Solitary neuroendocrine carcinoma of the heart: a case repor
Cardiac tumours are of rare incidence and usually occur in the form of secondary tumours. Most metastatic tumours are melanomas, sarcomas, lung, and haematological malignancies. Neuroendocrine carcinomas (NECs) of the heart are extremely unusual.

This case report, published in the European Heart Journal - Case Reports, demonstrates a solitary high-grade NEC of the heart with an individual therapy strategy and follow-up.

A 50-year-old gentleman presented with a 2 days history of recurrent episodes of chest pain. Echocardiography, computed tomography, and magnetic resonance imaging revealed tumorous lesions of the ventricles and aortic valve with large circular pericardial effusion.

Histopathology results of the biopsy revealed a poorly differentiated small cell tumour of the neuroendocrine type. Despite further investigations with multiple imaging modalities and laboratory, no primary was found. Chemotherapy was initiated but size progression of the tumour was detected.

As no other tumorous lesions were detected and resection was not possible because of the tumour complexity, decision on heart transplantation was made. However, due to the necessary immunosuppression after the heart transplantation, multiple metastases were discovered in the course of treatment.

For this individual case, heart transplantation was the therapy of choice due to tumour progression under chemotherapy and lacking the possibility of resection, as no other suspect lesion was found other than the ones found in the heart.

Learning points
• Solitary neuroendocrine carcinoma of the heart is very rare.

• Even with large malignant tumours of the heart, diagnostic assessment of pericardial effusion may be inconclusive.

• Individual treatment strategies have to be decided following multidisciplinary team discussion; chemotherapy and resection of the tumour have to be considered in these cases.

• Heart transplantation for cardiac tumours should be undertaken with caution due to the risk of immunosuppression exacerbating undiagnosed micrometastases.

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