Figure 2 : Macroscopic view of metastatic melanoma.
Discussion :
This patient’s past surgical history is pertinent for esophageal
gastrectomy (Ivor Lewis technique) performed for resection of metastatic
melanoma. Intra-operatively, the tumor extended by pedicle into the
gastric pull up’s mesentery implying that the cardiac metastasis most
likely originated by direct extension from the adjacent gastric
mesentery. The mesenteric portion of the resected specimen contained
surgical staples, which further supports the possibility of direct
extension into the cardiac structures. Cardiac metastases of melanoma to
the heart are usually hematogenous[6] .
They commonly present as multifocal lesions in the left ventricle, right
atrium, and/ or the right ventricle. However, our patient’s tumor
presented as a solitary metastasis to the right atrial caval junction.
Trans-cardiac resection of the tumor was affected with deep hypothermic
circulatory arrest without complications. We felt this was the safest
way to access the metastasis at the atrial caval junction without
disrupting the tumor.
IRB Approval and Consent : N/A
Prior to journal submission, we received confirmation from the Indiana
University IRB and compliance officer that IRB submission and approval
is not required for this case study. However, verbal consent was granted
by patient prior to hospital discharge.
Funding : N/A
None – not applicable
Conflict of Interest : N/A
None – not applicable