Images in Cardiovascular Pathology
Giant intracardiac neoplasic thrombus of a large cell neuroendocrine
carcinoma of the lung
Victor S. Costache
, Sylvie Lantuejoul
, Serban Stoica
, Arnaud Fluttaz
, Pierre-Yves Brichon
Department of Thoracic and Cardiac Surgery, Grenoble University Hospital, Grenoble, France
Department of Pathology and INSERM U 823 Institut A Bonniot, Grenoble University Hospital, Grenoble, France
Received 15 February 2008; received in revised form 9 October 2008; accepted 28 October 2008
Cardiac invasion by lung cancer is associated with a poor prognosis. We describe the case of a large cell neuroendocrine
carcinoma of the lung with left intra-atrial extension in a patient presenting with a catastrophic nutritional status. © 2010 Elsevier Inc.
All rights reserved.
Keywords: Intracardiac tumor; Neoplasic thrombus; Lung cancer
1. Clinical history
A 49-year-old man with a long history of smoking was
referred to our institution for cough, weight loss, and
hemoptysis. A chest X-ray revealed a parahilar mass
responsible for a left upper lobe collapse and a complete
obstruction of the origin of the left upper bronchus on
bronchoscopy; the carina and the left lower bronchus
appeared to be sane. Bronchial biopsies revealed an
infiltration of the mucosa by large malignant cells, forming
lobules and trabeculae, and showing no glandular or
CT scan confirmed the presence of a hilar mass inducing a
complete collapse of the upper lobe (Fig. 1). Surprisingly, an
additional opacity of 6 cm in its greater diameter was seen in
close relationship with that mass, extending from the upper
left pulmonary vein into the left atrium. This finding was
confirmed by transesophageal echocardiography (TOE),
showing a freely mobile echo dense mass within the left
atrium. The patient was staged T4N1M0 and his file was
presented to our interdisciplinary oncology meeting. As
severe embolic complications were reported due to neoplasic
masses within the left atrium [1,2], surgical removal of the
intracardiac mass was decided.
2. Pathologic findings
Macroscopic examination showed a dark red papillary
tumor of approximately 50 mm in diameter.
The histological study of the surgically removed
intracardiac thrombus revealed the presence within fibrin
deposits of large malignant cells, showing atypia and mitoses
(N11 per high power field) arranged in lobules with central
necrosis. They frequently displayed perivascular palisades
and rosettes, suggestive of a neuroendocrine differentiation
(Figs. 2 and 3). This was confirmed by an immunohisto-
chemical analysis showing an expression by the tumor cells
of neuroendocrine markers, such as CD56, chromogranine
A, and synaptophysin. The diagnosis of malignant intracar-
Cardiovascular Pathology 19 (2010) e85 – e87
Corresponding author. Department of Cardiac Surgery, CHU
Grenoble, BP 217 Grenoble cedex 9, France. Tel.: +33 4 76 76 55 75;
fax: +33 4 76 76 52 64.
E-mail address: firstname.lastname@example.org (V.S. Costache).
1054-8807/ – see front matter © 2010 Elsevier Inc. All rights reserved.