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Metastatic disease of the heart is rare, with an incidence of 1.23% depending on the autopsy series [1]. Metastasis can occur in various ways: through the lymph system, direct extension, and hematogenous or intracavitary dissemination by direct extension via the caval or pulmonary veins. Cardiac metastases mostly involve the pericardium and with lower incidence the epicardium or the myocardium. However, only 5% of tumors affect the endocardium [2]. Pericardial invasion usually occurs through lymphatic propagation, while endocardial involvement mainly results from hematogenous dissemination [2]. This rare form of metastasis leading to intracavitary, endocardial, or valvular metastatic deposits mainly occurs in the right chambers and is only rarely seen in the left chambers. This is attributed to the filtering role of the pulmonary circulation and the slower flow in the right chambers [3].  We report a very rare case of squamous cell carcinoma-detected snake-like hypermobile metastatic intracardiac masses in three chambers of the heart from an unknown primary origin.

Snake-like hypermobile masses in three chambers of the heart: very unusual metastasis of squamous cell carcinoma