Cardiac metastasis from squamous cell carcinoma of the oral cavity: A rare case report

A 58-year-old male with squamous cell carcinoma of the floor of mouth underwent surgical planning for tumor resection and floor of mouth reconstruction. Unexpectedly, preoperative cervico-thoracic computed tomography (CT) indicated possible right ventricular intramural thrombosis, prompting initiation of unfractionated heparin. Follow-up echocardiography revealed no thrombus reduction, raising concerns of intracardiac metastasis. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose with computed tomography (18F-FDG PET/CT) showed a hypermetabolic mass in the right ventricle, raising concern for a distant tumor metastasis. Under anti-coagulation, the patient experienced recurrent tumor-related hemorrhage, necessitating urgent lingual artery embolization. Due to disease progression, surgical options were dismissed in favor of palliative chemo-immunotherapy, which both led to significant regression of both primary and metastatic lesions.