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Burns EA, Ahmed A, Sunkara A, Khan U, Sharif R, Abdelrahim M, Reardon M, Trachtenberg B. Primary cardiac angiosarcoma diagnosed in the first trimester of pregnancy. Ecancermedicalscience 2019; 13:922. [PMID: 31281419 PMCID: PMC6546259 DOI: 10.3332/ecancer.2019.922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Indexed: 11/06/2022] Open
Abstract
Primary cardiac angiosarcoma (PCAS) is a malignancy seldom seen in pregnancy. A 23-year-old G1P0 Chinese female was found to have PCAS during her first trimester when she presented with tamponade physiology. The transthoracic echocardiography (TTE) results did not indicate the presence of an intracardiac lesion, and pericardial fluid cytology analysis showed no evidence of malignancy. Cardiac magnetic resonance imaging (CMRI) exhibited a right atrial mass, and tissue biopsy indicated a high-grade angiosarcoma. MRI of the abdomen was suggestive of liver metastasis. She underwent an abortion and was started on combination chemotherapy, with a reduction in both the cardiac and liver masses. In cardiac angiosarcomas, advanced imaging modalities such as MRI should be utilised when there is high clinical suspicion or in the case of pregnancy when trying to minimise foetal harm. Prognosis is poor, and a standardised treatment protocol regardless of pregnancy continues to elude the medical community.
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Affiliation(s)
- Ethan A Burns
- Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Amna Ahmed
- Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Anusha Sunkara
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
| | - Usman Khan
- Houston Methodist Cancer Center, Houston, TX 77030, USA
| | | | | | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
| | - Barry Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
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52
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Zhu X, Zhang J. Primary malignant schwannoma of the heart. J Card Surg 2019; 34:211-213. [PMID: 30803029 DOI: 10.1111/jocs.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 12/13/2022]
Abstract
Primary malignant schwannoma of the heart is an extremely rare disease. We, herein, report a 42-year-old female who underwent successful surgical excision of such a tumor.
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Affiliation(s)
- Xiliang Zhu
- Department of Cardiovascular Surgery, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, Henan Cardiovascular Hospital and Zhengzhou University, Zhengzhou, China
| | - Jie Zhang
- Department of Cardiovascular Surgery, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, Henan Cardiovascular Hospital and Zhengzhou University, Zhengzhou, China
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Deceiving spindle cell sarcoma of the heart. Indian J Thorac Cardiovasc Surg 2018; 35:218-221. [PMID: 33061010 DOI: 10.1007/s12055-018-0754-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022] Open
Abstract
Primary cardiac tumors are rare and when they occur, 75% are benign. Atrial myxomas having a good prognosis compromise 50% of all primary cardiac tumors. Only 25% of the primary cardiac tumors are malignant and 75% of these malignant tumors are sarcomas. Sarcomas often occur in young patients without any predisposing factors and tend to have very poor prognosis. We present an unfortunate case of a young female with high-grade spindle cell sarcoma. She was initially diagnosed to have mitral valve pathology and hypertrophic cardiomyopathy but confirmation of diagnosis was made only after a second operation and patient's demise.
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Cardiac Dedifferentiated Liposarcoma Requiring a Mitral Valve Replacement Complicated by Severe Paravalvular Leak: A Rare Case Report with Literature Review. Case Rep Cardiol 2018; 2018:2506368. [PMID: 30254766 PMCID: PMC6142734 DOI: 10.1155/2018/2506368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022] Open
Abstract
Cardiac sarcomas have a high infiltrative and metastatic potential and are often associated with poor prognosis. These tumors are often identified incidentally by thoracic and cardiac imaging. However, when symptomatic, their presentation can differ based on the localized structural effects on the endocardium, myocardium, pericardium, and valves as well as on dynamic effects on the cardiac function. We report a case of a 61-year-old female who presented to the emergency room with recurrent chest pain, fatigue, and chronic anemia. A transthoracic echocardiogram demonstrated a left atrial mass attached to the septal wall and anterior leaflet of the mitral valve. The mass was further characterized by a transesophageal echocardiogram and cardiac MRI. The patient underwent a resection of the left atrial mass with mitral valve replacement (MVR) and atrial septal defect repair. MVR was later complicated by paravalvular leak leading to acute congestive heart failure. Tissue immune histology was consistent with dedifferentiated liposarcoma. Cardiac dedifferentiated liposarcoma is extremely rare with only few cases reported in literature. We attempt to review the clinical features, diagnosis, and management of cardiac sarcoma with great emphasis.
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Sudden Unexpected Death From Unusually Large Primary Cardiac B-cell Lymphoma. ACTA ACUST UNITED AC 2018; 39:161-163. [DOI: 10.1097/paf.0000000000000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience. RECENT FINDINGS The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients. Cardiac MRI (CMR) appears to be helpful in determining whether cardiac tumors are benign or malignant by identifying presence of infiltration, uptake of contrast in first pass perfusion and gadolinium enhancement. Patients with evidence of cardiac metastases by CMR show similar survival to stage IV cancer without cardiac metastases. In our institution, we use a standardized approach for the evaluation of cardiac masses, which includes multimodality imaging in the appropriate clinical context. The autotransplantation surgical technique has shown some promise in improving survival in patients with primary cardiac sarcomas. In our institution, we do not routinely recommend anticoagulation for "tumor-thrombus" in renal cell carcinoma due to risk of bleeding from primary tumor. Cardiac masses are often found incidentally, but sometimes can present with cardiovascular symptoms due to obstruction and valvular dysfunction, which may prompt imaging. It is important to determine whether the mass is a normal variant, imaging artifact, vegetation, thrombus, or tumor. Transthoracic echocardiography is ideally suited to be the initial imaging modality because of the portability, wide availability, lack of radiation, and relatively low cost. The gold standard cardiac imaging technique to distinguish tumor from thrombus is contrast enhanced CMR with prolonged inversion time. Advantages of CMR when compared to echocardiography regarding characterization of cardiac tumors are as follows: larger field of view, better spatial resolution, better tissue characterization, lack of attenuation, and ability to image at any prescribed plane. Primary and secondary cardiac tumors have particular characteristics in echocardiography and CMR. Imaging of cardiac tumors plays an important role in establishing a diagnosis and in planning management.
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Atypically mitral valve originated giant myxoma presenting with acute ST-segment elevation myocardial infarction and acute pulmonary edema. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.379659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Staudt GE, Fiedler AG, Tolis G, Dudzinski DM, Streckenbach SC. Incidental Discovery of an Atypical Cardiac Tumor. J Cardiovasc Echogr 2018; 28:198-200. [PMID: 30306028 PMCID: PMC6172883 DOI: 10.4103/jcecho.jcecho_7_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary cardiac tumors are rare, present in roughly 0.05% of the population. Cardiac papillary fibroelastoma (CPF) is the second most common, accounting for 10% of primary cardiac tumors.[1] Most cases of CPFs are discovered incidentally on autopsy; however, they may present clinically with systemic embolization or heart failure symptoms. The recommended treatment for symptomatic CPF patients is surgical resection.[1] Treatment in asymptomatic patients remains somewhat controversial with incidentally discovered tumors presenting a clinical dilemma. We present a case of an atypically located CPF that was discovered incidentally on intraoperative transesophageal echocardiography (TEE) during a routine coronary artery bypass graft operation. This case highlights several important points for cardiac anesthesiologists. The first is the importance of performing a comprehensive intraoperative TEE. Next, this case reinforces the broad utility of TEE for evaluation of intracardiac tumors. Finally, this case demonstrates the importance of precise localization of intracardiac tumors.
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Affiliation(s)
- Genevieve E Staudt
- Department of Anesthesia, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy G Fiedler
- Department of Cardiac Surgery, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - George Tolis
- Department of Cardiac Surgery, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David M Dudzinski
- Department of Cardiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Scott C Streckenbach
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
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Mkalaluh S, Szczechowicz M, Torabi S, Schmack B, Sabashnikov A, Dib B, Karck M, Weymann A. Surgical Treatment of Cardiac Tumors: Insights from an 18-Year Single-Center Analysis. Med Sci Monit 2017; 23:6201-6209. [PMID: 29289957 PMCID: PMC5757895 DOI: 10.12659/msm.905451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to investigate the clinical presentation, operative data, and early and late outcomes of a large patient cohort undergoing surgical treatment for cardiac tumors in our institution. Material/Methods A total of 181 patients underwent surgery because of suspected cardiac tumor in our institution between 1998 and 2016. In 162 cases, the diagnosis was confirmed postoperatively and these patients were included in this study. Preoperative baseline characteristics, operative data, and postoperative early and long-term outcomes were analyzed. Results Mean age at presentation was 56.6±17.6 years, and 95 (58.6%) patients were female. There were 126 (77.8%) patients with benign cardiac tumors, while the remaining patients had malignant tumors (primary and metastasized). The mean follow-up time was 5.2±4.7 years. The most frequent histologically verified tumor type was myxoma (63%, n=102). In terms of malignant tumors, various types of sarcomas presented most primary malignant cardiac tumors (7.4%, n=12). The mean ICU length of stay was 1.7±2.2 days and overall in-hospital mortality was 3.1% (n=5). Frequent postoperative complications included mediastinal bleeding (5.8%, n=9), wound infection (1.3%, n=2), acute renal failure (5.6%, n=9), and major cerebrovascular events (n=7, 4.6%). The overall cumulative survival after cardiac tumor resection was 94% at 30 days, 85% at 1 year, 72% at 5 years, and 59% at 15 years. Conclusions Surgical treatment of cardiac tumors is a safe and highly effective strategy associated with good early and long-term outcomes.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
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Saad AM, Abushouk AI, Al-Husseini MJ, Salahia S, Alrefai A, Afifi AM, Abdel-Daim MM. Characteristics, survival and incidence rates and trends of primary cardiac malignancies in the United States. Cardiovasc Pathol 2017; 33:27-31. [PMID: 29414429 DOI: 10.1016/j.carpath.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/17/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The available literature on the incidence, management and prognosis of primary malignant cardiac tumors [PMCTs] is limited to single-center studies, prone to small sample size and referral bias. We used data from the Surveillance, Epidemiology, and End Results [SEER]-18 registry (between 2000 and 2014) to investigate the distribution, incidence trends and the survival rates of PMCTs. METHODS We used SEER*Stat (version 8.3.4) and the National Cancer Institute's Joinpoint Regression software (version 4.5.0.1) to calculate the incidence rates and annual percentage changes [APC] of PMCTs, respectively. We later used SPSS software (version 23) to perform Kaplan-Meier survival tests and covariate-adjusted Cox models. RESULTS We identified 497 patients with PMCTs, including angiosarcomas (27.3%) and Non-Hodgkin's lymphomas [NHL] (26.9%). Unlike the incidence rate of NHL (0.108 per 106 person-years) that increased significantly (APC=3.56%, 95% CI, [1.445 to 5.725], P=.003) over the study period, we detected no significant change (APC=1.73%, 95% CI [-3.354 to 7.081], P=.483) in the incidence of cardiac angiosarcomas (0.107 per 106 person-years). Moreover, our analysis showed that the overall survival of NHL is significantly better than angiosarcomas (P<.001). In addition, surgical treatment was associated with a significant improvement (P=.027) in the overall survival of PMCTs. CONCLUSION Our analysis showed a significant increase in the incidence of cardiac-NHL over the past 14 years with a significantly better survival than angiosarcomas. To further characterize these rare tumors, future studies should report data on the medical history and diagnostic and treatment modalities in these patients.
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Affiliation(s)
- Anas M Saad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Sami Salahia
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anas Alrefai
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Afifi
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed M Abdel-Daim
- Pharmacology Department, Suez Canal University, Ismailia, Egypt; Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
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Tse CS, Tan N, Idossa D, Click R. Cardiac melanoma: Retrospective review of a rare disease at the Mayo clinic (1988-2015). Int J Cardiol 2017; 249:383-386. [PMID: 28923551 DOI: 10.1016/j.ijcard.2017.08.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Melanoma metastasizing to the heart (cardiac melanoma) is a rare entity that has been described only in autopsy studies or isolated pre-mortem case reports. We aim to better characterize cardiac melanoma, and describe its presenting features, imaging findings, and disease course with a case series collected over nearly 30years. METHODS We performed a retrospective review of all patients diagnosed with cardiac melanoma at the Mayo Clinic from 1988 to 2015. Qualitative analysis was performed on patient demographics, clinical history, and imaging modalities. RESULTS 11 patients (7 male, median age 63years) were identified with cardiac melanoma. Shortness of breath (64%) was the most common presenting symptom. Transthoracic echocardiography (TTE) was utilized in the assessment of all patients though it failed to identify 20% of masses that were seen on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) or cardiac magnetic resonance (CMR). The majority of masses were located within the cardiac chambers (46% right atrium, 18% right ventricle, 18% left atrium), and 36% appeared mobile on TTE. Patients lived for a median of 68months (interquartile range [IQR] 14-143months) after the initial diagnosis of primary melanoma, and only 12months (IQR 2-150months) after diagnosis of cardiac melanoma. CONCLUSION Echocardiography can generally identify most cases of cardiac melanoma, though it misses one-fifth of masses seen on FDG PET/CT or CMR. Cardiac melanoma is associated with a poor prognosis.
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Affiliation(s)
- Chung Sang Tse
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicholas Tan
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dame Idossa
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Roger Click
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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Shimbori M, Osaka K, Kawahara T, Kasahara R, Kawabata S, Makiyama K, Kondo K, Nakaigawa N, Yamanaka S, Yao M. Large cell neuroendocrine carcinoma of the kidney with cardiac metastasis: a case report. J Med Case Rep 2017; 11:297. [PMID: 29052535 PMCID: PMC5649063 DOI: 10.1186/s13256-017-1460-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/19/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Primary large cell neuroendocrine carcinoma of the kidney is a rare and generally very aggressive disease. We present a case of a patient with primary large cell neuroendocrine carcinoma of the kidney with cardiac metastasis. CASE PRESENTATION A 59-year-old Japanese man presented to his previous physician with hematuria. Computed tomography revealed masses in the heart and right kidney, and fluorodeoxyglucose-positron emission tomography showed abnormal uptake in the heart. A cardiac biopsy under transesophageal echocardiographic guidance revealed a metastatic tumor. Subsequently, multiple lung lesions were detected, and a right nephrectomy was performed after these metastases were suspected to have originated from renal carcinoma. Large cell neuroendocrine carcinoma of the kidney was ultimately diagnosed. Pancreatic metastasis was detected on computed tomography postoperatively. Three courses of chemotherapy with carboplatin and irinotecan were administered, and were temporarily effective against the metastatic lesions in the lungs and pancreas. However, our patient's general condition deteriorated with the progression of the lesions, and he died 9 months after his initial examination. CONCLUSIONS Multi-agent chemotherapy, including platinum-based drugs was effective against large cell neuroendocrine carcinoma metastases, albeit only temporarily. This is the first reported case of large cell neuroendocrine carcinoma with cardiac metastasis.
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Affiliation(s)
- Moeka Shimbori
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
| | - Kimito Osaka
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryo Kasahara
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
| | - Sayuki Kawabata
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
| | - Keiichi Kondo
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
| | - Noboru Nakaigawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
| | - Shoji Yamanaka
- Departments of Anatomy and Clinical Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 2360004 Japan
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He J, Sun M, Li E, Hou Y, Shepard MJ, Chen D, Pacak K, Wang C, Guo L, Zhuang Z, Liu Y. Recurrent somatic mutations of PRKAR1A in isolated cardiac myxoma. Oncotarget 2017; 8:103968-103974. [PMID: 29262613 PMCID: PMC5732779 DOI: 10.18632/oncotarget.21916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/20/2017] [Indexed: 01/08/2023] Open
Abstract
Background Cardiac myxomas are benign tumors that commonly arise within the left atria. Familial cardiac myxomas are a part of Carney Complex (CNC), an autosomal dominant multiple neoplasia syndrome caused by germline mutations in PRKAR1A. Seven percent of cardiac myxomas are associated with CNC. To date, the genetic basis of isolated cardiac myxomas (ICM), however, has not been fully elucidated. Methods We investigated the genetic profile of ICM using whole exome sequencing (WES). Suspected mutations were confirmed using targeted sanger sequencing. To further examine the presence of PRKAR1A mutations in ICM, we performed targeted sequencing in an additional 61 ICM specimens. Results 87.5% (7/8) of ICM harbored mutations in PRKAR1A. Three of the 8 ICM harbored biallelic somatic mutations of PRKAR1A, including c.607_610del:p.Leu203fs (pathogenic) + c.C896G:p.Ser299X (pathogenic), c.952delT:p.Leu318fs (pathogenic) + c.769-2 A>G (pathogenic) and c.178-1 G>C (pathogenic) + c. 550+1 G>C (pathogenic). Four of 8 tumors harbored monoallelic PRKAR1A mutations, including c.523_524insG:p.Tyr175_Val176delinsX (pathogenic), c.C920A:p.Ser307X (pathogenic), c.30delG:p.Glu10fs (pathogenic) and c.C289T:p.Arg97X (pathogenic). No identical variants were observed across the 8 ICM samples. Interestingly, none of these variants have been previously described in familial cardiac myxomas. In order to confirm our findings, directed sequencing of 61 ICM specimens was subsequently performed. Sixty-four percent (39/61) of ICMs tumors contained inactivating PRKAR1A mutations. Conclusion Our findings suggest that loss-of-function mutations of PRKAR1A may play a vital role in the formation of isolated cardiac myxomas.
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Affiliation(s)
- Jian He
- Scientific Research Center for Translational Medicine, Department of Biotechnology, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Mingju Sun
- Scientific Research Center for Translational Medicine, Department of Biotechnology, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Enyou Li
- Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingyong Hou
- Department of Pathology, School of Basic Medical Sciences & Zhongshan Hospital, Fudan University, Shanghai, China
| | - Matthew J Shepard
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Di Chen
- Scientific Research Center for Translational Medicine, Department of Biotechnology, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Karel Pacak
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Changsong Wang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China
| | - Lei Guo
- Department of Anesthesiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Yang Liu
- Scientific Research Center for Translational Medicine, Department of Biotechnology, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
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Mo R, Mi L, Zhou Q, Wang D. Outcomes of surgical treatment in 115 patients with primary cardiac tumours: a 15-year experience at a single institution. J Thorac Dis 2017; 9:2935-2941. [PMID: 29221265 DOI: 10.21037/jtd.2017.08.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Primary cardiac tumours are rare, and few studies have examined large samples. The aim of this study was to review a single institution's 15 years of experience with primary cardiac tumours. Methods We conducted a retrospective analysis of 119 consecutive patients admitted to the Nanjing Drum Tower Hospital from April 2002 to January 2017. Five patients declined surgery due to illness or for financial reasons, and one patient underwent a second operation due to tumour recurrence 10 years after the first operation. In total, 115 patients underwent surgery. The surgeons used median sternotomy and a right atrial approach to complete the gross total resection. The patients were separated into three groups according to their tumour pathology (myxomas, other benign tumours, or malignant tumours). A total of 84 patients were followed up for an average of 34.8±31.2 months (range 2-141 months). Results The sites of the cardiac tumours included the left atrium (n=93, 80.1%), right atrium (n=14, 14.0%), left ventricle (n=2, 1.7%), valves (n=7, 6.0%), and other sites (n=1, 0.8%). According to the postoperative pathology, 99 (86.0%) tumours were classified as myxomas, 8 (7.0%) were other types of benign tumours, and 8 (7.0%) were malignant tumours. Patients with malignant tumours had a longer surgical time (P=0.035) and postoperative hospitalization time (P=0.009). Patients with myxoma tumours exhibited better 5-year survival than patients with malignant tumours (95.7% vs. 57.1%, P<0.001). Conclusions In the Chinese population, the incidence of primary cardiac tumours is mainly attributable to myxomas. Gross total resection is a safe and effective treatment for both benign and malignant tumours. Long-term survival is satisfactory for benign tumours but low for malignant tumours, and a risk of recurrence exists. Postoperative chemotherapy or radiotherapy may be needed to achieve better outcomes.
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Affiliation(s)
- Ran Mo
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Lin Mi
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Qing Zhou
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Dongjin Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
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Mkalaluh S, Szczechowicz M, Torabi S, Dib B, Sabashnikov A, Mashhour A, Karck M, Weymann A. Surgery for Cardiac Papillary Fibroelastoma: A 12-Year Single Institution Experience. Med Sci Monit Basic Res 2017; 23:258-263. [PMID: 28706178 PMCID: PMC5523956 DOI: 10.12659/msmbr.904881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We reviewed our clinical experience with cardiac papillary fibroelastoma from 2005 to 2017. The objective of this study was to investigate the clinical and operative data, as well as the early survival rate and immediate postoperative complications. MATERIAL AND METHODS We performed a retrospective analysis of 11 patients (eight males and three females) who underwent resection of cardiac papillary fibroelastoma in our institution. RESULTS Mean age at tumor diagnosis was 60±14 years. The mean dimension of the tumor was 14±11 mm. The most common symptoms were dyspnea, palpitation, and angina pectoris, while one patient had recurrent fever attacks and another patient had a transient ischemic attack. Two patients had concomitant malignant tumors (cervical and colon carcinoma) and another two had concomitant benign neoplasms (liver cyst and thyroid adenoma). Bypass and cross clamp times were 77±32 minutes and 54±18 minutes, respectively. The tumors were found predominantly on cardiac valves (n=7). In eight cases, only tumor extirpation was performed, whereas in the other three cases, the valves had to be replaced. The mean intensive care unit length of stay was 1.1±0.3 days and there was no in-hospital mortality. All patients were alive at one-year follow-up and the survival rate was 91% in the mean follow-up period of 4.15 years. CONCLUSIONS The surgical treatment of cardiac papillary fibroelastoma was curative and safe. Thus, potential complications such as embolization or mechanical irritation of the valves can be avoided without high surgical risk.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.,Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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67
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Zitzelsberger T, Eigentler TK, Krumm P, Nikolaou K, Garbe C, Gawaz M, Klumpp B. Imaging characteristics of cardiac metastases in patients with malignant melanoma. Cancer Imaging 2017; 17:19. [PMID: 28666473 PMCID: PMC5493885 DOI: 10.1186/s40644-017-0122-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/26/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Due to prolonged survival and technical advances in CT imaging, cardiac metastases in patients with malignant melanoma are observed more frequently nowadays. The aim of the present study was to assess the anatomic distribution as well as the morphologic and histologic appearance of cardiac metastases from malignant melanoma. METHODS Twenty five patients with known metastasized melanoma and with incidental finding of cardiac metastases during routine staging CT were retrospectively included in this study. CT images were assessed for the presence, localization and extent of cardiac metastases. Histological results, mutational analysis and tumor markers were reviewed. RESULTS Fourteen out of 25 patients presented with singular cardiac mass (56%), whereas ten patients (40%) presented with multifocal and one patient with disseminated cardiac metastases. Twelve patients presented with endocardial (48%), eight with myocardial and two with pericardial metastases. Most frequent site involved in endocardial metastases was the right atrium (67%) followed by the right ventricle (33%). There seems to be a correlation between histological subtype and location of cardiac metastasis. Median survival after diagnosis of cardiac metastases was 8 months, with no significant difference regarding the localization of metastases within the heart. CONCLUSION Cardiac metastases can involve every part of the heart possibly in dependence of histological subtype. The awareness of different types of cardiac metastases and their characteristic appearance on CT images is necessary for further investigations and might contribute to targeted therapy.
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Affiliation(s)
- Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Thomas K. Eigentler
- Eberhard-Karls-University Tuebingen, Center for Dermatooncology, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Claus Garbe
- Eberhard-Karls-University Tuebingen, Center for Dermatooncology, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Bernhard Klumpp
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
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Shenoy S, Shetty S, Lankala S, Anwer F, Yeager A, Adigopula S. Cardiovascular Oncologic Emergencies. Cardiology 2017; 138:147-158. [PMID: 28654925 DOI: 10.1159/000475491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
Abstract
Oncologic emergencies can present either as a progression of a known cancer or as the initial presentation of a previously undiagnosed cancer. In most of these situations, a very high degree of suspicion is required to allow prompt assessment, diagnosis, and treatment. In this article, we review the presentation and management of cardiovascular oncologic emergencies from primary and metastatic tumors of the heart and complications such as pericardial tamponade, superior vena cava syndrome, and hyperviscosity syndrome. We have included the cardiovascular complications from radiation therapy, chemotherapeutic agents, and biologic agents used in modern cancer treatment.
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Affiliation(s)
- Sundeep Shenoy
- Department of Inpatient Medicine, Banner University of Arizona, Tucson, AZ, USA
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69
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Lang JE, Pflaumer A, Davis AM. Causes of sudden death in the young — Cardiac and non-cardiac. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Li S, Gao C. Surgical Experience of Primary Cardiac Tumor: Single-Institution 23-Year Report. Med Sci Monit 2017; 23:2111-2117. [PMID: 28469127 PMCID: PMC5426384 DOI: 10.12659/msm.903324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Primary cardiac tumors are rare but have favorable surgical prognosis. Previous studies have been small series studies with limited surgical approaches. To date, few studies have examined the clinical features associated with different surgical procedures. Material/Methods In a search of the cardiovascular surgery database of our institution, we retrospectively identified 225 patients who had cardiac tumor resection from January 1993 to May 2016. The patients’ clinical characteristics and operation information were reviewed, and the operation parameters, postoperative complications, and short-term prognosis among robotic, mini-thoracotomy, and conventional procedures in our center were compared. Results A total of 228 operations were performed, including 156 traditional open surgeries (68.4%), 60 robotically assisted neoplasm resections (26.3%), and 12 mini-thoracotomy procedures (5.3%). Among 232 lesions, myxoma (94.8%) was the most common neoplasm, and the remainders were fibroma (1.3%) and lipoma (0.9%). Operative complications occurred in 36 patients (15.8%). Arrhythmia (8.8%) was the first common complication, and delayed mechanical ventilation (4.8%) ranked second. The overall risk of recurrence of myxoma was 2.7%. The cardiopulmonary bypass (CPB) time in the mini-thoracotomy group was longer than in the robotic group (p=0.034) and the conventional group (p=0.002). There were no significant differences in cross clamp time (p=0.266) or complications (p=0.835) among the three groups. The in-hospital survival rate was 100% in all patients. There were no significant differences in main adverse events among the three groups at six-month follow-up (p=0.285). Conclusions Prognosis for cardiac neoplasm surgical resection is favorable for primary cardiac tumors. The minimally invasive surgery of cardiac tumor resection can be an alternative to conventional operations in selected patients.
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Affiliation(s)
- Shuanglei Li
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China (mainland)
| | - Changqing Gao
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China (mainland)
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Abstract
In the past, cardiac tumors were a just clinical curiosity and the prognosis was poor. Surgical management became possible after the advent of cardiopulmonary bypass, and more recently, preoperative diagnosis was greatly improved by the development of echocardiography, computed tomography, and magnetic resonance imaging. The value of echocardiography for diagnosing cardiac mass lesions has become well established. Numerous advances have occurred in the last 5 decades, and the evolution of echocardiography involves the development of its many modalities. This review is intended to help echocardiologists and forensic pathologists in providing good medical practice when faced with the challenge of investigating unexpected clinical signs, particularly in young people, or unexpected postmortem findings.
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72
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Farris GR, Andrikopoulou E, De La Cuesta AV, Seghatol-Eslami F, Scarabelli TM. Cardiac Lymphoma Presenting as Subacute Progressive Dyspnea: A Case Report and Review of the Literature on the Pathophysiology and Imaging of Intracardiac Tumors. CASE (PHILADELPHIA, PA.) 2017; 1:6-10. [PMID: 30062232 PMCID: PMC6034491 DOI: 10.1016/j.case.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
•The case of a 64-year-old man with progressive dyspnea is presented. •Imaging revealed a large intracardiac mass invading the right chambers and the left atrium. •Extensive testing was conducted to reach the final diagnosis of primary cardiac B-cell lymphoma. •Primary cardiac lymphomas are very rare, especially in immunocompetent patients. •Due to inoperability, the patient underwent palliative chemotherapy.
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Affiliation(s)
- Gary R Farris
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Efstathia Andrikopoulou
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Frank Seghatol-Eslami
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tiziano M Scarabelli
- St. John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, Michigan
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Miwa E, Tani T, Okada Y, Furukawa Y. A rare cardiac tumor: Bronchogenic cyst of interatrial septum. Echocardiography 2017; 34:474-475. [PMID: 28139004 DOI: 10.1111/echo.13445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Intracardiac bronchogenic cysts are uncommon congenital tumors, which rarely become symptomatic. We describe a rare case of bronchogenic cyst in the atrioventricular node. A 36-year-old man with third-degree atrioventricular block was referred to our hospital. Transthoracic echocardiography revealed a cystic mass at the right atrial aspect of the low interatrial septum. He underwent surgical resection of the mass, and a permanent epicardium pacemaker was implanted. His postoperative course was uneventful. Microscopic examination showed a cyst surrounded by ciliated columnar epithelium and partially smooth muscle, and the histopathological diagnosis was bronchogenic cyst.
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Affiliation(s)
- Eriko Miwa
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomoko Tani
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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Di Franco A, Gaudino M, Weinsaft JW, Pun SC, Narula N, Khan SA, Malik ZM, Ohmes LB, Skubas NJ, Girardi LN. “Second” Primary Cardiac Sarcoma in a Patient With Ewing Sarcoma. Always Expect The Unexpected. Ann Thorac Surg 2017; 103:e131-e133. [DOI: 10.1016/j.athoracsur.2016.07.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/09/2016] [Accepted: 07/20/2016] [Indexed: 10/20/2022]
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Bao M, Zheng C, Zhang H, Ruan Y, Cao A, Wu T, Luo YI. Inflammatory myofibroblastic tumor of the left atrium in infant. Int J Cardiol 2016; 222:965-967. [DOI: 10.1016/j.ijcard.2016.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Surgery for massive malignant tumors of the left atrium - one center's experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:229-235. [PMID: 27785137 PMCID: PMC5071590 DOI: 10.5114/kitp.2016.62610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Abstract
Introduction Surgery for primary non-resectable malignant tumors of the left atrium is controversial. Today heart autotransplantation as a method of surgical treatment for patients suffering primary massive malignant tumors of the left atrium is still not sufficiently studied. Material and methods We provide information on our single-center 5-year experience in performing surgical interventions for massive malignant tumors of the left atrium and including cases of 5 patients (3 males – 60%, 2 females – 40%). One case (1/5, 20%) involved debulking surgery with partial resection of the left atrial (LA) wall and its reconstruction using a xenopericardium patch. Orthotopic heart transplantation was performed in 1 patient (1/5, 20%) and heart autotransplantation (HA) in the 3 other cases (3/5, 60%). Results Mean myocardial ischemia duration was 165.6 ±12.0 minutes (range: 137–198), cardiopulmonary bypass (CPB) duration was 248.6 ±36.6 minutes (range: 188–392), and intervention duration was 498.0 ±77.4 minutes (range: 330–780). Mean total blood loss was estimated to be 2432 ±616.5 ml (range: 1610–4880). Major in-hospital complications were registered in 4 patients (4/5, 80%). In-hospital mortality was registered in 3 patients (3/5, 60%). Survival time in 2 (2/5, 40%) patients discharged from the hospital was 29 and 9 months, respectively. Both died because of disease progression. Conclusions Surgery in patients with massive resectable primary malignant tumor of the left atrium is associated with high incidence of major hospital complications and mortality. Heart autotransplantation with radical tumor resection is the treatment of choice for these cases. The surgical approach implies thorough primary hemostasis and selection of a proper surgical approach, allowing revision of all the regions of intervention during each step. The possibility of excessive tension and bleeding in the area of bicaval anastomosis should be considered when performing heart autotransplantation, and appropriate preventive measures should be applied.
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Kukla P, Pleva L, Porzer M, Brát R, Handlos P, Buzrla P, Plášek J, Mrozek J, Homza M. Inferior vena cava leiomyosarcoma with right atrium tumorous mass presenting as heart failure in a 70-year-old man: A case report. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Letters. THE ULSTER MEDICAL JOURNAL 2016; 85:203-210. [PMID: 27698525 PMCID: PMC5031110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ujihira K, Yamada A, Nishioka N, Iba Y, Maruyama R, Nakanishi K, Shimizu A, Hatanaka KC, Mitsuhashi T, Shinohara T, Ueda HI. A case report of primary cardiac myxofibrosarcoma presenting with severe congestive heart failure. J Cardiothorac Surg 2016; 11:95. [PMID: 27387491 PMCID: PMC4936254 DOI: 10.1186/s13019-016-0490-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary cardiac sarcomas are extremely rare. Furthermore, the myxofibrosarcomas are one of the rarest forms of cardiac sarcomas, and its prognosis is known to be quite poor. CASE PRESENTATION This is a case of a 23-year-old man who presented with acute severe congestive heart failure caused by almost complete obstruction of the mitral valve due to a large left atrial tumor. The patient required endotracheal intubation before his arrival to the hospital, and underwent an emergent surgical excision of the tumor. The tumor had a complex shape and originated from the orifice of the right upper pulmonary vein. Because the tumor seemed to extend over most of the surface of the left atrium, it seemed impossible to reconstruct the left atrium had we done a complete transmural resection. Instead, we carefully peeled the tumor leaving the outer layer of the left atrial wall. We applied cryoablation to the attached site, in order to prevent a recurrence of the tumor. The pathology report revealed that the tumor was a myxofibrosarcoma, and it seemed to originate from the heart. The patient received radiation therapy after the surgery and continues to be alive and well after 1-year, without apparent recurrence. CONCLUSIONS Cardiac myxofibrosarcoma can cause acute, severe left-sided heart failure. Non-transmural atrial wall resection with cryoablation might be effective for patients with cardiac myxofibrosarcomas with extensive atrial attachment.
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Affiliation(s)
- Kosuke Ujihira
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan.
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan
| | - Naritomo Nishioka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan
| | - Katsuhiko Nakanishi
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan
| | - Ai Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan
| | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan
| | - Toshiya Shinohara
- Department of Pathology, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan
| | - Hatsue Ishibashi Ueda
- Department of Pathology and Biobank, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565, Japan
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Hirschberg K, Wiedmann F, Zitron E, Fortner P, Riffel JH, Chorianopoulos E, Gdynia G, Mechtersheimer G, Andrassy M, Szabó G, Arif R, Katus HA, Buss SJ. Incidental finding of a giant intracardiac angioma infiltrating both ventricles in a 35-year-old woman: a case report. J Med Case Rep 2016; 10:94. [PMID: 27071931 PMCID: PMC4830042 DOI: 10.1186/s13256-016-0860-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Primary cardiac tumors are rare and often asymptomatic or present with unspecific symptoms. Benign cardiac tumors of vascular origin are especially rare, with only few existing data in the literature. Case presentation A 35-year-old Caucasian female patient presented to our department with an asymptomatic giant intracardiac angioma infiltrating both ventricles. Evaluation of this tumor involved electrocardiography, echocardiography, cardiac magnetic resonance imaging, coronary angiography, an open myocardial biopsy, and histological examination of the resected specimen. Because our patient was asymptomatic, she was managed conservatively with regular follow-up. We discuss the treatment options available in comparison with similar cases. Conclusion Diagnosis and therapy of benign cardiac tumors, especially of asymptomatic lesions, can be a challenge. There is no evidence available to help in the management of such patients. An extensive evaluation is needed with different imaging modalities, and case-specific decisions should be made that involve experts in cardiology, cardio-oncology, and heart surgery. Electronic supplementary material The online version of this article (doi:10.1186/s13256-016-0860-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Hirschberg
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - F Wiedmann
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - E Zitron
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - P Fortner
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - J H Riffel
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - E Chorianopoulos
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - G Gdynia
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany
| | - G Mechtersheimer
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany
| | - M Andrassy
- Fürst-Stirum-Klinik, Gutleutstraße 1-14, 76646, Bruchsal, Germany
| | - G Szabó
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - R Arif
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - H A Katus
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - S J Buss
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Simultaneous removal of a tumour of the right atrium and inferior vena cava and coronary bypass-grafting in a patient with recurrent clear renal cell carcinoma. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 12:348-50. [PMID: 26855653 PMCID: PMC4735538 DOI: 10.5114/kitp.2015.56787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/31/2013] [Indexed: 11/20/2022]
Abstract
Metastatic cardiac tumours are the most common malignant cardiac tumours. In the early stages they are usually asymptomatic, but their consequences can be very serious, and the prognosis is poor. We present a patient with recurrent renal cell carcinoma as a tumour of the right atrium and the vena cava inferior in whom cancerous masses were removed with simultaneously coronary artery bypass-grafting.
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83
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Kim SA, Park SM, Hwang SH, Kim MN, Son HS, Shim WJ. Unexpected Pathologic Diagnosis of the Mitral Valvular Mass. J Cardiovasc Ultrasound 2016; 23:271-3. [PMID: 26755938 PMCID: PMC4707315 DOI: 10.4250/jcu.2015.23.4.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/22/2022] Open
Abstract
A 59-year-old man with multifocal cerebral infarction was found to have the large obstructive mitral valvular mass. Although benign tumor was under suspicion before surgery, he was finally diagnosed as chronic infective endocarditis by microscopic evaluation. The precise diagnosis and the proper management of a cardiac mass are very important since even the benign tumor may cause fatal complications. However, primary cardiac mass has the broad spectrum from pseudo-tumor to malignancy and the differential diagnosis using non-invasive methods is not easy even with the currently available imaging techniques.
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Affiliation(s)
- Su-A Kim
- Division of Cardiology, Department of Internal Medicine, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Mi-Na Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ho-Sung Son
- Department of Thoracic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Wan-Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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84
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Primary Pericardial Sarcoma with Right Atrial Invasion and Multiple Bilateral Pulmonary Metastases in a Patient with Hereditary Nonpolyposis Colorectal Cancer. Case Rep Oncol Med 2016; 2016:6208029. [PMID: 27990306 PMCID: PMC5136629 DOI: 10.1155/2016/6208029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022] Open
Abstract
Primary tumours originating from the pericardium are extremely rare. Previous studies have reported that these tumours account for only 6.7–12.8% of all mediastinal tumours with an overall prevalence of 0.001% to 0.007%. The majority of these tumours are benign lipomas or pericardial cysts. The most common pericardial malignancy is mesothelioma. Sarcomas are soft-tissue mesenchymal malignancies originating from various parts of the body but are extremely rare in this area. We report a case of a 52-year-old female who was diagnosed with a primary sarcoma with rhabdoid differentiation originating from the pericardium. The patient presented to her GP with a four-week history of progressive dyspnea and chest pain on exertion. Chest X-Ray demonstrated a prominent pericardial effusion and suspicious chest and pericardial lesions. Biopsies of the effusion and primary tumour identified on FDG/PET scans revealed the diagnosis of primary undifferentiated sarcoma. On thoracotomy, it was noted that the tumour had invaded the right atrium; therefore, pericardial window was aborted and a drain inserted instead. The patient was then started on chemotherapy; however, progression soon occurred and the patient died within 4 months, suggesting there is urgent need for efficacious treatments for sarcomatous lesions.
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85
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Giant lymphomatous cardiac mass: In vivo imaging and histological findings. Int J Cardiol 2016; 202:81-3. [PMID: 26386929 DOI: 10.1016/j.ijcard.2015.08.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/20/2022]
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86
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Isobe S. Editorial: Cardiac tumors: Histopathological aspects and assessments with cardiac noninvasive imaging. J Cardiol Cases 2015; 12:37-38. [PMID: 30524535 PMCID: PMC6262153 DOI: 10.1016/j.jccase.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Satoshi Isobe
- Corresponding author at: Department of Cardiology, Isobe Naika Clinic, 3F Nichimaru Nagoya Bldg, 1-3 Shinsakae-machi, Naka-ku, Nagoya 460-0004, Japan. Tel.: +81 52 971 0515; fax: +81 52 971 6829.
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87
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Sánchez-Enrique C, Vivas D, Carnero Alcázar M, Vilacosta I. Giant right atrial hemangioma: Correlation between magnetic resonance imaging and histopathologic evaluation. J Thorac Cardiovasc Surg 2015. [PMID: 26198130 DOI: 10.1016/j.jtcvs.2015.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - David Vivas
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
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88
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Acute Liver Failure Due to Budd-Chiari Syndrome in the Setting of Cardiac Synovial Sarcoma. ACG Case Rep J 2015; 2:181-3. [PMID: 26157957 PMCID: PMC4435395 DOI: 10.14309/crj.2015.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/04/2015] [Indexed: 11/23/2022] Open
Abstract
Primary malignant tumors of the heart, specifically cardiac sarcomas, are rare and mainly diagnosed at autopsy. Acute Budd-Chiari syndrome is a recognized cause of acute liver failure and has been associated with several rare cardiac tumors: atrial myxoma, caval rhabdomyosarcoma, and primary cardiac adenocarcinoma. We present the first case of a fatal, highly differentiated cardiac synovial sarcoma that presented as acute liver failure from Budd-Chiari syndrome.
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89
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Pacini D, Careddu L, Pantaleo A, Parolari A, Leone O, Daprati A, Gargiulo GD, Di Bartolomeo R. Primary malignant tumors of the heart: Outcomes of the surgical treatment. Asian Cardiovasc Thorac Ann 2015; 23:645-51. [DOI: 10.1177/0218492315573674] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Malignant cardiac tumors are rare and have an extremely poor prognosis even when complete resection is attempted. The aim of this study was to review the experience of primary malignant cardiac tumors in 2 Italian academic hospitals. Methods The hospital records were searched to identify patients with primary malignant cardiac tumors who underwent surgery between January 1979 and December 2012. Secondary cardiac tumors, whether metastatic or invasive, were excluded as were primary sarcomas of the great arteries. Fourteen patients selected from our institution’s surgical series were identified. Eleven (78.6%) were men and 3 (21.4%) were women, and the mean age at surgery was 47.4 years. Results The most common histological type was angiosarcoma (28.6%). The mean survival was 28.8 ± 28 months and it was better in men than in women (30.5 ± 8.7 vs. 21.1 ± 3.2 months). Patients with a radical resection at the first surgery had a longer survival compared to patients with a partial resection (39.9 ± 23.2 vs. 24 ± 4 months). Conclusions The treatment outcome for patients affected by primary malignant heart tumors remains poor. Aggressive surgery alone does not provide good results in terms of survival rate. A new multidisciplinary approach is mandatory to improve long-term survival.
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Affiliation(s)
- Davide Pacini
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lucio Careddu
- Pediatric Cardiac Surgery and GUCH Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Pantaleo
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Ornella Leone
- Department of Pathology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Daprati
- Cardiac Surgery Department, Monzino Hospital, Milano, Italy
| | - Gaetano Domenico Gargiulo
- Pediatric Cardiac Surgery and GUCH Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Roberto Di Bartolomeo
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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90
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Tamene AM, Masri C, Konety SH. Cardiovascular MR Imaging in Cardio-oncology. Magn Reson Imaging Clin N Am 2015; 23:105-16. [DOI: 10.1016/j.mric.2014.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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91
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Seo GW, Seol SH, Song PS, Kim DK, Kim KH, Kim WG, Kim YM, Oh SJ, Jun HJ, Kim DI. Right ventricle inflow obstructing mass proven to be a synovial sarcoma. J Thorac Dis 2014; 6:E226-9. [PMID: 25364537 DOI: 10.3978/j.issn.2072-1439.2014.09.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/25/2014] [Indexed: 11/14/2022]
Abstract
Soft tissue sarcoma is the most common malignant cardiac tumor. The chief modes of presentation are embolization, obstruction, and arrhythmogenesis. We describe an unusual case of a 27-year-old man who presented with nausea and dyspnea on exertion. Transthoracic echocardiography and computed tomography revealed a huge mass in the right heart that extended through the inferior vena cava and right renal vein to the right kidney. The cardiac mass was resected, and an immunohistochemical analysis revealed it to be a TLE1-positive synovial sarcoma. After surgery, the patient received serial adjuvant chemotherapy. We herein describe the case with a brief review.
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Affiliation(s)
- Guang-Won Seo
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang-Hoon Seol
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Pil-Sang Song
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Kie Kim
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki-Hun Kim
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Gyeong Kim
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yeon Mee Kim
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sun Ju Oh
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hee-Jae Jun
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Doo-Il Kim
- 1 Division of Cardiology, Department of Internal Medicinie, 2 Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea ; 3 Department of Pathology, Asan Medical Center, Seoul, Korea ; 4 Division of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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92
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Di Vito A, Mignogna C, Donato G. The mysterious pathways of cardiac myxomas: a review of histogenesis, pathogenesis and pathology. Histopathology 2014; 66:321-32. [DOI: 10.1111/his.12531] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Di Vito
- Department of Clinical and Experimental Medicine; University of Catanzaro ‘Magna Graecia Medical School; Catanzaro Italy
| | - Chiara Mignogna
- Department of Health Science, Pathology Unit; University of Catanzaro ‘Magna Graecia Medical School; Catanzaro Italy
| | - Giuseppe Donato
- Department of Health Science, Pathology Unit; University of Catanzaro ‘Magna Graecia Medical School; Catanzaro Italy
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93
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Knur R, Ozse J. Atrial fibrillation as the first clinical presentation of an adenoid cystic bronchial carcinoma. Neth Heart J 2014; 22:472-3. [PMID: 24842374 PMCID: PMC4188846 DOI: 10.1007/s12471-014-0565-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rainer Knur
- Department of Cardiology and Angiology, Allgemeines Krankenhaus Viersen, Hoserkirchweg 63, 41747, Viersen, Germany,
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94
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Crenitte MRF, Galvão MD, Bernardi FDC, da Fonseca LG. Cardiac angiosarcoma: an unexpected diagnosis. AUTOPSY AND CASE REPORTS 2014; 4:53-58. [PMID: 28573119 PMCID: PMC5444399 DOI: 10.4322/acr.2014.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/02/2014] [Indexed: 11/23/2022] Open
Abstract
Cardiac angiosarcoma is a rare entity. The incidence through autopsy findings ranges between 0.001% and 0.03%. The disease usually presents with non-specific symptoms, although asymptomatic cases are frequent; therefore, diagnosis is unexpected and consequently delayed. The authors report the case of a middle-aged man with a recent onset cough and dyspnea. He sought medical care several times without receiving a definite diagnosis until a plain chest radiography was taken showing a mediastinal enlargement, which was the reason why he was hospitalized for clinical investigation. During the diagnostic workup, an echodopplercardiogram and a thoracic computed tomography were performed, showing a heterogeneous soft-tissue mass infiltrating the pericardium and the anterior atrial wall. Multiple and scattered pulmonary nodules were also present. A pulmonary nodule was biopsied, which revealed an angiosarcoma. The clinical features added to the radiological and histological findings permitted the diagnosis of right atrial angiosarcoma. The authors highlight the unexpected pattern in the presentation of cardiac tumors.
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Affiliation(s)
| | - Mariana Domingues Galvão
- Department of Radiology and Imaging - Instituto do Coração - Universidade de São Paulo, São Paulo/SP - Brazil
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95
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Desai MY, Jellis CL. Differentiation of cardiac masses by CMR: judging a character by the company it keeps. JACC Cardiovasc Imaging 2014; 7:906-8. [PMID: 25212795 DOI: 10.1016/j.jcmg.2014.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022]
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96
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Fu B, Yu H, Yang J. Primary intimal (spindle cell) sarcoma of the left atrium. Echocardiography 2014; 32:192-4. [PMID: 25196496 DOI: 10.1111/echo.12777] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Bo Fu
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, ChengDu, China
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97
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Prolonged survival after surgery for cardiac metastasis from malignant melanoma. J Cardiol Cases 2014; 10:150-152. [PMID: 30534229 DOI: 10.1016/j.jccase.2014.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/05/2014] [Accepted: 06/23/2014] [Indexed: 11/20/2022] Open
Abstract
Malignant melanoma often involves the heart in patients with advanced tumor disease but isolated cardiac metastasis is rare. We describe successful removal of isolated metastasis in the right ventricular outflow tract of a 64-year-old woman with exertional dyspnea and prior history of melanoma. She remains asymptomatic for 3 years after surgery while median survival is about 3 months after diagnosis without treatment. This report should promote early surgery in order to relieve symptoms and improve survival. <Learning objective: Metastatic melanoma has an ominous prognosis, particularly in case of widespread disease and cardiac localization. When isolated metastasis of the heart is present the optimal treatment remains controversial, either chemotherapy, surgery, or both. As shown in this case, long-term favorable outcomes can be obtained when isolated surgery of obstructive cardiac metastasis is performed, even incomplete.>.
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98
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Burazor I, Aviel-Ronen S, Imazio M, Markel G, Grossman Y, Yosepovich A, Adler Y. Primary malignancies of the heart and pericardium. Clin Cardiol 2014; 37:582-8. [PMID: 24895291 DOI: 10.1002/clc.22295] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 11/11/2022] Open
Abstract
Primary malignancies of the heart and pericardium are rare. All the available data come from autopsy studies, case reports, and, in recent years, from large, specialized, single-center studies. Nevertheless, if primary malignancy is present, it may have a devastating implication for patients. Malignancies may affect heart function, also causing left-sided or right-sided heart failure. In addition, they can be responsible for embolic events or arrhythmias. Today, with the widespread use of noninvasive imaging modalities, heart tumors become evident, even as an incidental finding. A multimodality imaging approach is usually required to establish the final diagnosis. Despite the increased awareness and improved diagnostic techniques, clinical manifestations of primary malignancy of the heart and pericardium are so variable that their occurrence may still come as a surprise during surgery or autopsy. No randomized clinical trials have been carried out to determine the optimal therapy for these primary malignancies. Surgery is performed for small tumors. Chemotherapy and radiation therapy can be of help. Partial resection of large neoplasms is performed to relieve mechanical effects, such as cardiac compression or hemodynamic obstruction. Most patients present with marginally resectable or technically nonresectable disease at the time of diagnosis. It seems that orthotopic cardiac transplantation with subsequent immunosuppressive therapy may represent an option for very carefully selected patients. Early diagnosis and radical exeresis are of great importance for long-term survival of a primary cardiac malignancy. This can rarely be accomplished, and overall results are very disappointing.
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Affiliation(s)
- Ivana Burazor
- Cardiology Department, Institute for Rehabilitation, Belgrade, Serbia
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99
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100
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Lake A, Ashraf O, Maywald R, Jalali H. Unique presentation of a primary pleomorphic sarcoma of the left atrium. Asian Cardiovasc Thorac Ann 2014; 23:973-5. [PMID: 24682338 DOI: 10.1177/0218492314529782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes an extremely rare cause of a common presentation. A 59-year-old man who presented with symptoms of progressive cardiac failure, was demonstrated to have a large left intraatrial mass on computed tomography pulmonary angiography and an echocardiogram. He proceeded to urgent surgery under cardiopulmonary bypass. Histology of the resected mass diagnosed primary pleomorphic sarcoma of the left atrium. This exceedingly rare malignancy has a poor prognosis and often presents with nonspecific symptoms. Echocardiography remains vital in diagnosis, and treatment is primarily surgical excision, with some reports of adjuvant chemotherapy.
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Affiliation(s)
- Alexis Lake
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Omer Ashraf
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Rachel Maywald
- Department of Anatomical Pathology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Homayoun Jalali
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
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