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Sass R, Tandra PK, Shonka N, Manzer M. Primary clear cell sarcoma in the lung apex with spinal metastasis: a fatal outcome. BMJ Case Rep 2020; 13:13/1/e231556. [PMID: 31924706 DOI: 10.1136/bcr-2019-231556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clear cell sarcoma (CCS) is a rare tumour that manifests in tendons and aponeuroses of the distal extremities and comprises roughly 1% of all soft tissue cancers. Only two cases of a primary CCS arising in the lung have been reported in the literature, and neither were located in the lung apex. We report a case of a primary CCS located in the lung apex that originally presented as ptosis, as well as arm pain and weakness. Distant metastasis was discovered on diagnosis, which led to irreversible paraplegia and death of the patient.
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Affiliation(s)
- RemyGrace Sass
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Pavan Kumar Tandra
- Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Nicole Shonka
- Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Manzer
- Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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2
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Delatore LR. The Cancer Emergency Department-The Ohio State University James Cancer Center Experience. Emerg Med Clin North Am 2018; 36:631-636. [PMID: 30037448 DOI: 10.1016/j.emc.2018.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2015, The James Cancer Hospital's Emergency Department (ED) opened at The Ohio State University Wexner Medical Center's ED. Careful planning was undertaken to assure that the needs of patients with cancer would be addressed. Strong relationships between experts in hematology, oncology, and emergency medicine were built to maximize the positive impact. Ongoing reevaluation of operational needs facilitates optimal patient flow, resource use, and opportunities to build and develop new resources. The results are evident in improved patient satisfaction in the cancer ED and a much smoother flow of patients into the system.
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Affiliation(s)
- Luca R Delatore
- Department of Emergency Medicine, Emergency Services, Wexner Medical Center at The Ohio State University, 760 Prior Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
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Abstract
Superior vena cava syndrome occurs from obstruction of the superior vena cava. The most common cause is malignancy. Small cell lung cancer and non-Hodgkin lymphoma are the most frequent culprits. Intravascular devices associated with thrombus are becoming more common causes. Classic symptoms include edema, plethora, and distended veins of the face, neck, and chest; shortness of breath; cough; headache; and hoarseness. Treatment in the emergency department is mostly supportive, with head elevation, oxygen, and steroids. Rarely, emergent airway issues and cerebral edema must be addressed. Definitive treatment includes radiotherapy, chemotherapy, and stenting.
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Affiliation(s)
- Shelly Zimmerman
- Emergency Medicine Residency, Norman Regional Health Systems, GME Office, 901 North Porter, Norman, OK 73071, USA; Department of Family Medicine, Oklahoma State University College of Osteopathic Medicine, 1111 West 17th Street, # A247, Tulsa, OK 74107, USA.
| | - Matthew Davis
- Emergency Medicine Residency, Norman Regional Health Systems, GME Office, 901 North Porter, Norman, OK 73071, USA
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Abstract
The United States cancer population is growing and is projected to grow further. The current cancer population has a high rate of emergency department admission. Further training about oncologic emergencies may be needed and would ideally strive to care for the whole patient, including sequelae of the malignancy, progressive disease, symptom control, adverse effects of treatment, and palliative care. The James Cancer Hospital at The Ohio State University Wexner Medical Center and The University of Texas MD Anderson Cancer Center fellowship training programs in oncologic emergency medicine are described.
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Affiliation(s)
- Michael G Purcell
- Department of Emergency Medicine, The Ohio State University, 750 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, USA.
| | - Imad El Majzoub
- Department of Emergency Medicine, UT MD Anderson Cancer Center, 1515 Holcombe boulevard, Unit 1468, Houston, TX 77030, USA
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Pech-Alonso B, Fermín-Hernández C, Saavedra-de Rosas S, Cicero-Sabido R. Superior vena cava syndrome: Clinical considerations. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Morin S, Grateau A, Reuter D, de Kerviler E, de Margerie-Mellon C, de Bazelaire C, Zafrani L, Schlemmer B, Azoulay E, Canet E. Management of superior vena cava syndrome in critically ill cancer patients. Support Care Cancer 2017; 26:521-528. [PMID: 28836006 DOI: 10.1007/s00520-017-3860-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study is to describe the management and outcome of critically ill cancer patients with Superior Vena Cava Syndrome (SVCS). METHODS All cancer patients admitted to the medical intensive care unit (ICU) of the Saint-Louis University Hospital for a SVCS between January 2004 and December 2016 were included. RESULTS Of the 50 patients included in the study, obstruction of the superior vena cava was partial in two-thirds of the cases and complete in one-third. Pleural effusion was reported in two-thirds of the patients, pulmonary atelectasis in 16 (32%), and pulmonary embolism in five (10%). Computed tomography of the chest showed upper airway compression in 18 (36%) cases, while echocardiography revealed 22 (44%) pericardial effusions. The causes of SVCS were diagnosed one (0-3) day after ICU admission, using interventional radiology procedures in 70% of the cases. Thirty (60%) patients had hematological malignancies, and 20 (40%) had solid tumors. Fifteen (30%) patients required invasive mechanical ventilation, seven (14%) received vasopressors, and renal replacement therapy was implemented in three (6%). ICU, in-hospital, and 6-month mortality rates were 20, 26, and 48%, respectively. The cause of SVCS was the only factor independently associated with day 180 mortality by multivariate analysis. Patients with hematological malignancies had a lower mortality than those with solid tumors (27 versus 80%) (odds ratio 0.12, 95% confidence interval (0.02-0.60), p < 0.01). CONCLUSION Airway obstruction and pleural and pericardial effusions contributed to the unstable condition of cancer patients with SVCS. The vital prognosis of SVCS was mainly related to the underlying diagnosis.
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Affiliation(s)
- Sarah Morin
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Adeline Grateau
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Danielle Reuter
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Eric de Kerviler
- Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | | | - Cédric de Bazelaire
- Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Benoit Schlemmer
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.
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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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Emergencies in Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Torres VBL, Vassalo J, Silva UVA, Caruso P, Torelly AP, Silva E, Teles JMM, Knibel M, Rezende E, Netto JJS, Piras C, Azevedo LCP, Bozza FA, Spector N, Salluh JIF, Soares M. Outcomes in Critically Ill Patients with Cancer-Related Complications. PLoS One 2016; 11:e0164537. [PMID: 27764143 PMCID: PMC5072702 DOI: 10.1371/journal.pone.0164537] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. MATERIALS AND METHODS Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality. RESULTS Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94-1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11-12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57-5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04-3.71), P = 0.038] were independently associated with in-hospital mortality. CONCLUSIONS The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.
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Affiliation(s)
- Viviane B. L. Torres
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliana Vassalo
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Pedro Caruso
- ICU, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - André P. Torelly
- Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Eliezer Silva
- ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marcos Knibel
- Hospital São Lucas, Travessa Frederico Pamplona 32, Rio de Janeiro, Brazil
| | - Ederlon Rezende
- ICU, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - José J. S. Netto
- ICU, Instituto Nacional de Câncer, Hospital do Câncer II, Rio de Janeiro, Brazil
| | | | | | - Fernando A. Bozza
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Nelson Spector
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jorge I. F. Salluh
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marcio Soares
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- * E-mail:
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Straka C, Ying J, Kong FM, Willey CD, Kaminski J, Kim DWN. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. SPRINGERPLUS 2016; 5:229. [PMID: 27026923 PMCID: PMC4771672 DOI: 10.1186/s40064-016-1900-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/17/2016] [Indexed: 12/25/2022]
Abstract
Superior vena cava syndrome (SVCS) is a relatively common sequela of mediastinal malignancies and may cause significant patient distress. SVCS is a medical emergency if associated with laryngeal or cerebral edema. The etiologies and management of SVCS have evolved over time. Non-malignant SVCS is typically caused by infectious etiologies or by thrombus in the superior vena cava and can be managed with antibiotics or anti-coagulation therapy, respectively. Radiation therapy (RT) has long been a mainstay of treatment of malignant SVCS. Chemotherapy has also been used to manage SVCS. In the past 20 years, percutaneous stenting of the superior vena cava has emerged as a viable option for SVCS symptom palliation. RT and chemotherapy are still the only modalities that can provide curative treatment for underlying malignant etiologies of SVCS. The first experiences with treating SVCS with RT were reported in the 1970’s, and several advances in RT delivery have subsequently occurred. Hypo-fractionated RT has the potential to be a more convenient therapy for patients and may provide equal or superior control of underlying malignancies. RT may be combined with stenting and/or chemotherapy to provide both immediate symptom palliation and long-term disease control. Clinicians should tailor therapy on a case-by-case basis. Multi-disciplinary care will maximize treatment expediency and efficacy.
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Affiliation(s)
- Christopher Straka
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX 75390 USA
| | - James Ying
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX 75390 USA
| | - Feng-Ming Kong
- Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA USA
| | - Christopher D Willey
- Department of Radiation Oncology, The University of Alabama Birmingham, Birmingham, AL USA
| | - Joseph Kaminski
- Dattoli Cancer Center, 2803 Fruitville Rd, Sarasota, FL 34237 USA
| | - D W Nathan Kim
- Department of Radiation Oncology, Texas Oncology, 1700 W. Highway 6, Waco, TX 76712 USA
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Pleuritic chest pain in a young female: a reminder for acute health care providers. Case Rep Emerg Med 2014; 2014:824786. [PMID: 25247097 PMCID: PMC4163392 DOI: 10.1155/2014/824786] [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: 08/08/2014] [Accepted: 08/20/2014] [Indexed: 11/17/2022] Open
Abstract
Chest pain is one of the most common reasons for emergency department visits. Emergency medicine doctors should focus their initial assessment on patients' stability. History, physical examination, and ancillary testing should exclude serious causes such as acute coronary syndrome, acute aortic syndromes, pulmonary embolism, pneumothorax, esophageal perforation, and rupture as well as pericardial tamponade. Young age should not be used alone as a predictor of a benign condition. Below we present a case of a 24-year-old female who was found to have ascending aortic dissection and was sent for emergent surgery.
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