Content area
Full Text
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer mortality (Jemal, Siegel, Xu, & Ward, 2010). HCC usually is diagnosed at advanced stages because of the absence of pathogenomic symptoms and the liver's large functional reserve. At the time of diagnosis, extrahepatic metastasis of HCC is found in 10%-20% of patients; the most common sites are the lung, intra-abdominal lymph nodes, bone, and adrenal gland (Yoon et al., 2007). HCC usually shows a tendency for vascular invasion, but it rarely presents with intracardiac mass. In addition, only a few cases of HCC with cardiac metastases have been reported in the literature. Herein we report a patient with a right atrial mass because of extrahepatic metastases of HCC (see Figure 1).
A 45-year-old man was admitted to the hospital with complaints of weight loss, dyspnea, abdominal swelling, and bilateral edema of the lower extremities for two weeks. The patient's medical history was unremarkable. On initial examination, the patient had a chronically ill appearance, his sclera was icteric, and cardiovascular system examination revealed a grade III-IV diastolic murmur. The patient's abdomen was distended, and generalized ascites was present with bilateral edema of the lower extremities. Laboratory findings showed elevated liver enzymes, prolonged prothrombin time, hypoalbuminemia, hyperbilirubinemia, and impaired renal functions with a high level of alpha fetoprotein ([AFP]...