Long-Term Survival of Right Ventricular Cardiac Metastasis From Colon Cancer Causing Outflow Tract Obstruction

BACKGROUND: Cardiac metastasis from colorectal cancer is rare and has a poor prognosis. However, the optimal management remains uncertain. CASE SUMMARY: A 50-year-old woman underwent colectomy with lymph node dissection for descending colon cancer, followed by chemotherapy. Six months later, computed tomography revealed a right ventricular mass that was initially suspected to be a thrombus. Despite anticoagulation, the mass enlarged, causing progressive right ventricular outflow tract stenosis, and was considered a cardiac metastasis from colon cancer. To prevent sudden death, complete resection with pulmonary valve replacement and right ventricular outflow tract reconstruction was performed. Seventeen months after surgery, no intracardiac recurrence or systemic progression was observed with continued chemotherapy. DISCUSSION: This case suggests that surgical resection of a cardiac mass followed by early chemotherapy may reduce life-threatening events and improve prognosis. TAKE-HOME MESSAGES: Systemic therapy is central to managing colorectal cancer with cardiac metastasis. Surgery may be warranted to prevent catastrophic cardiac events and facilitate safe chemotherapy.