
==== Front
Clin Case Rep
Clin Case Rep
10.1002/(ISSN)2050-0904
CCR3
Clinical Case Reports
2050-0904
John Wiley and Sons Inc. Hoboken

10.1002/ccr3.9417
CCR39417
CCR3-2024-06-1908-IV.R1
General Medicine
Cardiology
Case Image
Case Image
A case image of epicardial implants in a young male with mixed germ cell tumor
Ozgur et al.
Ozgur Sacide S. https://orcid.org/0009-0008-2592-4927
1 r_ozgurs@sjhmc.org

Elkattawy Sherif 2
Shamoon Yezin 2
Ahmad Abdullah 2
Perez Maria 1
Abboud Rachel 2
Shamoon Fayez 2
1 Department of Internal Medicine St. Joseph's University Medical Center Paterson New Jersey USA
2 Department of Cardiology St. Joseph's University Medical Center Paterson New Jersey USA
* Correspondence
Sacide S. Ozgur, Department of Internal Medicine, St. Joseph's University Medical Center, Xavier 509, 703 Main St, Paterson, NJ 07503, USA.
Email: r_ozgurs@sjhmc.org

03 9 2024
9 2024
12 9 10.1002/ccr3.v12.9 e941708 7 2024
29 6 2024
29 7 2024
© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Key Clinical Message

Epicardial metastasis from mixed germ cell tumors is exceedingly rare and poses a significant risk for cardiac morbidity. This case highlights the crucial need for comprehensive systemic evaluation in patients with known malignancies presenting with cardiac symptoms.

epicardium
germ cell tumor
imaging
metastasis
pericardium
source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:03.09.2024
Ozgur SS , Elkattawy S , Shamoon Y , et al. A case image of epicardial implants in a young male with mixed germ cell tumor. Clin Case Rep. 2024;12 :e9417. doi:10.1002/ccr3.9417
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pmc1 BACKGROUND

Mixed germ cell tumors (MGCTs) are a heterogeneous group of neoplasms commonly found in the testes and ovaries. While these tumors frequently metastasize to the retroperitoneal lymph nodes, lungs, liver, and brain, the occurrence of epicardial metastasis is extremely rare. Due to the rarity of germ cell tumors with cardiac metastasis, the exact incidence of pericardial metastasis remains unknown. Nunes et al. reported 17 cases of germ cell tumors with cardiac metastasis in the literature, only two of the cases had pericardial involvement. 1 We present the fourth case of pericardial metastasis of germ cell tumor.

2 CASE PRESENTATION

A 25‐year‐old male with no prior medical history presented with a nonproductive cough persisting for 2 weeks. Initial chest X‐ray imaging revealed multiple well‐defined lesions in both lung fields. Subsequent CT scans of the chest, abdomen, and pelvis confirmed extensive intrathoracic metastatic disease, a liver mass, a right‐sided retroperitoneal mass and right‐sided hydronephrosis. On admission, a testicular examination and ultrasound identified a 3 cm mass in the right testicle, leading to a right testicular radical orchiectomy. Pathological evaluation revealed a mixed germ cell tumor comprising 65% seminoma and 35% teratoma. Before the initiation of chemotherapy, the patient developed acute dyspnea, tachypnea, and tachycardia, raising suspicion of a pulmonary embolism (PE). Although the CT angiogram of the chest was negative for PE, it uncovered right‐sided epicardial implants (Figure 1A). A transthoracic echocardiogram (TTE) showed no evidence of pericardial effusion or tamponade physiology (Figure 1B).

FIGURE 1 (A) CT Angiogram of the chest axial and sagittal views showing right sided epicardial implants. (B) TTE showing no pericardial effusion.

3 DISCUSSION

The exceptional rarity and potential complications associated with epicardial metastasis necessitated a multidisciplinary approach involving both oncology and cardiology teams. Given the risk of cardiac complications from the metastatic implants, a treatment strategy was created that combined targeted chemotherapy (Bleomycin, Etoposide, Cisplatin) 2 with close cardiac monitoring for possible arrhythmias. The patient maintained hemodynamic stability throughout the medical management and did not require surgical intervention from cardiothoracic surgery. Urgent surgical intervention is recommended for hemodynamically unstable patients to reduce mortality. 3 However, the patient's course was complicated by bleomycin‐induced pneumonitis and spontaneous pneumothorax requiring intubation. He had multi‐organ failure, his code status was changed to Do Not Resuscitate—May Intubate (DNR‐B), and the patient expired.

AUTHOR CONTRIBUTIONS

Sacide S. Ozgur: Data curation; investigation; visualization; writing – original draft. Sherif Elkattawy: Investigation; supervision; visualization; writing – review and editing. Yezin Shamoon: Investigation; supervision; visualization; writing – review and editing. Abdullah Ahmad: Investigation; supervision; visualization; writing – review and editing. Maria Perez: Conceptualization; investigation; writing – review and editing. Rachel Abboud: Investigation; supervision; validation; writing – review and editing. Fayez Shamoon: Investigation; supervision; validation; writing – review and editing.

FUNDING INFORMATION

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTEREST STATEMENT

The authors report no conflict of interest.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.
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REFERENCES

1 Nunes MC , Moreira DR , Ferrari TC . Cardiac metastasis from yolk sac tumor: case report and review. Exp Hematol Oncol. 2013;2 :13. doi:10.1186/2162-3619-2-13 23631464
2 Oing C , Seidel C , von Amsberg G , Oechsle K , Bokemeyer C . Pharmacotherapeutic treatment of germ cell tumors: standard of care and recent developments. Expert Opin Pharmacother. 2016;17 (4 ):545‐560. doi:10.1517/14656566.2016.1127357 26630452
3 Taghavi F , Markar S , Williams M , Large S . Intra‐cardiac metastasis from testicular non‐seminoma germ cell tumour; to resect or not to resect. Interact Cardiovasc Thorac Surg. 2010;11 (6 ):843‐845. doi:10.1510/icvts.2010.242198 20858655
