Squamous cell metastasis from the tongue to the myocardium presenting as pericardial effusion

Cardiac metastasis from head and neck cancer is rarely encountered. We present a base-of-tongue squamous cell carcinoma with metastasis to the heart that was diagnosed antemortem. Autopsy series indicate that tongue cancer may metastasize more frequently to the heart than from other head and neck sites. However, none of these studies was controlled. Most importantly, cardiac metastasis should be suspected in any patient with cancer in whom new cardiac symptoms develop. The diagnosis is best confirmed with two-dimensional echocardiography or cardiac MRI. A myocardial or endocardial biopsy specimen can be obtained with angiographic guidance. Despite the improvement in diagnostic capability, available treatments are only palliative. All patients eventually die of their metastatic disease.