Management of Epicardial Metastasis in Breast Cancer

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Management of Epicardial Metastasis in Breast Cancer

Laura Rebegea, Ana Maria Ilie, Ana Maria Paslaru, Dorel Firescu, Cristina Serban, Carina Voinescu, Violeta Sapira, Gabriela Stoleriu, Mihaela Lungu, Anca Zgura, Rodica Anghel
Clinical case, no. 5, 2021
Article DOI: 10.21614/chirurgia.116.5.627
Background: Cardiac metastasis may be encountered more frequently than primary cardiac tumors. They are discovered at autopsies with an incidence between 1.5 - 20%. The primary tumors that generate cardiac metastasis are malignant melanomas, lymphoma, the lungs, the breast, the esophagus. The organ most affected is the pericardium (62-81%). In 90% of cases from a clinical point of view, they are generally silent. In the case of patients diagnosed with breast cancer and who have undergone radiotherapy, differential diagnosis with fibrosis post radiotherapy interferes. The treatment is palliative and should be administered according to the primary location of the tumor and the patient's performance status.

Case presentation: We are presenting the case of a 73-year-old diagnosed and treated for a breast neoplasm in the left breast in 2006. After a period of time of 9 years, the patient presents secondary sternal bone determination, radio-treated and for which she once again goes under hormonal therapy. In 2018, patient performed an imaging evaluation that revealed lung metastases. At the moment of stage review, performed in 2020, secondary epicardial determinations are noted. We present the case, the therapeutic management, diagnostic procedures and treatment and also, we discuss the data from literature.

Conclusion: Cardiac metastases are rare and and in most cases are silent. The incidence has changed due to treatment options and imaging investigations. Stereotactic body radiation therapy can be considereda a therapeutic option in the cases with good performance status and with oligometastatic disease.

Keywords: breast tumor, epicardial metastases, radiotherapy, surgery, chemotherapy