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Frederiksen H, Ashwath ML. Disseminated Melanoma: A Disappearing Left Ventricular Mass. CASE (PHILADELPHIA, PA.) 2023; 7:456-460. [PMID: 38028384 PMCID: PMC10679527 DOI: 10.1016/j.case.2023.08.003] [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: 12/01/2023]
Abstract
•Melanoma may lead to asymptomatic cardiac metastasis. •Resolution of the intracardiac mass occurred with nonsurgical treatment. •Echocardiography is important for screening for metastatic involvement.
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Affiliation(s)
- Hunter Frederiksen
- Division of Internal Medicine, Department of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mahi L. Ashwath
- Division of Internal Medicine, Department of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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2
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Akimana G, Mesmoudi B, Benasser M, Errihani H, Oukerraj L. Secondary Cardiac Involvement From Diffuse Large B-cell Lymphoma: A Case Report. Cureus 2022; 14:e27664. [PMID: 36072208 PMCID: PMC9440400 DOI: 10.7759/cureus.27664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
The cardiac localization of metastases is a rare condition, most often found on autopsy. Lymphoma is among the primary cancers often involved, as was the case for our patient in whom cardiac involvements were discovered during the extension assessment by imaging. Clinically asymptomatic in the majority of cases, we mainly find general symptoms related to the primary disease. Because histological diagnosis is rarely possible by biopsy, confirmation is made by imaging in the context of disseminated disease. The treatment of cardiac involvements of lymphomatous origin is often medical with a poor prognosis.
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3
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Balinski AM, Vasbinder AL, Kerndt CC, Catalan TC, Parry NP, Rehman RA, Blakely P, Yeow RY, Leja MJ, Lao CD, Fecher LA, Hayek SS. Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes. Cancer Med 2022; 12:2356-2367. [PMID: 35894689 PMCID: PMC9939187 DOI: 10.1002/cam4.5058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cardiac metastasis of melanoma is rare and typically diagnosed post-mortem. Here we perform a retrospective cohort study and systematic review of patients with metastatic melanoma to characterize prevalence, clinical characteristics, and outcomes of cardiac metastasis. METHODS We reviewed the electronic medical records of all outpatients with metastatic melanoma who underwent evaluation at the University of Michigan in Ann Arbor from January 2009 to January 2022, identifying patients with a clinical or histopathologic diagnosis of cardiac metastasis. We performed a systematic review of the literature to summarize the clinical characteristics and outcomes of patients with melanoma and cardiac metastasis. RESULTS Overall, 23 of 1254 (1.8%) patients with metastatic melanoma were diagnosed with cardiac metastasis. Cardiac metastasis was reported in the right ventricle (65%), left ventricle (35%), and right atrium (35%). A total of 11 (48%) patients experienced at least one cardiovascular complication after the diagnosis of cardiac metastasis, the most common being arrhythmia (30%), heart failure (22%), and pericardial effusion (17%). Immunotherapy was more commonly used in patients with cardiac metastasis (80% vs 65%; p = 0.005). Mortality at 2-years post-diagnosis was higher for patients with cardiac metastasis compared to those without (59% vs 37%; p = 0.034). Progression of malignancy was the underlying cause of death of all patients. CONCLUSIONS Cardiac metastasis occurs in <2% of patients with metastatic melanoma, can affect all cardiac structures, and is associated with various cardiovascular complications and high mortality.
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Affiliation(s)
| | - Alexi L. Vasbinder
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Connor C. Kerndt
- Department of Internal MedicineSpectrum Health/Michigan State University College of Human MedicineGrand RapidsMichiganUSA
| | - Tonimarie C. Catalan
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Nathan P. Parry
- Oakland University William Beaumont School of MedicineRochesterMichiganUSA
| | - Rafey A. Rehman
- Oakland University William Beaumont School of MedicineRochesterMichiganUSA
| | - Pennelope Blakely
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Raymond Y. Yeow
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Monika J. Leja
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Christopher D. Lao
- Department of Internal MedicineDivision of Hematology/Oncology, University of MichiganAnn ArborMichiganUSA
| | - Leslie A. Fecher
- Department of Internal MedicineDivision of Hematology/Oncology, University of MichiganAnn ArborMichiganUSA
| | - Salim S. Hayek
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
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4
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Makunda N, Vallabhaneni S, Lefebvre B, Fradley MG. Cardiotoxicity of Systemic Melanoma Treatments. Curr Treat Options Oncol 2022; 23:240-253. [PMID: 35192138 DOI: 10.1007/s11864-021-00924-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Melanoma is the least common but most dangerous skin cancer, accounting for 75% of all deaths from a primary cutaneous malignancy, with incidence rates rising significantly over the last decade. Traditional treatments for melanoma including interferon and cytotoxic chemotherapy had marginal efficacy. With the advent of targeted and immunotherapies, the prognosis for patients with advanced melanoma has significantly improved including those with metastatic disease to the heart. BRAF and MEK inhibitors as well as immune checkpoint inhibitors have become front line therapy for eligible patients with metastatic melanoma and have led to long-term durable response and in some cases can be curative. Despite these oncologic advances, various treatment-limiting side effects can occur. In particular, cardiovascular toxicities can contribute to overall morbidity and mortality in these patients. Toxicities range from asymptomatic QT prolongation and mild LV dysfunction to fulminant myocarditis and potentially life-threatening arrhythmias. A multidisciplinary approach to the care of these patients which includes cardio-oncology evaluation is necessary to develop both risk mitigation and treatment strategies to ensure patients continue receiving necessary and effective melanoma treatments while minimizing long-term adverse cardiovascular effects.
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Affiliation(s)
- Neha Makunda
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Srilakshmi Vallabhaneni
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Benedicte Lefebvre
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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5
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Styczeń A, Kozak M, Karaś-Głodek M, Czekajska-Chehab E, Tomaszewski A, Wysokiński A, Zapolski T. Atypical Cardiac Location of Melanoma of Unknown Origin. ACTA ACUST UNITED AC 2021; 57:medicina57020107. [PMID: 33503841 PMCID: PMC7911921 DOI: 10.3390/medicina57020107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
The subject was a 66-year-old woman, suffering from the chest pain evoked by physical activity. Transthoracic echocardiography (TTE) revealed an abnormal structure, 41 × 29 mm. In MSCT, a hypodensic mobile tissue lesion that was infiltrating the whole thickness of left ventricle was confirmed. PET excluded the existence of other remote lesions. After surgical tumor removal, histopathological differential diagnosis revealed melanoma, myoepithelial cancer, and MPNST “high–grade” sarcoma. A control TTE detected a tumor that was 14 × 10 mm. After immunohistochemical results, immunotherapy with pembrolizumab was used, which resulted in complete tumor resolution. Presently, surgical resection and neoadjuvant targeted immunochemotherapy remain the treatment of choice for clinical stage III/IV melanoma.
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Affiliation(s)
- Agnieszka Styczeń
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (A.S.); (M.K.); (M.K.-G.); (A.T.); (A.W.)
| | - Mariusz Kozak
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (A.S.); (M.K.); (M.K.-G.); (A.T.); (A.W.)
| | - Marta Karaś-Głodek
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (A.S.); (M.K.); (M.K.-G.); (A.T.); (A.W.)
| | | | - Andrzej Tomaszewski
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (A.S.); (M.K.); (M.K.-G.); (A.T.); (A.W.)
| | - Andrzej Wysokiński
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (A.S.); (M.K.); (M.K.-G.); (A.T.); (A.W.)
| | - Tomasz Zapolski
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (A.S.); (M.K.); (M.K.-G.); (A.T.); (A.W.)
- Correspondence:
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Yanagawa B, Mazine A, Chan EY, Barker CM, Gritti M, Reul RM, Ravi V, Ibarra S, Shapira OM, Cusimano RJ, Reardon MJ. Surgery for Tumors of the Heart. Semin Thorac Cardiovasc Surg 2018; 30:385-397. [PMID: 30205144 DOI: 10.1053/j.semtcvs.2018.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
Most surgeons will encounter only a handful of primary cardiac tumors outside of myxomas. Approximately 3 quarters of primary cardiac tumors are benign and 1 quarter is malignant. In most cases, cardiac tumors are silent but when symptoms do occur, they are primarily determined by tumor size and anatomical location, not by histopathology. The diagnosis and preoperative imaging relies heavily on multimodal imaging including echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Surgical resection is the most common treatment for most simple primary cardiac tumors and for some complex benign tumors. Surgical resection of primary cardiac tumors frequently involves the need for complex cardiac reconstruction, particularly when malignant. Secondary tumors to the heart are 30 times more frequent than primary cardiac tumors, and their incidence is increasing, largely as a result of advances in cancer diagnosis and therapy. Surgical resection is feasible in only a small fraction of highly-selected patients with secondary tumors to the heart. For complex benign tumors-such as paraganglioma or large fibromas-and all primary and secondary malignant tumors, a multidisciplinary cardiac tumor team review in experienced centers of excellence is recommended.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Edward Y Chan
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Colin M Barker
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael Gritti
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ross M Reul
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Vinod Ravi
- Department of Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Sergio Ibarra
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, Jerusalem, Israel
| | - Robert J Cusimano
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
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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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Higashi M, Hodatsu A, Uchiyama K, Tada H, Mori M, Ohira M, Hayashi K, Kawashiri MA. Huge right ventricular mass lesion associated with genital malignant tumor: a case report. J Med Case Rep 2017; 11:282. [PMID: 28969678 PMCID: PMC5625781 DOI: 10.1186/s13256-017-1439-4] [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: 07/19/2017] [Accepted: 08/28/2017] [Indexed: 11/24/2022] Open
Abstract
Background Primary heart tumors are rare, whereas metastatic heart tumors occur more frequently. Case presentation We report a case of a 75-year-old Japanese woman who had metastatic heart tumors of the right ventricle. Although she initially received antibiotic therapy following a diagnosis of pneumonia and pleuritis, her symptoms worsened, and she developed dyspnea and bilateral lower limb edema. Echocardiography showed a huge mass lesion occupying the entire right ventricle. Because the patient’s tumor markers were elevated, we used computed tomography to search for the primary lesion, which was located in the vagina or the uterus. Histology demonstrated the presence of basaloid squamous cell carcinoma in the vaginal tissue. Chemotherapy with paclitaxel and carboplatin was initiated. Conclusions These data suggest that the tumor in the right ventricle metastasized from the genital organs.
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Affiliation(s)
- Masaya Higashi
- Division of Cardiology, Keiju General Hospital, Nanao, Japan
| | - Akihiko Hodatsu
- Division of Cardiology, Keiju General Hospital, Nanao, Japan
| | | | - Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Mika Mori
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Miho Ohira
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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9
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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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Friedel I, Burchert W, Horstkotte D, Faber L. A Rare Case of Cardiac Melanoma Mimicking Hypertrophic Cardiomyopathy. Can J Cardiol 2017; 33:950.e1-950.e3. [PMID: 28668146 DOI: 10.1016/j.cjca.2017.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/24/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022] Open
Abstract
A 40-year-old female patient with a remote history of a malignant melanoma treated with curative intent presented with the diagnosis of hypertrophic cardiomyopathy (HCM) made at another hospital. Further diagnostic workup included positron emission tomography/computed tomography, which revealed that the HCM phenotype was produced by cardiac involvement of metastatic melanoma. For this reason, the primary diagnosis of HCM had to be retracted and melanoma-specific antineoplastic treatment was initiated.
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Affiliation(s)
- Imke Friedel
- Clinic for Cardiology, Institute for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Wolfgang Burchert
- Clinic for Cardiology, Institute for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Institute for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Lothar Faber
- Clinic for Cardiology, Institute for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
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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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12
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Cardiac Metastases of Malignant Melanoma. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2015. [DOI: 10.5812/rijm.3(2)2015.28077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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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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15
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Bhattacharyya S, Khattar RS, Gujral DM, Senior R. Cardiac tumors: the role of cardiovascular imaging. Expert Rev Cardiovasc Ther 2013; 12:37-43. [PMID: 24345096 DOI: 10.1586/14779072.2014.872031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of cardiac tumors with cardiovascular imaging aims to establish aetiology, identify complications of tumor and help define management strategy. 2D echocardiography remains the primary diagnostic modality. Additional use of newer echocardiographic techniques such as 3D, strain and contrast echocardiography better characterise tumor morphology, tissue characteristics and vascularity respectively. Cardiac MRI and computed tomography provide complementary information and are able to identify extra-cardiac infiltration and also provide further tissue characterisation. This review explores the non-invasive diagnostic approach to evaluation of cardiac tumors.
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16
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Judge JM, Tillou JD, Slingluff CL, Kern JA, Kron IL, Weiss GR. Surgical management of the patient with metastatic melanoma to the heart. J Card Surg 2013; 28:124-8. [PMID: 23406162 DOI: 10.1111/jocs.12054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Melanoma has a high propensity for cardiac seeding, with heart involvement noted in a significant number of patients at autopsy. Therapeutic options are currently limited, and the prognosis of cardiac metastasis is poor. We report two cases of cardiac metastasis of melanoma and review the current literature. In addition, we propose an algorithm for dealing with this difficult problem.
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Affiliation(s)
- Joshua M Judge
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Katalinic D, Stern-Padovan R, Ivanac I, Aleric I, Tentor D, Nikolac N, Santek F, Juretic A, Plestina S. Symptomatic cardiac metastases of breast cancer 27 years after mastectomy: a case report with literature review--pathophysiology of molecular mechanisms and metastatic pathways, clinical aspects, diagnostic procedures and treatment modalities. World J Surg Oncol 2013; 11:14. [PMID: 23343205 PMCID: PMC3562152 DOI: 10.1186/1477-7819-11-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 01/13/2013] [Indexed: 01/06/2023] Open
Abstract
Metastases to the heart and pericardium are rare but more common than primary cardiac tumours and are generally associated with a rather poor prognosis. Most cases are clinically silent and are undiagnosed in vivo until the autopsy. We present a female patient with a 27-year-old history of an operated primary breast cancer who was presented with dyspnoea, paroxysmal nocturnal dyspnoea and orthopnoea. The clinical signs and symptoms aroused suspicion of congestive heart failure. However, the cardiac metastases were detected during a routine cardiologic evaluation and confirmed with computed tomography imaging. Additionally, this paper outlines the pathophysiology of molecular and clinical mechanisms involved in the metastatic spreading, clinical presentation, diagnostic procedures and treatment of heart metastases. The present case demonstrates that a complete surgical resection and systemic chemotherapy may result in a favourable outcome for many years. However, a lifelong medical follow-up, with the purpose of a detection of metastases, is highly recommended. We strongly call the attention of clinicians to the fact that during the follow-up of all cancer patients, such heart failure may be a harbinger of the secondary heart involvement.
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Affiliation(s)
- Darko Katalinic
- Department of Oncology, University Hospital Centre (KBC Zagreb), University of Zagreb School of Medicine, Kispaticeva 12, Zagreb, Croatia.
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Parissis H, Al-Alao BS, Young VK. Case report and literature review: surgical treatment of a right atrial metastatic melanoma from a previously resected "advanced" primary site with regional lymph nodes involvement. Gen Thorac Cardiovasc Surg 2012; 60:655-60. [PMID: 22644819 DOI: 10.1007/s11748-012-0059-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 12/09/2011] [Indexed: 11/28/2022]
Abstract
Although melanoma of the right atrium is a rare cardiac tumor, melanoma in general has a high propensity to involve the heart. Unfortunately, however, when the tumor is involving the heart, widespread metastasis ensues and hence surgery becomes a questionable option. We report a case of a young female who presented with an advanced skin primary melanoma and regional lymph node involvement and a metastasis into the right atrium. Postoperatively tumor dissemination was controlled with adjuvant chemotherapy. A vigorous attempt aiming at tumor clearance followed by adjuvant multimodality therapy along with a tumor surveillance program may improve survival even in advanced cases.
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Affiliation(s)
- Haralabos Parissis
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Rd, Belfast, BT12 6BA, Northern Ireland, UK.
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19
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Abstract
Cardiac metastasis from epithelial thyroid cancer is a very rare and potentially serious complication. We have identified only 54 reported cases over a 130-year period. Here we review this literature. Cardiac metastases are frequently asymptomatic, but when symptoms develop these tend to be severe and often fatal. The prognosis of cardiac metastases from thyroid cancer is unclear as survival data are often missing or absent in reported cases. However, as many patients died suddenly from cardiac complications, the prognosis seems poor. Of those patients who survived, all underwent surgical intervention. Trans-thoracic echocardiography is the diagnostic modality of choice as it allows dynamic evaluation of intracardiac masses. Metastatic involvement of the heart from thyroid cancer is uncommon. Left untreated this complication seems likely to be fatal. Therefore, in patients with established thyroid malignancy who develop cardiac arrhythmias, new murmurs, or signs of cardiac decompensation, we suggest that cardiac metastases be considered. Echocardiography should be performed in patients with advanced thyroid cancer and cardiac symptoms or signs. If a cardiac metastasis is present, we recommend surgical intervention if possible.
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Affiliation(s)
- Sarah R Catford
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia
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20
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Karamitsos TD, Bull S, Francis JM, Newton J, Westaby S, Neubauer S, Myerson S. Massive melanotic myocardial metastasis characterized by multiple cardiac imaging modalities. Int J Cardiol 2011; 146:e27-9. [DOI: 10.1016/j.ijcard.2008.12.179] [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] [Received: 12/04/2008] [Accepted: 12/14/2008] [Indexed: 10/21/2022]
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21
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Castillo JG, Silvay G. Characterization and Management of Cardiac Tumors. Semin Cardiothorac Vasc Anesth 2010; 14:6-20. [DOI: 10.1177/1089253210362596] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiac tumors are infrequent clinical entities with an autopsy frequency ranging from 0.001% to 0.030%. The occurrence of metastatic cardiac tumors has been reported a 100-fold more commonly than primary lesions. Three quarters of primary cardiac tumors are benign; approximately half of these are cardiac myxomas, and the rest are lipomas, papillary fibroelastomas, and rhabdomyomas. Among malignant primary cardiac tumors, the most reported are those histopathologically considered as undifferentiated, followed by angiosarcomas and leiomyosarcomas. Traditionally, cardiac tumors have been identified as curious autopsy findings resulting in a literature paucity of large clinical series, therefore, providing knowledge mostly based on case report collection. However, recent technological advances in noninvasive imaging modalities such as echocardiography and cardiac magnetic resonance imaging (MRI) have resulted in a rapid acquisition of real-time heart images with high spatial and temporal resolution and an excellent tissue characterization of the tumor. This consequent earlier, more frequent, and more complete assessment of cardiac tumors before significant symptoms develop has challenged cardiologists, cardiac anesthesiologists, and surgeons to create a tailored referral pattern and approach.
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22
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Provost P, Blocklet D, Renard M, Stoupel E, Thoma P, Vereecken P. Cardiac masses in a patient with AJCC stage II melanoma: cautious interpretation of the magnetic resonance imaging. Clin Exp Dermatol 2010; 34:e986-7. [PMID: 20055879 DOI: 10.1111/j.1365-2230.2009.03625.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Symptomatische Herzmetastase. Hautarzt 2009; 60:913-5. [DOI: 10.1007/s00105-009-1722-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Multiple cardiac metastases from a malignant melanoma causing consecutive pulmonary embolism. Herz 2009; 34:410-1. [PMID: 19711037 DOI: 10.1007/s00059-009-3253-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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Wood A, Markovic SN, Best PJM, Erickson LA. Metastatic malignant melanoma manifesting as an intracardiac mass. Cardiovasc Pathol 2009; 19:153-7. [PMID: 19211272 DOI: 10.1016/j.carpath.2008.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 12/09/2008] [Accepted: 12/19/2008] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Antemortem diagnoses of intracardiac metastases are uncommon. Metastatic melanoma shows a propensity for cardiac involvement, but cardiac involvement by melanoma is rarely identified clinically due to a paucity of cardiac symptoms. METHODS The surgical pathology files of Mayo Clinic were searched for cases of metastatic melanoma presenting or manifesting as an intracardiac mass. The lesions were evaluated pathologically for diagnoses. Clinical information was obtained by chart review. RESULTS Seven patients, four female and three male (age 31 to 79 years), were identified. No patient had a history of metastatic melanoma. All patients presented with dyspnea and symptoms of outflow obstruction. Echocardiography or CT revealed an intracardiac mass (four atrial, three ventricular). Six cases involved the right side of the heart and one involved the left ventricle. Five of the seven patients had a history of malignant melanoma, but none had a history of metastases when they presented with cardiac symptoms. In four cases, the history of primary melanoma was remote, occurring 7, 9, 13, and 28 years prior to the discovery of their cardiac mass. One patient had no history of melanoma, and no primary melanoma was ever identified. One patient had a history of a benign melanocytic lesion biopsied 2 years before, but retrospective review showed malignant melanoma. CONCLUSIONS Melanoma is known to have an unpredictable and prolonged course. Neoplastic involvement of the heart should be considered in patients with cardiac symptoms when a documented malignancy exists, no matter how remote.
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Affiliation(s)
- Angela Wood
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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26
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Javangula KC, O'Regan DJ. Emergency surgery for left atrial metastatic alveolar rhabdomyosarcoma manifesting as a right atrial mass. Ann Thorac Surg 2008; 86:1008-11. [PMID: 18721606 DOI: 10.1016/j.athoracsur.2008.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Revised: 02/03/2008] [Accepted: 02/21/2008] [Indexed: 10/21/2022]
Abstract
We report the case of a 43-year-old woman with a history of alveolar rhabdomyosarcoma of the forearm, scalp, and paraspinal region who developed acute shortness of breath owing to a tumor arising from the left atrium and extending through the coronary sinus. This was causing partial obstruction across the tricuspid valve as a result of the ball-valve effect. Emergency resection of the atrial mass was performed, and histologic analysis confirmed the presence of metastatic rhabdomyosarcoma. To our knowledge, this is the first reported case of emergency surgical resection of intracardiac metastatic alveolar rhabdomyosarcoma.
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Affiliation(s)
- Kalyana C Javangula
- Division of Cardiothoracic Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, England.
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27
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Rathi VK, Williams RB, Yamrozik J, Grill H, Biederman RWW. Cardiovascular magnetic resonance of the charcoal heart. J Cardiovasc Magn Reson 2008; 10:37. [PMID: 18611282 PMCID: PMC2475533 DOI: 10.1186/1532-429x-10-37] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 07/09/2008] [Indexed: 12/17/2022] Open
Abstract
We report a case of malignant melanoma metastasis to the heart presenting as complete heart block. The highlight of the case is to demonstrate that silent cardiac metastasis is not uncommon and CMR has the potential to characterize these cardiac metastases and should be used routinely as a screening tool for those cancers with a high chance of cardiac involvement.
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Affiliation(s)
- Vikas K Rathi
- Division of Cardiology, Allegheny General Hospital, Drexel University College of Medicine, 320 E North Avenue, Pittsburgh, PA-15212, USA
| | - Ronald B Williams
- Division of Cardiology, Allegheny General Hospital, Drexel University College of Medicine, 320 E North Avenue, Pittsburgh, PA-15212, USA
| | - June Yamrozik
- Division of Cardiology, Allegheny General Hospital, Drexel University College of Medicine, 320 E North Avenue, Pittsburgh, PA-15212, USA
| | - Howard Grill
- Division of Cardiology, Allegheny General Hospital, Drexel University College of Medicine, 320 E North Avenue, Pittsburgh, PA-15212, USA
| | - Robert WW Biederman
- Division of Cardiology, Allegheny General Hospital, Drexel University College of Medicine, 320 E North Avenue, Pittsburgh, PA-15212, USA
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28
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Moustafa SE, Sauvé C, Amyot R. Assessment of a right ventricular metastasis using contrast echocardiography perfusion imaging. ACTA ACUST UNITED AC 2008; 9:326-8. [DOI: 10.1093/ejechocard/jen067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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29
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Diagnosis of Metastatic Melanoma to the Heart With an Intrinsic Contrast Approach Using Melanin Inversion Recovery Imaging. J Comput Assist Tomogr 2007; 31:924-30. [DOI: 10.1097/rct.0b013e31804b213b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Affiliation(s)
- Sridevi R Pitta
- Department of Cardiology, Wayne State University, Detroit, Mich, USA
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31
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Uzun O, Wilson DG, Vujanic GM, Parsons JM, De Giovanni JV. Cardiac tumours in children. Orphanet J Rare Dis 2007; 2:11. [PMID: 17331235 PMCID: PMC3225855 DOI: 10.1186/1750-1172-2-11] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 03/01/2007] [Indexed: 01/12/2023] Open
Abstract
Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10-20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT) and Magnetic Resonance Imaging (MRI) of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor.
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Affiliation(s)
- Orhan Uzun
- Consultant Paediatric Cardiologist, Department of Paediatric Cardiology, University Hospital Of Wales, Heath Park Cardiff, CF14 4XW, Wales, UK
| | - Dirk G Wilson
- Consultant Paediatric Cardiologist, Department of Paediatric Cardiology, University Hospital Of Wales, Heath Park Cardiff, CF14 4XW, Wales, UK
| | - Gordon M Vujanic
- Consultant Senior Lecturer in Paediatric Pathology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XW, Wales, UK
| | - Jonathan M Parsons
- Consultant Paediatric Cardiologist, Yorkshire Heart Centre, Department Of Paediatric Cardiology, Leeds, UK
| | - Joseph V De Giovanni
- Consultant Paediatric Cardiologist. Birmingham Children's Hospital, Birmingham, UK
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32
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Fukuchi K, Ohta H, Matsumura K, Ishida Y. Benign variations and incidental abnormalities of myocardial FDG uptake in the fasting state as encountered during routine oncology positron emission tomography studies. Br J Radiol 2006; 80:3-11. [PMID: 17005513 DOI: 10.1259/bjr/92105597] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Increased 18fluoro-2-deoxyglucose (FDG) uptake in the myocardium is frequently observed while performing clinical positron emission tomography (PET) body scans for oncology under fasting conditions. This article reviews the normal variations and abnormal appearances of myocardial FDG accumulation which are likely to be encountered in the routine PET studies. Knowledge about the myocardial glucose metabolism and specific abnormalities are indispensable in the interpretation of myocardial FDG uptake.
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Affiliation(s)
- K Fukuchi
- PET Imaging Center, Shizuoka General Hospital, Shizuoka, Japan.
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33
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Basarici I, Demir I, Yilmaz H, Altekin RE. Obstructive metastatic malignant melanoma of the heart: Imminent pulmonary arterial occlusion caused by right ventricular metastasis with unknown origin of the primary tumor. Heart Lung 2006; 35:351-4. [PMID: 16963367 DOI: 10.1016/j.hrtlng.2005.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Revised: 10/26/2005] [Accepted: 11/07/2005] [Indexed: 11/23/2022]
Abstract
Whether primary or metastatic, cardiac neoplastic diseases are relatively uncommon disorders. Although any malignancy may involve the heart, malignant melanoma (MM) has a significant tendency to metastasize to the heart. Cardiac involvement may occur during the course of MM or years after surgical therapy, but rarely metastasis may be the initial manifestation of the disease. This article reports a metastatic MM case that was initially manifested by heart failure symptoms because of right ventricle outflow obstruction and for which the primary focus could not be determined.
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34
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Ozyuncu N, Sahin M, Altin T, Karaoguz R, Guldal M, Akyurek O. Cardiac metastasis of malignant melanoma: a rare cause of complete atrioventricular block. ACTA ACUST UNITED AC 2006; 8:545-8. [PMID: 16798769 DOI: 10.1093/europace/eul058] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Malignant melanoma has an aggressive biological behaviour and a high rate of cardiac involvement. As shown from post-mortem studies, metastases of melanoma can involve any organ and cardiac metastases are frequent. This report describes a case of widespread malignant melanoma in a patient with clinical presentation of complete atrioventricular (AV) block. Thorax CT and transthoracic echocardiography revealed a mass involving the conduction system. By VDD permanent pacing (atrial synchronous ventricular pacing), haemodynamic stability was maintained and the patient remains under follow-up receiving chemo-immunotherapy. In the retrospective analysis of the patient's records, we realized that the AV conduction delay had been progressing for at least 7 months. Cardiac metastasis of malignant melanoma is a common finding and can proceed in the absence of overt clinical manifestations. Therefore, the clinician should be alert to the development of cardiac signs and symptoms in a metastatic melanoma patient and should perform a detailed cardiac examination to exclude cardiac metastasis of the tumour.
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Affiliation(s)
- Nil Ozyuncu
- Department of Cardiology, Faculty of Medicine, Ankara University, Sihhiye, Ankara 06002, Turkey.
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Abstract
Cutaneous melanoma is one of the most deadly malignancies. Although it accounts for approximately 4% of all cancer cases, it ac-counts for approximately 79% of skin cancer-related deaths. In the past few years, the nuclear medicine platform used in the management of melanoma has extended to biochemical and structural imaging. In clinical practice, integrated positron emission tomography/CT devices allow anatomic and metabolic characterization of meta-static disease in a single study. Similarly, more accurate localization of sentinel nodes in a 3-D space now is feasible with hybrid single photon emission CT/CT system. In translational research, [18F]fluorodeoxyglucose probes have been designed to optimize the detection of melanoma tumor sites in vivo.
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Affiliation(s)
- Richard Essner
- Department of Surgical Oncology and Molecular Therapeutics, John Wayne Cancer Institute, Santa Monica, CA 90404, USA.
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36
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Tesolin M, Lapierre C, Oligny L, Bigras JL, Champagne M. Cardiac Metastases from Melanoma. Radiographics 2005; 25:249-53. [PMID: 15653599 DOI: 10.1148/rg.251045059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Maude Tesolin
- Department of Medical Imaging, Hôpital Sainte-Justine, University of Montreal, 3175 Côte Ste-Catherine Rd, Montreal, Quebec H3T 1C5, Canada
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37
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Affiliation(s)
- K Reynen
- Department of Internal Medicine II, University of Dresden, Heart Center Dresden, Dresden, Germany.
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38
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Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, DeCara JM, Weinert L, Krausz T, Lang RM. Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol 2004; 43:1412-9. [PMID: 15093876 DOI: 10.1016/j.jacc.2003.09.065] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Revised: 08/26/2003] [Accepted: 09/09/2003] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated the usefulness of echocardiographic contrast perfusion imaging in differentiating cardiac masses. BACKGROUND Two-dimensional echocardiography is the primary diagnostic modality for cardiac masses. However, differentiation between the different types of cardiac masses may be difficult at times. We hypothesized that echocardiographic contrast perfusion imaging would differentiate the neo-vascularization of malignancies from the avascularity of thrombi and the sparse vascularity of stromal tumors. METHODS Sixteen patients with cardiac masses underwent power-modulation imaging after echocardiographic intravenous contrast administration. Pixel intensities in the mass and an adjacent section of myocardium were analyzed visually and by dedicated software. All masses had a pathologic diagnosis or resolved after anticoagulation. In a subset of patients, video-intensity curves of contrast replenishment in the mass and myocardium over time were generated. The post-impulse steady-state pixel intensity (A) and initial rate of contrast replenishment after impulse (beta) were compared with an index of blood vessel area on pathology. RESULTS In seven of 16 patients, contrast enhancement resulted in greater pixel intensity in the mass than in the adjacent myocardium. All of these masses were classified pathologically as malignant (n = 6) or benign and vascular (n = 1). Nine masses demonstrated decreased pixel intensity, compared with the myocardium, and were diagnosed pathologically as myxomas (n = 2) or thrombi (n = 5), or they resolved with anticoagulation (n = 2). For the subset of patients, beta correlated with the vessel area index (r = 0.60). CONCLUSIONS Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.
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Affiliation(s)
- James N Kirkpatrick
- Adult Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, University of Chicago, Chicago, Illinois 60637, USA
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Martí G, Galve E, Huguet J, Soler Soler J. Metástasis cardíacas de melanoma maligno manifestadas en forma de enfermedad del nodo sinusal. Rev Esp Cardiol (Engl Ed) 2004. [DOI: 10.1016/s0300-8932(04)77152-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Belda-Iniesta C, Sánchez-Aquino González RM, Cuesta E, González-Barón M. Atrioventricular nodal blocking secondary to melanoma infiltration. Melanoma Res 2003; 13:433-4. [PMID: 12883373 DOI: 10.1097/00008390-200308000-00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Abstract
We present a rare case of malignant melanoma of unknown primary origin presenting as cardiac and cholecystic masses. In this 72-year-old man, a cardiac lesion caused right ventricular outlet obstruction, and gallbladder lesions led to hemobilia. Right atrial and gallbladder metastases were resected. After 2 years of disease-free survival, the patient had recurrent skin lesions, which were treated with local resection and dacarbazine. The patient has survived for more than 5 years after initial diagnosis, with continued complete clinical remission. This case illustrates the importance of aggressive surgical resection and chemotherapy in the treatment of metastatic malignant melanoma.
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Affiliation(s)
- Guangzhi Qu
- Divisions of Medical Oncology, Mayo Clinic Rochester, MN 55905, USA
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42
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Abstract
The surgical management of melanoma has evolved over the last 100 years. when early concepts of lymphatic permeation of the tumors and metastases led surgeons to perform radical operative procedures. Wide excision of primary melanoma is now performed with 1- to 2-cm radial margins, significantly reducing the need for complex plastic closures, skin grafts. and hospital admissions. Although elective lymph node dissection remains controversial as a therapeutic procedure, the development of SL has improved the staging of the regional lymph nodes and diminished the morbidity of lymph node dissection. The role of SL for routine care of melanoma patients remains unknown. Metastasectomy, which is the surgical resection of distant metastases with tumor-free surgical margins, has not been popular for AJCC stage IV patients with multiple metastases, because surgery is considered a local therapy and therefore of little value for management of disseminated disease. Nevertheless, the many reports of long-term survival after resection of distant melanoma metastases to diverse soft tissue and organ sites clearly indicate that this form of cytoreductive surgery can be extremely successful in carefully selected patients. Unlike chemotherapy, complete surgical metastasectomy can rapidly render a patient disease-free with only a short period of postoperative morbidity. Most patients fully recover from the surgical procedure within 6 weeks, returning to most or all activities. The ability to select patients for surgery is based on the development of more sophisticated imaging techniques, which allow better preoperative differentiation of patients with single versus multiple metastases and improve the surgeon's ability to identify and resect multiple metastatic sites. The overall data suggest that patients whose metastases can be completely resected will experience improved overall survival and occasional long-term cure regardless of the metastatic organ site and number of metastases. We believe that increased understanding of the biology of the primary and metastases, dramatic improvement in the accuracy of staging metastatic disease, and better techniques of surgical resection provide the best chance for long-term palliation or cure of melanoma. Cytoreductive surgery should be considered a form of immunotherapy. The long-term clinical benefit of this therapy depends on the patient's immune response to, the surgical reduction in tumor burden: an immune response that controls subclinical micrometastases should optimize postoperative survival.
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Affiliation(s)
- Richard Essner
- John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA.
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43
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Lepper W, Shivalkar B, Rinkevich D, Belcik T, Wei K. Assessment of the vascularity of a left ventricular mass using myocardial contrast echocardiography. J Am Soc Echocardiogr 2002; 15:1419-22. [PMID: 12415242 DOI: 10.1067/mje.2002.124641] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In addition to a thrombus, an intracardiac mass lesion can represent a primary cardiac tumor, or a metastatic lesion to the heart. The echocardiographic appearance and location of the mass, as well as the associated clinical scenario provide useful clues regarding cause, but these echocardiographic features alone may not always be diagnostic. Because most benign cardiac tumors are relatively avascular, the vascularity of a mass may be a feature that can help differentiate benign from malignant tumors. We present a case of a patient with a history of malignant melanoma who was found incidentally to have a cardiac mass on echocardiography. Contrast echocardiography (CE) was used to evaluate the vascularity of the mass. This case is compared with another patient with an apical thrombus, which represents an "avascular" intracardiac structure.
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Affiliation(s)
- Wolfgang Lepper
- Cardiac Imaging Center, Cardiovascular Division, University of Virginia School of Medicine, Charlottesville 22908, USA
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44
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Abstract
When deciding whether or not to perform a resection for metastatic melanoma, one should follow general principles that apply to the patient with melanoma as well as to the patient with metastases from other types of primary tumors. When the resection is palliative, the success of surgical treatment will be governed by the presence of identifiable symptoms, the morbidity of the procedure, the course of the disease, and the ability to communicate treatment goals among surgeon, patient, and family. When the resection is performed with curative intent, long-term survival depends on the ability of the surgeon to select patients with a pattern of recurrence suggestive of a less aggressive tumor biology. Regardless of the extent of the operative procedure, resection of metastases in patients whose disease recurs early after the treatment of the primary tumor, in those who present with multiple lesions, and in those who present with disease that cannot be completely resected will only rarely be associated with subsequent long-term survival.
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Affiliation(s)
- Peter J Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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45
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Langley RR, Carlisle R, Ma L, Specian RD, Gerritsen ME, Granger DN. Endothelial expression of vascular cell adhesion molecule-1 correlates with metastatic pattern in spontaneous melanoma. Microcirculation 2002. [PMID: 11687945 DOI: 10.1111/j.1549-8719.2001.tb00180.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Adhesive interactions between tumor cell surface receptors and endothelial cell adhesion molecules are thought to contribute to tumor cell arrest and extravasation during hematogenous metastasis. Recent reports suggest that melanoma cell integrin alpha4beta1 (very late antigen-4, VLA-4) interaction with the inducible cell adhesion molecule, vascular cell adhesion molecule-1 (VCAM-1), is critical for tumor cell arrest. However, no information is available regarding microvascular VCAM-1 expression during spontaneous melanoma metastasis. The objectives of this study were to evaluate VCAM-1 expression in pulmonary and extrapulmonary vascular beds during melanoma progression, and to determine whether there is an organ-specific profile for VCAM-1 expression which corresponds with the clinical pattern of melanoma metastasis. METHODS The dual-radiolabeled monoclonal antibody (mAb) technique for quantification of VCAM-1 in different vascular beds was applied to a physiological model of melanoma (B16-BL6) metastasis. Measurements of VCAM-1 were obtained when primary tumors reached 5 mm in size, and every 7 days following removal of the primary lesion. Histological examinations were performed, and mice were placed into 2 groups, based on the presence (+colonies) or absence (-colonies) of pulmonary metastases. VCAM-1 measurements obtained from several organ systems were then compared between these 2 groups of mice. Localization of VCAM-1 was achieved through immunohistochemical staining of tissues. Plasma collected from each experimental animal, as well as melanoma-conditioned media, was assayed to determine levels of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-1alpha (IL-1alpha). RESULTS Data collected from the dual-radiolabeled mAb technique indicate that 3 weeks following removal of the primary lesion, there is a tendency for VCAM-1 expression to increase in cardiac, hepatic, and cerebral vascular beds. Four weeks following primary resection, when pulmonary metastatic burden was maximal, VCAM-1 was significantly upregulated in each of these vascular beds. Results obtained from the lung indicate that VCAM-1 remains unchanged in pulmonary vessels at all time points examined. Immunohistochemical staining of heart and brain support the radiolabeled mAb measurements, and reveals that these organs exhibit an inflammatory phenotype in mice with heavy pulmonary tumor burden. Furthermore, 25% of these mice had histological evidence of melanoma metastases in heart and brain. Transplantation of liver fragments from mice with advanced pulmonary metastases into subcutaneous tissue of donor mice resulted in the formation of melanotic outgrowths. Plasma levels of the cytokines TNF-alpha and IL-1alpha were negligible in both groups of mice. CONCLUSIONS Our results indicate that upregulation of VCAM-1 is not a prerequisite for the formation of pulmonary metastases during spontaneous melanoma metastases. However, once lung metastases become well established, organ-specific increases in VCAM-1 expression become apparent. Furthermore, these organ-specific increments in VCAM-1 expression correspond with documented clinical patterns of melanoma metastasis. The enhanced expression of VCAM-1 is independent of systemic levels of TNF-alpha and IL-1alpha, but may be the result of melanoma-induced alterations at the local level, as we found evidence of melanoma cell occupation in heart, brain, and liver in pulmonary metastases-bearing mice.
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Affiliation(s)
- R R Langley
- Department of Molecular and Cellular Physiology, LSU Health Sciences Center, Shreveport, LA 71130-3932, USA
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46
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Abstract
BACKGROUND Malignant melanoma has an unpredictable biologic behavior and is the neoplasm with the greatest propensity for cardiac involvement. Although relatively frequent at autopsy, cardiac metastases are rarely identified antemortem. METHODS We reviewed 2,810 patients with histologically confirmed malignant melanoma, who were diagnosed and followed up by our clinic. Clinical, histological, and imaging data are presented. RESULTS Five cases of metastatic melanoma of the heart were identified out of 314 melanoma patients with visceral involvement. One case of a 53-year-old woman, who died unexpectedly during her first chemotherapy course, is described in detail. Postmortem examination determined the cause of death to be the presence of multiple melanoma metastases in the heart, even though the patient had shown no signs of cardiac involvement. CONCLUSIONS The unpredictable biologic behavior of melanoma may lead to unusual metastatic sites, and, therefore, the heart also should be included in routine examinations.
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Affiliation(s)
- P Savoia
- Department of Medical and Surgical Specialties, Ist Section of Dermatology, University of Turin, Torino, Italy.
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47
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Kemp C. Lung cancer, malignant melanoma, multiple myeloma. Am J Hosp Palliat Care 1999; 16:545-53. [PMID: 10661062 DOI: 10.1177/104990919901600312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is the fourth of a six-part series on the metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Parts two and three charted the natural histories, problems, and assessment parameters of advanced cancers of the breast, colon and rectum, esophagus, kidney, and liver; and leukemia. Part four provides corresponding information on lung cancer, malignant melanoma, and multiple myeloma. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncology emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able anticipate the spread of these cancers and can thus identify problems early in their development so that the problems are more easily managed.
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Affiliation(s)
- C Kemp
- Baylor University, School of Nursing, Dallas, TX, USA
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