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