Case presentation
A 57-year-old female patient detected masses on the tricuspid valve’s
ventricular surface by transthoracic echocardiography(TTE). The patient
had a medical history of squamous carcinoma of the cervix(SCC) one year
ago when the TTE was no abnormality. On physical examination, vital
signs were stable with a blood pressure of 100/64 mmHg, a heart rate of
79 b.p.m, and a respiratory rate of 18 per minute. Laboratory
examination proved mild anemia. It slightly elevated the counts of
C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), D-dimer
(turbidimetry), and fibrinogen degradation products(FDP). Transthoracic
echocardiography showed a mobile mass on the tricuspid ventricular
surface protruding into the pulmonary valve during systole (Fig 1A,
marks) and many neoplasms attaching the tricuspid valve and its chordae
tendineae(Fig 1B, arrow). The imaging showed no sign of pulmonary
emboli. Considering the high risk of the lump falling off, the patient
underwent a one-stage operation through median sternotomy to establish
cardiopulmonary bypass. A honeycomb mass (Fig 1C, arrows) was attached
to the anterior tricuspid valve with a dimension of about 33mm×18mm.
Moreover, many small groups were attached to the ventricular surface of
the tricuspid valve and its chordae tendineae. All masses and part of
the chordae tendineae were removed and reconstructed. Histopathology
revealed SCC (Fig 1D, E). The enhanced positron emission
tomography-computed tomography(PET-CT) showed increased glucose
metabolism in the lymph nodes on the left side of the abdominal aorta
and behind the foot of the left diaphragm(Fig 1F, arrows). It was
supposed to originate from cervical squamous cell carcinoma recurrence
and distant metastasis. Furthermore, the TTE found no abnormality (Fig
2A), electrocardiogram, and PET-CT(Fig 2 B, arrows) after the
operation on the heart. The patient recovered successfully postoperative
course. However, the postoperative patients did not receive regular
chemotherapy. One month after the procedure, the color Doppler
Echocardiography showed normality in color Doppler Echocardiography(Fig
2C, arrow).
Three months after discharge, the patient has admitted again because he
found a mass in the left neck with a dimension of about 22mm×30mm, which
was hard, with poor mobility, and no tenderness.
Color Doppler ultrasonography of
cervical lymph nodes revealed hypoechoic nodules in the left neck,
considering lymph node growth and structural abnormalities. The 64-slice
Spiral Computed Tomography of the chest showed left supraclavicular
fossa and axillary multiple lymph nodes with partial enlargement. The
patient underwent left cervical mass resection. The pathological
examination showed metastatic squamous cell carcinoma of lymph nodes
(Fig 2D, arrow) and tumor thrombus (Fig 2E, arrow). After the operation,
the patient was successfully discharged from the hospital but still did
not receive traditional chemotherapy. Next, the TTE revealed a mass
attached to the tricuspid valve with a dimension of about
28.1mm×18.2mm(Fig 2F, arrow). There is no noticeable change in examining
the 64-slice Spiral Computed Tomography of the chest and
electrocardiogram compared with last time. According to the current
condition of the patients, the short-term effect after the operation is
not ideal, and the progress of the patient’s condition still needs
further follow-up.