Cardiac conduction system involvement in metastatic pancreatic ductal adenocarcinoma

While almost all malignant tumors are occasionally found to have metastasized to the heart, the involvement of the heart is not common and is poorly studied. The authors report the histological examination of the heart and conducting tissue on serial sections in a case of sudden death due to a cardiac localization of pancreatic ductal adenocarcinoma. Post mortem histologic examination showed the presence of cardiac metastatic pancreatic ductal adenocarcinoma compressing the atrio-ventricular node and the His bundle. The accurate examination of the cardiac conduction system has been crucial in finding the compression of the conduction system by the tumor as the morphological substrate responsible for lethal electrical cardiac instability and sudden death.