Cardiac Metastasis as Initial Site of Recurrence in Rectal Cancer

Metastatic colorectal carcinoma to the right atrium: a case report and review of the literature

BACKGROUND

Cardiac metastasis due to colon cancer is extraordinarily uncommon. Given the rarity of diagnosis, there is paucity of evidence and hence, no established guidelines for evaluation or clinical management strategy.

CLINICAL PRESENTATION

We present the case of a 59 year old male with a previously treated colonic carcinoma who presented with new onset exertional dyspnea. He was noted to be having a right atrial mass on an echocardiogram performed at his cardiologist's office. Further workup with CT angiogram of the chest confirmed a right atrial mass measuring 4.0 cm. Serum CEA was normal. Biopsies of the right atrial mass demonstrated metastatic moderately differentiated colonic adenocarcinoma. Mismatch repair protein expression analysis by immunohistochemistry showed no loss of MLH1, MSH2, MSH6 or PMS2 expression. Next generation sequencing for RAS and BRAF mutations was negative. Patient received treatment with FOLFIRINOX/ bevacizumab with noted reduction in size of mass.

CONCLUSION

To the best of our knowledge, this is the first report of next generation sequencing results available on a biopsy of metastatic colorectal cancer to the heart with the largest literature review of 31 reported cases of metastatic colorectal cancer to the heart. It will help direct clinical management and also adds evidence to the potential efficacy of treatment of this rare aggressive disease with chemotherapy in combination with VEGF inhibitors.

Value of high resolution magnetic resonance imaging in preoperative staging of rectal cancer

AIM

To assess the value of conventional magnetic resonance imaging (MRI) combined with high resolution MRI (HR-MRI) in preoperative T and N staging of rectal cancer by comparing with pathological staging.

METHODS

The clinical data of 84 patients with primary rectal cancer who were admitted to Tianjin Haibin People's Hospital from January 2017 to October 2017 and underwent conventional MRI and HR-MRI preoperatively and pathological examination postoperatively were collected. The consistency and correlation were analyzed between preoperative T and N staging by conventional MRI and HR-MRI and pathological T and N staging. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of conventional MRI combined with HR-MRI in diagnosing T and N stages were calculated.

RESULTS

There was a strong consistency between preoperative T and N staging by conventional MRI and HR-MRI and pathological T and N staging (κ = 0.691, P = 0.000), and the correlation rate was 84.52% (71/84). The accuracy, sensitivity, and specificity of conventional MRI and HR-MRI were 93.15%, 87.44%, and 92.36% for preoperative T1 staging, 91.23%, 86.19%, and 95.42% for preoperative T2 staging, 93.15%, 87.44%, and 92.36% for preoperative T3 staging, and 95.24%, 100.00%, and 77.78% for preoperative T4 staging. The accuracy, sensitivity, and specificity of conventional MRI combined with HR-MRI for preoperative N staging were 93.15%, 87.44%, and 92.36%, respectively. Using postoperative pathological results as the "gold standard", the accuracy, specificity, and sensitivity of conventional MRI combined with HR-MRI in predicting mesorectal invasion before surgery were 93.15%, 87.44%, and 92.36%, respectively.

CONCLUSION

Conventional MRI combined with HR-MRI has high diagnostic value in preoperative evaluation of T and N stages and mesangial invasion in patients with rectal cancer, which can provide a reliable reference for the clinical planning of surgical procedures.