PCJIjoco. Cardiac metastases. 2008;13(4):369-72. [DOI:10.1007/s10147-007-0749-8] [PMID]
  11. Choufani EB, Lazar HL, Hartshorn KLJJoCO. Two Unusual Sites of Colon Cancer Metastases and a Rare Thyroid Lymphoma: Case 2. Chemotherapy-Responsive Right Artial Metastasis from Colon Carcinoma. 2001;19(15): 3574-5. [DOI:10.1200/JCO.2001.19.15.3574] [PMID]
  12. Choi PW, Kim CN, Chang SH, Chang WI, Kim CY, Choi HMJWjogW. Cardiac metastasis from colorectal cancer: a case report. 2009;15(21): 2675. [DOI:10.3748/wjg.15.2675] [PMID] [PMCID]
  13. Oneglia C, Negri A, Bonora-Ottoni D, Gambarotti M, Bisleri G, Rusconi C, et al. Congestive heart failure secondary to right ventricular metastasis of colon cancer. A case report and review of the literature. 2005;6(9):778-81.
  14. Chu P, Ko Y, Liao W, Chiang CJCyxzz. Metastatic colonic carcinoma with intracavitary right ventricular outflow tract obstruction and cardiac tamponade: a case report. 1996;19(3): 264-7.
  15. Mohammadianpanah M, Nasrollahi H, Sasani MR, Zangouri V, Shamsolvaezin N, Hamedi SH, et al. Colon Cancer with Metastasis to the Right Atrium: A Case Report and Review of Literature. 2020;11(4):507-11.
  16. Reisenauer JS, Said SM, Allen MSJTAots. Metastatic rectal adenocarcinoma presenting as a giant left atrial mass: resection combined with right lower lobectomy. 2016;102(1):e19-e21. [DOI:10.1016/j.athoracsur.2015.11.064] [PMID]
  17. Bayrak R, Yenidünya S, Haltas HJP-R, Practice. Cytokeratin 7 and cytokeratin 20 expression in colorectal adenocarcinomas. 2011;207(3):156-60. [DOI:10.1016/j.prp.2010.12.005] [PMID]
  18. Coons SW, Estrada SI, Gamez R, White WLJEp. Cytokeratin CK 7 and CK 20 expression in pituitary adenomas. 2005;16(3):201-10. [DOI:10.1385/EP:16:3:201]
  19. Ortiz-Rey JA, Álvarez C, San Miguel P, Iglesias B, Antón IJAI, Morphology M. Expression of CDX2, cytokeratins 7 and 20 in sinonasal intestinal-type adenocarcinoma. 2005;13(2):142-6. [DOI:10.1097/01.pai.0000133058.00588.15] [PMID]
  20. Sack MJ, Roberts SAJDc. Cytokeratins 20 and 7 in the differential diagnosis of metastatic carcinoma in cytologic specimens. 1997;16(2): 132-6. [DOI:10.1002/(SICI)1097-0339(199702)16:23.0.CO;2-J]
  21. Werling RW, Yaziji H, Bacchi CE, Gown AMJTAjosp. CDX2, a highly sensitive and specific marker of adenocarcinomas of intestinal origin: an immunohistochemical survey of 476 primary and metastatic carcinomas. 2003;27(3): 303-10. [DOI:10.1097/00000478-200303000-00003] [PMID]
  22. Aasebø K, Dragomir A, Sundström M, Mezheyeuski A, Edqvist P-H, Eide GE, et al. CDX2: a prognostic marker in metastatic colorectal cancer defining a better BRAF mutated and a worse KRAS mutated subgroup. 2020;10:8. [DOI:10.3389/fonc.2020.00008] [PMID] [PMCID]
  23. Dalerba P, Sahoo D, Paik S, Guo X, Yothers G, Song N, et al. CDX2 as a prognostic biomarker in stage II and stage III colon cancer. 2016;374 (3):211-22. [DOI:10.1056/NEJMoa1506597] [PMID] [PMCID]
  24. Bruun J, Sveen A, Barros R, Eide PW, Eilertsen I, Kolberg M, et al. Prognostic, predictive, and pharmacogenomic assessments of CDX 2 refine stratification of colorectal cancer. 2018;12(9): 1639-55. [DOI:10.1002/1878-0261.12347] [PMID] [PMCID]
  25. Hanfling SMJC. Metastatic cancer to the heart: review of the literature and report of 127 cases. 1960;22(3):474-83. [DOI:10.1161/01.CIR.22.3.474] [PMID]
  26. Ekmektzoglou KA, Samelis GF, Xanthos TJJoCM. Heart and tumors: location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations. 2008;9(8):769-77. [DOI:10.2459/JCM.0b013e3282f88e49] [PMID]
  27. Koizumi J, Agematsu K, Ohkado A, Shiikawa A, Uchida TJTJJoT, Surgery C. Solitary cardiac metastasis of rectal adenocarcinoma. 2003;51(7): 330-2. [DOI:10.1007/BF02719389] [PMID]
  28. Chiles C, Woodard PK, Gutierrez FR, Link KMJR. Metastatic involvement of the heart and pericardium: CT and MR imaging. 2001;21(2): 439-49. [PMID] [DOI:10.1148/radiographics.21.2.g01mr15439]
  29. Nishida H, Grooters RK, Coster D, Soltanzadeh H, Thieman KCJH, vessels. Metastatic right atrial tumor in colon cancer with superior vena cava syndrome and tricuspid obstruction. 1991;6(2): 125-7. [DOI:10.1007/BF02058761] [PMID]
  30. Murphy MC, Sweeney MS, Putnam Jr J, Walker WE, Frazier O, Ott DA, et al. Surgical treatment of cardiac tumors: a 25-year experience. 1990; 49 (4):612-8. [DOI:10.1016/0003-4975(90)90310-3]