1
|
Angeli F, Bergamaschi L, Paolisso P, Armillotta M, Sansonetti A, Stefanizzi A, Canton L, Bodega F, Suma N, Amicone S, Fedele D, Bertolini D, Impellizzeri A, Tattilo FP, Cavallo D, Di Iuorio O, Ryabenko K, Marinelli V, Alvarez MC, Belà R, Bavuso LL, Asta C, Ciarlantini M, Pastore G, Rinaldi A, Rucci P, Foà A, Pizzi C. The Spectrum of ECG Abnormalities in a Large Cohort of Cardiac Masses. Heart Rhythm 2024:S1547-5271(24)02809-1. [PMID: 38909718 DOI: 10.1016/j.hrthm.2024.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/07/2024] [Accepted: 06/19/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Cardiac masses represent a heterogeneous clinical scenario. Potential electrocardiographic red flags of malignancy remain to be investigated. OBJECTIVES To describe the spectrum of electrocardiographic abnormalities in a large cohort of cardiac masses and to evaluate potential red flags suggestive of malignancy. METHODS Observational cohort study of 322 consecutive patients with a cardiac mass and available ECG at Bologna University Hospital. All masses were diagnosed by histological examination or, in the case of cardiac thrombi, by radiological resolution after proper anticoagulant therapy. Multivariable regression analysis was used to assess potential predictors of malignancy among electrocardiographic abnormalities. All-cause mortality at follow-up was evaluated. RESULTS Of 322 patients, 98 (30.4%) had malignant tumors. Compared with patients with benign masses, those with malignant tumors exhibited a higher heart rate, right axis deviation, greater depolarization, repolarization abnormalities and bradyarrhythmia at presentation. Regarding specific ECG features, a higher heart rate on admission (p=0.014), bradyarrhythmias (p=0.009), ischemic-like repolarization abnormalities (ST-segment deviation, both depression and elevation, and negative T-wave; p<0.001), low voltages (p=0.001) and right axial deviation (0.025) were identified as independent predictors of malignancy. Considering these specific ECG alterations, a malignancy-oriented ECG was associated with higher mortality at follow up (median time of 20.7 months). CONCLUSION ECG is frequently abnormal in case of malignant cardiac tumors. Some specific electrocardiographic changes are strongly suggestive for malignancy and type of infiltration.
Collapse
Affiliation(s)
- Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Pasquale Paolisso
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant'Ambrogio Hospital, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Damiano Fedele
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Davide Bertolini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Francesco Pio Tattilo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Daniele Cavallo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Ornella Di Iuorio
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Khrystyna Ryabenko
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Virginia Marinelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Marcello Casuso Alvarez
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Rebecca Belà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Leonardo Luca Bavuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Claudio Asta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Mariachiara Ciarlantini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Pastore
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Andrea Rinaldi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy;; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via, Giuseppe Massarenti 9, 40138, Bologna, Italy;.
| |
Collapse
|
2
|
Lorca MC, Chen I, Jew G, Furlani AC, Puri S, Haramati LB, Chaturvedi A, Velez MJ, Chaturvedi A. Radiologic-Pathologic Correlation of Cardiac Tumors: Updated 2021 WHO Tumor Classification. Radiographics 2024; 44:e230126. [PMID: 38722782 DOI: 10.1148/rg.230126] [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: 06/06/2024]
Abstract
Cardiac tumors, although rare, carry high morbidity and mortality rates. They are commonly first identified either at echocardiography or incidentally at thoracoabdominal CT performed for noncardiac indications. Multimodality imaging often helps to determine the cause of these masses. Cardiac tumors comprise a distinct category in the World Health Organization (WHO) classification of tumors. The updated 2021 WHO classification of tumors of the heart incorporates new entities and reclassifies others. In the new classification system, papillary fibroelastoma is recognized as the most common primary cardiac neoplasm. Pseudotumors including thrombi and anatomic variants (eg, crista terminalis, accessory papillary muscles, or coumadin ridge) are the most common intracardiac masses identified at imaging. Cardiac metastases are substantially more common than primary cardiac tumors. Although echocardiography is usually the first examination, cardiac MRI is the modality of choice for the identification and characterization of cardiac masses. Cardiac CT serves as an alternative in patients who cannot tolerate MRI. PET performed with CT or MRI enables metabolic characterization of malignant cardiac masses. Imaging individualized to a particular tumor type and location is crucial for treatment planning. Tumor terminology changes as our understanding of tumor biology and behavior evolves. Familiarity with the updated classification system is important as a guide to radiologic investigation and medical or surgical management. ©RSNA, 2024 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Maria Clara Lorca
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Irene Chen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Gregory Jew
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Andrea C Furlani
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Savita Puri
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Linda B Haramati
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Apeksha Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Moises J Velez
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Abhishek Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| |
Collapse
|
3
|
Planas S, Salvador N, Lavarino C, Zuccarino F, Pereda D, Muñoz JP, Clemente EA. Hamartoma of Mature Cardiac Myocytes presenting as a polypoid epicardial tumor in the interatrial groove and with gene fusions by copy number anomalies of chromosome 7. Cardiovasc Pathol 2024:107660. [PMID: 38821230 DOI: 10.1016/j.carpath.2024.107660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
Hamartoma of Mature Cardiac Myocytes (HMCM) is an extremely rare cardiac tumor characterized by benign growth of differentiated mature striated cardiac myocytes, and usually involves the ventricular myocardium. We describe the case of a 15-year-old female who presented with a short history of atrial fibrillation and a polypoid epicardial tumor that was attached to the interatrial groove by a short pedicle. The resected specimen showed features consistent with HMCM. Although these tumors are not associated with any known molecular or cytogenetic abnormalities, we identified fusions transcripts along with complex copy number anomalies of chromosome 7.
Collapse
Affiliation(s)
- Silvia Planas
- Anatomical Pathology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Noelia Salvador
- Laboratory of Molecular Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Cinzia Lavarino
- Laboratory of Molecular Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Flavio Zuccarino
- Radiology Department, Sant Joan de Déu Children Hospital, Barcelona, Spain; Radiology Department, Hospital del Mar, Barcelona, Spain.
| | - Daniel Pereda
- Cardiovascular Surgery Department, Hospital Clínic Barcelona.
| | - Juan Pablo Muñoz
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Barcelona, Spain.
| | | |
Collapse
|
4
|
Ye JR, Chang YT, Wang CC, Huang JH, Huang SC, Wu ET. Cardiac lymphangioma encasing the right coronary artery: A case report. Pediatr Neonatol 2024; 65:308-309. [PMID: 38336595 DOI: 10.1016/j.pedneo.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Jing-Ren Ye
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Ya-Ting Chang
- Department of Pediatrics, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Chieh Wang
- Department of Pathology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Jou-Hsuan Huang
- Department of Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| |
Collapse
|
5
|
Nistor C, Stanciu Gavan C, Birceanu A, Betianu C, Carsote M, Cucu AP, Stanciu M, Popa FL, Ciuche A, Ciobica ML. Primary Cardiac Intimal Sarcoma: Multi-Layered Strategy and Core Role of MDM2 Amplification/Co-Amplification and MDM2 Immunostaining. Diagnostics (Basel) 2024; 14:919. [PMID: 38732333 PMCID: PMC11083306 DOI: 10.3390/diagnostics14090919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Primary cardiac tumours are relatively uncommon (75% are benign). Across the other 25%, representing malignant neoplasia, sarcomas account for 75-95%, and primary cardiac intimal sarcoma (PCIS) is one of the rarest findings. We aimed to present a comprehensive review and practical considerations from a multidisciplinary perspective with regard to the most recent published data in the specific domain of PCIS. We covered the issues of awareness amid daily practice clinical presentation to ultra-qualified management in order to achieve an adequate diagnosis and prompt intervention, also emphasizing the core role of MDM2 immunostaining and MDM2 genetic analysis. An additional base for practical points was provided by a novel on-point clinical vignette with MDM2-positive status. According to our methods (PubMed database search of full-length, English publications from January 2021 to March 2023), we identified three studies and 23 single case reports represented by 22 adults (male-to-female ratio of 1.2; male population with an average age of 53.75 years, range: 35-81; woman mean age of 55.5 years, range: 34-70) and a 4-year-old child. The tumour-related clinical picture was recognized in a matter of one day to ten months on first admission. These non-specific data (with a very low index of suspicion) included heart failure at least NYHA class II, mitral regurgitation and pulmonary hypertension, acute myocardial infarction, ischemic stroke, obstructive shock, and paroxysmal atrial fibrillation. Awareness might come from other complaints such as (most common) dyspnoea, palpitation, chest pressure, cough, asthenia, sudden fatigue, weakness, malaise, anorexia, weight loss, headache, hyperhidrosis, night sweats, and epigastric pain. Two individuals were initially misdiagnosed as having endocarditis. A history of prior treated non-cardiac malignancy was registered in 3/23 subjects. Distant metastasis as the first step of detection (n = 2/23; specifically, brain and intestinal) or during follow-up (n = 6/23; namely, intestinal, brain and bone, in two cases for each, and adrenal) required additional imagery tools (26% of the patients had distant metastasis). Transoesophageal echocardiography, computed tomography (CT), magnetic resonance imagery, and even 18F-FDG positronic emission tomography-CT (which shows hypermetabolic lesions in PCIS) represent the basis of multimodal tools of investigation. Tumour size varied from 3 cm to ≥9 cm (average largest diameter of 5.5 cm). The most frequent sites were the left atrium followed by the right ventricle and the right atrium. Post-operatory histological confirmation was provided in 20/23 cases and, upon tumour biopsy, in 3/23 of them. The post-surgery maximum free-disease interval was 8 years, the fatal outcome was at the earliest two weeks since initial admission. MDM2 analysis was provided in 7/23 subjects in terms of MDM2-positive status (two out of three subjects) at immunohistochemistry and MDM2 amplification (four out of five subjects) at genetic analysis. Additionally, another three studies addressed PCISs, and two of them offered specific MDM2/MDM2 assays (n = 35 patients with PCISs); among the provided data, we mention that one cohort (n = 20) identified a rate of 55% with regard to MDM2 amplification in intimal sarcomas, and this correlated with a myxoid pattern; another cohort (n = 15) showed that MDM2-positive had a better prognostic than MDM2-negative immunostaining. To summarize, MDM2 amplification and co-amplification, for example, with MDM4, CDK4, HMGA3, CCND3, PDGFRA, TERT, KIT, CCND3, and HDAC9, might improve the diagnosis of PCIS in addition to MDM2 immunostaining since 10-20% of these tumours are MDM2-negative. Further studies are necessary to highlight MDM2 applicability as a prognostic factor and as an element to be taken into account amid multi-layered management in an otherwise very aggressive malignancy.
Collapse
Affiliation(s)
- Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.N.); (A.C.)
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
| | - Camelia Stanciu Gavan
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
| | - Adelina Birceanu
- Pathology and Immunohistochemistry Laboratory, Pathoteam Diagnostic, 051923 Bucharest, Romania;
| | - Cezar Betianu
- Department of Interventional Imaging, “Doctor Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania
| | - Anca-Pati Cucu
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Adrian Ciuche
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.N.); (A.C.)
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| |
Collapse
|
6
|
Camargo FM, Brizot MDL, Francisco RPV, de Carvalho WB, Ikari NM, Peres SV, Lopes MAB, Lopes LM. Perinatal Results and Long-Term Follow-Up of Fetal Cardiac Tumors: A 30-Year Historical Cohort Study. Arq Bras Cardiol 2024; 121:e20220469. [PMID: 38536996 PMCID: PMC11081142 DOI: 10.36660/abc.20220469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 05/28/2023] [Accepted: 10/04/2023] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND This was a 30-year retrospective cohort study that approximates closely to the natural history of cardiac tumors diagnosed in the fetus, since there was no case of pregnancy interruption. OBJECTIVE To assess morbidity and mortality in the perinatal period and at long term in fetuses diagnosed with cardiac tumor. Our secondary objective was to assess the evaluating factors of perinatal and postnatal results. METHODS This was a retrospective cohort study with 74 pregnant women with an echocardiographic diagnosis of fetal cardiac tumor at two referral centers between May 1991 and November 2021. A descriptive analysis was performed, and data were expressed as absolute (n) and relative (%) frequencies, median and interquartile range. Fisher's exact test was used to evaluate the association of echocardiographic characteristics and clinical manifestations with perinatal and postnatal results. Global survival was calculated using the Kaplan-Meier method and the curves were compared by the log-rank test. The time of follow-up, calculated in months, corresponded to the time elapsed from hospital discharge to current status (survived/ censoring or death). The level of significance was set at 5% (p<0.05). RESULTS Rhabdomyoma is the most common type of cardiac tumor (85%), with a high morbidity (79.3%) and overall mortality of 17.4%. The presence of fetal hydrops was a predictor of death. CONCLUSION The presence of fetal hydrops had an impact on mortality, and hence is an important factor in counselling and determining the prognosis. Most deaths occurred before hospital discharge.
Collapse
Affiliation(s)
- Fabricio Marcondes Camargo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Maria de Lourdes Brizot
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Rossana Pulcineli Vieira Francisco
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Werther Brunow de Carvalho
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Nana Miura Ikari
- Universidade de São PauloFaculdade de medicinaSão PauloSPBrasilUniversidade de São Paulo – Faculdade de medicina, São Paulo, SP – Brasil
| | - Stella Verzinhasse Peres
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Marco Antônio Borges Lopes
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Lilian Maria Lopes
- Cardiologia e Ecocardiografia Fetal Pediátrica e MaternaSão PauloSPBrasilECOKID – Cardiologia e Ecocardiografia Fetal Pediátrica e Materna, São Paulo, SP – Brasil
| |
Collapse
|
7
|
Huang W, Zheng Z, Zhang Y, Qiu Y, Peng Y, Yang Q, Wang W, Kang L. A rare case of primary cardiac diffuse large B-cell lymphoma imaged with 18F-FDG PET/CT: a case report and literature review. Front Med (Lausanne) 2024; 11:1373773. [PMID: 38576712 PMCID: PMC10993256 DOI: 10.3389/fmed.2024.1373773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
Background One of the exceptionally rare forms of non-Hodgkin's lymphoma (NHL) is primary cardiac lymphoma (PCL). The principal clinical manifestation in patients with PCL involves cardiac symptoms resulting from myocardial infiltration by lymphoma, including arrhythmias, heart failure, and chest pain. 18F-FDG PET/CT serves as a reliable and indispensable imaging modality for assessing clinically staging NHL. Case report We present a rare case involving a 72-year-old woman diagnosed with primary intracardiac diffuse large B-cell lymphoma. For further staging, the patient underwent 18F-FDG PET/CT, revealing multiple nodular soft tissue density lesions in the heart and pericardium exhibiting increased FDG metabolism (SUVmax = 12.1). The supradiaphragmatic and infradiaphragmatic segments of the inferior vena cava exhibited irregular morphology with localized nodular changes and increased FDG metabolism in the surrounding area (SUVmax = 9.7). Additionally, multiple enlarged lymph nodes were identified in the left axilla, mediastinum, and adjacent to the abdominal aorta, displaying heterogeneous FDG uptake with an SUVmax of 9.3, indicating lymphoma involvement. The above imaging findings suggested that the mass was a PCL. Hence, the patient underwent a combination of chemotherapy and immunotherapy using R-CDOP (rituximab, cyclophosphamide, liposomal doxorubicin, vincristine, and prednisone). Following two courses of treatment within a span of 2 months, there was a partial remission observed in the cardiac lymphoma and the enlarged lymph nodes. Conclusion The case elucidated in this report contributes to an enhanced understanding of the disease for clinicians, with 18F-FDG PET/CT providing comprehensive insights into the extent of cardiac involvement, as well as the engagement of extracardiac organs and pathologic lymph nodes. The 18F-FDG PET/CT examination not only visually delineates the lesion's location and extent but also serves as a cornerstone for clinical tumor staging, offering valuable support for treatment monitoring and subsequent follow-up.
Collapse
Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zuohuan Zheng
- Department of Traditional Chinese Medicine, The Seventh People's Hospital of Chongqing, Chongqing, China
| | - Yongbai Zhang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yongkang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yushuo Peng
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Qi Yang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Wei Wang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| |
Collapse
|
8
|
Paolisso P, Bergamaschi L, Angeli F, Belmonte M, Foà A, Canton L, Fedele D, Armillotta M, Sansonetti A, Bodega F, Amicone S, Suma N, Gallinoro E, Attinà D, Niro F, Rucci P, Gherbesi E, Carugo S, Musthaq S, Baggiano A, Pavon AG, Guglielmo M, Conte E, Andreini D, Pontone G, Lovato L, Pizzi C. Cardiac Magnetic Resonance to Predict Cardiac Mass Malignancy: The CMR Mass Score. Circ Cardiovasc Imaging 2024; 17:e016115. [PMID: 38502734 PMCID: PMC10949976 DOI: 10.1161/circimaging.123.016115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Multimodality imaging is currently suggested for the noninvasive diagnosis of cardiac masses. The identification of cardiac masses' malignant nature is essential to guide proper treatment. We aimed to develop a cardiac magnetic resonance (CMR)-derived model including mass localization, morphology, and tissue characterization to predict malignancy (with histology as gold standard), to compare its accuracy versus the diagnostic echocardiographic mass score, and to evaluate its prognostic ability. METHODS Observational cohort study of 167 consecutive patients undergoing comprehensive echocardiogram and CMR within 1-month time interval for suspected cardiac mass. A definitive diagnosis was achieved by histological examination or, in the case of cardiac thrombi, by histology or radiological resolution after adequate anticoagulation treatment. Logistic regression was performed to assess CMR-derived independent predictors of malignancy, which were included in a predictive model to derive the CMR mass score. Kaplan-Meier curves and Cox regression were used to investigate the prognostic ability of predictors. RESULTS In CMR, mass morphological features (non-left localization, sessile, polylobate, inhomogeneity, infiltration, and pericardial effusion) and mass tissue characterization features (first-pass perfusion and heterogeneity enhancement) were independent predictors of malignancy. The CMR mass score (range, 0-8 and cutoff, ≥5), including sessile appearance, polylobate shape, infiltration, pericardial effusion, first-pass contrast perfusion, and heterogeneity enhancement, showed excellent accuracy in predicting malignancy (areas under the curve, 0.976 [95% CI, 0.96-0.99]), significantly higher than diagnostic echocardiographic mass score (areas under the curve, 0.932; P=0.040). The agreement between the diagnostic echocardiographic mass and CMR mass scores was good (κ=0.66). A CMR mass score of ≥5 predicted a higher risk of all-cause death (P<0.001; hazard ratio, 5.70) at follow-up. CONCLUSIONS A CMR-derived model, including mass morphology and tissue characterization, showed excellent accuracy, superior to echocardiography, in predicting cardiac masses malignancy, with prognostic implications.
Collapse
Affiliation(s)
- Pasquale Paolisso
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Italy (P.P., M.B.)
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Marta Belmonte
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Italy (P.P., M.B.)
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (M.B.)
| | - Alberto Foà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Damiano Fedele
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Emanuele Gallinoro
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy (E. Gherbesi, S.C.)
| | - Domenico Attinà
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Fabio Niro
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum (P.R.), University of Bologna, Italy
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy (E. Gherbesi, S.C.)
| | - Saima Musthaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (S.M., A.B.)
| | - Andrea Baggiano
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (S.M., A.B.)
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (A.G.P.)
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, the Netherlands (M.G.)
| | - Edoardo Conte
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
| | - Daniele Andreini
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
- Department of Biomedical, Surgical and Dentals Sciences (G.P.), University of Milan, Italy
| | - Luigi Lovato
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| |
Collapse
|
9
|
Li T, Zhang S, Liu C, Peng X, Gong S, Pan W, Wang Y. Long-Term Efficacy Analysis of Surgical Resection of 70 Primary Right Heart Tumors. Cardiology 2024; 149:147-154. [PMID: 38417418 PMCID: PMC10994591 DOI: 10.1159/000535656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/01/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION The aim of the study was to investigate the clinical characteristics, surgical treatment, and long-term efficacy of primary right heart tumors. METHODS This study is retrospective analysis of the clinical data of 70 patients with primary right heart tumors admitted to our department between 1980 and 2022 (observation group) and 70 patients with left heart tumors during the same period (control group). The surgical treatment was performed under cardiopulmonary bypass after differential diagnosis by echocardiography, cardiac CTA, and PET-CT before the surgery. The perioperative characteristics, recurrence rate, and long-term survival rates of right heart tumor versus left heart tumor were compared. RESULTS The most common pathological types of right heart tumors were myxoma (60%), lipoma (8.57%), and papillary elastofibroma (7.14%). During the perioperative period, there were 1 case of systemic embolism in the observation group, compared with 6 in the control group (p = 0.026), 13 cases of malignant tumor in the observation group versus 1 in the control group (p = 0.01). During the follow-up period, there were 15 cases of tumor recurrence and 17 cases of death in the observation group versus 4 (p = 0.002) and 7 in the control group (p = 0.006), comparatively. CONCLUSION Compared with left heart tumors, primary right heart tumors had a higher incidence of malignant tumors and a lower risk of systemic embolism during perioperative period. During the follow-up period, primary right heart tumors had a higher rate of tumor recurrence and a lower long-term survival rate.
Collapse
Affiliation(s)
- Tianbo Li
- Center of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Si Zhang
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Liu
- Center of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaobo Peng
- Center of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Siming Gong
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Wencheng Pan
- Center of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yong Wang
- Center of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| |
Collapse
|
10
|
Li J, Liu J, Yao X, Yang J. A rare inflammatory myofibroblastic tumor appearing both inside and outside the heart. Eur J Med Res 2024; 29:132. [PMID: 38368344 PMCID: PMC10874007 DOI: 10.1186/s40001-024-01710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) is an uncommon cardiac tumor that primarily affects infants, children, and young adults. While complete surgical resection generally leads to a favorable prognosis, accurate diagnostic tests remain limited. CASE PRESENTATION We describe the case of a 26-year-old female who had a dual tumor inside and outside the heart and was misdiagnosed by echocardiography and MRI. We also review 71 cases of cardiac IMTs from the literature regarding their epidemiology, clinical presentation, and outcome. CONCLUSION Early detection of this rare disorder is essential for optimal surgical management.
Collapse
Affiliation(s)
- Jiarong Li
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China
| | - Jijia Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China
| | - Xingwang Yao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China.
| |
Collapse
|
11
|
Köster LS, Newkirk K, Krawec P. A case report: Null-cell cardiac lymphoma in an English bulldog. Front Vet Sci 2024; 11:1256442. [PMID: 38384958 PMCID: PMC10879359 DOI: 10.3389/fvets.2024.1256442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
This case report describes a novel example of an extranodal null-type lymphoma in the myocardium of a middle-aged English bulldog who presented with signs of right heart failure. An echocardiogram found, in addition to the pericardial effusion, thickened right and left ventricular free walls and the interventricular septum. The right ventricular free wall myocardium had multinodular lesions, suspicious for infiltrative disease. The owner elected humane euthanasia, and permission for necropsy was obtained. Multifocal left and right ventricular nodules and an incidental aortic root mass were detected, the latter of which was later confirmed as a chemodectoma. Microscopically, the myocardial nodules were sheets of round cells consistent with a high-grade lymphoma. Neoplastic cells were not immunoreactive to CD3 (T-cell) or CD20 and CD79a (B-cell), Mum-1 (plasma cell), CD117 (mast cell), or CD18 (histiocyte). These findings are consistent with a high-grade, null-cell-type lymphoma.
Collapse
Affiliation(s)
- Liza S. Köster
- Department of Small Animal Clinical Sciences, C247 Veterinary Medical Center, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Kim Newkirk
- Department of Biomedical Sciences and Diagnostic Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Philip Krawec
- Department of Small Animal Clinical Sciences, C247 Veterinary Medical Center, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| |
Collapse
|
12
|
Potey K, Jhajhria N, Mallik M, Bhushan R, Aiyer P, Grover V. Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted? Braz J Cardiovasc Surg 2024; 39:e20230040. [PMID: 38315074 PMCID: PMC10836847 DOI: 10.21470/1678-9741-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/06/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. METHODS A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. RESULTS A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. CONCLUSION Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.
Collapse
Affiliation(s)
- Ketika Potey
- Department of Cardiothoracic and Vascular Surgery, Dr Ram Manohar
Lohia Hospital and Post Graduate Institute of Medical Education and Research, New
Delhi, New Delhi, India
| | - Narender Jhajhria
- Department of Cardiothoracic and Vascular Surgery, Dr Ram Manohar
Lohia Hospital and Post Graduate Institute of Medical Education and Research, New
Delhi, New Delhi, India
| | - Manish Mallik
- Department of Cardiothoracic and Vascular Surgery, Dr Ram Manohar
Lohia Hospital and Post Graduate Institute of Medical Education and Research, New
Delhi, New Delhi, India
| | - Rahul Bhushan
- Department of Cardiothoracic and Vascular Surgery, Dr Ram Manohar
Lohia Hospital and Post Graduate Institute of Medical Education and Research, New
Delhi, New Delhi, India
| | - Palash Aiyer
- Department of Cardiothoracic and Vascular Surgery, Dr Ram Manohar
Lohia Hospital and Post Graduate Institute of Medical Education and Research, New
Delhi, New Delhi, India
| | - Vijay Grover
- Department of Cardiothoracic and Vascular Surgery, Dr Ram Manohar
Lohia Hospital and Post Graduate Institute of Medical Education and Research, New
Delhi, New Delhi, India
| |
Collapse
|
13
|
Wang Q, Wang B, Zhang X, Zhong X, Chang S, Yang J, Liang J, You Q, Zhou H, Zhang J. The usefulness of contrast echocardiography in the evaluation of cardiac masses: a multicenter study. BMC Cardiovasc Disord 2024; 24:43. [PMID: 38218809 PMCID: PMC10787966 DOI: 10.1186/s12872-024-03708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Cardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE. METHODS Between April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2). RESULTS The final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively. CONCLUSIONS Combined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.
Collapse
Affiliation(s)
- Qingtao Wang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Bing Wang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Xiaofeng Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Xin Zhong
- Department of Ultrasound, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410002, China
| | - Shuai Chang
- Department of Ultrasound, First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Jinbo Yang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Jian Liang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Qiangqiang You
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Heng Zhou
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
| | - Jiaqi Zhang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
| |
Collapse
|
14
|
Killian M, Barry T, Larsen C, Alsidawi S. Case series: cardiac sarcoma. Eur Heart J Case Rep 2023; 7:ytad546. [PMID: 38046649 PMCID: PMC10691649 DOI: 10.1093/ehjcr/ytad546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/22/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
Background Cardiac masses encompass a wide differential including primary and secondary malignancies and can present with a variety of symptoms, many of which are non-specific. Early identification and classification are important, particularly for cardiac malignancies such as sarcomas as these are aggressive tumours with exceptionally poor prognoses when metastases are present at diagnosis. Case summary We report two cases of patients who presented with dyspnoea and were diagnosed with cardiac sarcomas; the former a primary sarcoma (undifferentiated pleomorphic subtype) and the latter a secondary sarcoma (round cell myxoid liposarcoma) that serve as comparisons for presentation and management of different types of this disease. Computed Tomography (CT) and echocardiography imaging findings are demonstrated showing the typical location and morphology of each subtype. Discussion Cardiac sarcomas are the most common primary cardiac malignancy, of which undifferentiated pleomorphic sarcoma is a common subtype. Undifferentiated pleomorphic sarcomas are aggressive, have a tendency to arise in the left atrium, and can appear similar to benign cardiac masses. Round cell myxoid liposarcomas by contrast are rare causes of secondary cardiac malignancies, metastasizing to the heart from soft tissues. Both diagnoses carry poor prognoses and although rare, are important to recognize as timely intervention with surgery, radiotherapy, and consideration of chemotherapy is key to maximizing survival.
Collapse
Affiliation(s)
- Michael Killian
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Timothy Barry
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Carolyn Larsen
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Said Alsidawi
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| |
Collapse
|
15
|
Machida N, Sasaki T, Kimura Y. Pathological features of primary cardiac myxoid tumour in dogs: a review of 11 cases (2002-2022). J Comp Pathol 2023; 207:50-58. [PMID: 37944473 DOI: 10.1016/j.jcpa.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/30/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
This report documents the pathological features of primary cardiac myxoid tumour (MT) in 11 dogs. Macroscopically, all the tumours were located in the tricuspid valve (TV), its septal leaflet being predominantly affected. Therefore, it appears that the TV is the most common site of occurrence for cardiac MT in dogs. Two gross anatomical types of canine valvular MT were evident. Seven of the 11 tumours were round or oval with a smooth or gently lobulated and glistening surface, while the other four were gelatinous, multilobulated and polypoid, with an irregular surface. Microscopically, in nine cases the tumours had an abundant myxoid matrix within which elongated spindle-shaped cells with no remarkable cytological atypia were sparsely embedded, suggesting a benign character (ie, myxoma). In the other two cases the tumours consisted of variably dense, haphazardly arranged, interlacing streams of anaplastic spindle-shaped or polygonal cells containing many mitotic figures, indicative of a malignant form of myxoma (ie, myxosarcoma). Isolated or clustered collections of myxoma cells (eg, cords, rings, syncytia) characteristic of human atrial myxoma were only rarely evident or lacking in all 11 cases, indicating that rarity or absence of such structural features may be specific to valvular MTs. Immunohistochemical findings were indicative of smooth muscle differentiation of the neoplastic cells. Tumour embolization to the intrapulmonary arteries and/or tumour implantation on the endocardium of the right heart chambers was evident only in the four cases of irregular-surfaced MT.
Collapse
Affiliation(s)
- Noboru Machida
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan.
| | - Takafumi Sasaki
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| | - Yusuke Kimura
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| |
Collapse
|
16
|
Ghantous E, Hochstadt A, Aviram G, Perry C, Ingbir M, Havakuk O, Banai S, Topilsky Y, Laufer-Perl M. Primary Cardiac Lymphoma Patients Presenting With Heart Failure. CASE (PHILADELPHIA, PA.) 2023; 7:449-455. [PMID: 38028382 PMCID: PMC10679538 DOI: 10.1016/j.case.2023.08.008] [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
•DLBCL is the most common type of lymphoma with cardiac involvement. •Obtaining tissue for diagnosis may be challenging in PCLs. •A safe diagnostic procedure may diagnose DLBCL patients with cardiac masses. •R-CHOP chemotherapy protocol is the standard treatment for PCL.
Collapse
Affiliation(s)
- Eihab Ghantous
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Aviram
- Division of Radiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Division of Hematology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Ingbir
- Department of Internal Medicine J, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Havakuk
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Laufer-Perl
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Foster J, Parsons S. Histiocytoid cardiomyopathy presenting as sudden death in an 18-month-old infant. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00730-2. [PMID: 37831311 DOI: 10.1007/s12024-023-00730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Histiocytoid cardiomyopathy (HC) is an arrhythmogenic disorder, usually involving children under two years of age with a strong Caucasian and female predominance. The disease is fatal in the vast majority and diagnosis is nearly always established at autopsy, but this is only possible with adequate myocardial sampling. Meticulous gross and histological examination of the heart in collaboration with a cardiovascular-trained pathologist maximises the opportunity to make specific diagnoses (and therefore rule out the differentials of SIDS, SUDC and child abuse), guide genetic testing, and inform potentially life-saving medical interventions for blood relations. We present a typical HC case presenting as sudden death, without prodrome, in a previously healthy 18-month-old boy. The disease is characterised histologically by discrete groups of enlarged, polygonal histiocyte-like cells with distinct margins and abundant faintly eosinophilic foamy cytoplasm. Cells often contain coarse granules, microvacuoles and irregular, round nuclei. In our case, dysplastic fascicles were predominantly located immediately deep to the endocardium of the left ventricle. We report our own autopsy findings with histological images, and discuss the expected clinical, morphological and ultrastructural features of the disease.
Collapse
Affiliation(s)
- Jacob Foster
- School of Medicine, Cardiff University, Cardiff, Wales, UK.
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Melbourne, VIC, Australia
- Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
18
|
Medina Perez M, Lichtenberger JP, Huppmann AR, Gomez M, Ramirez Suarez KI, Foran A, Vaiyani D, White AM, Biko DM. Cardiac and Pericardial Neoplasms in Children: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230010. [PMID: 37561644 DOI: 10.1148/rg.230010] [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: 08/12/2023]
Abstract
Primary cardiac and pericardial neoplasms are rare in the pediatric population and can include both benign and malignant lesions. Rhabdomyomas, teratomas, fibromas, and hemangiomas are the most common benign tumors. The most common primary cardiac malignancies are soft-tissue sarcomas, including undifferentiated sarcomas, rhabdomyosarcomas, and fibrosarcomas. However, metastatic lesions are more common than primary cardiac neoplasms. Children with primary cardiac and pericardial tumors may present with nonspecific cardiovascular symptoms, and their clinical presentation may mimic that of more common nonneoplastic cardiac disease. The diagnosis of cardiac tumors has recently been facilitated using noninvasive cardiac imaging. Echocardiography is generally the first-line modality for evaluation. Cardiac MRI and CT are used for tissue characterization and evaluation of tumor size, extension, and physiologic effect. The varied imaging appearances of primary cardiac neoplasms can be explained by their underlying abnormality. Treatment of these lesions varies from conservative management, with spontaneous regression of some lesions such as rhabdomyomas, to surgical resection, particularly in patients with associated heart failure. With adequate imaging techniques and knowledge of the pathologic basis of the neoplasm, it is often possible to differentiate benign from malignant tumors, which can greatly affect adequate and timely treatment. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Mariangeles Medina Perez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - John P Lichtenberger
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Alison R Huppmann
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Mariangela Gomez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Karen I Ramirez Suarez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ann Foran
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Danish Vaiyani
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ammie M White
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - David M Biko
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| |
Collapse
|
19
|
Schafer EA, Maldonado M, Iskander PA, Aloysius MM. An Intracardiac Atrioventricular Vena Caval Mass: A Case Report. Cureus 2023; 15:e45928. [PMID: 37766774 PMCID: PMC10520998 DOI: 10.7759/cureus.45928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 09/29/2023] Open
Abstract
Cardiac tumors (CTs) and intracardiac masses are rare, with an incidence of 1 per 2 million people annually. We present a case of an intracardiac mass where the patient exhibited progressive lower extremity swelling, night sweats, and diarrhea. Computed tomography of the chest with intravenous contrast revealed a sizable intracardiac mass with mixed attenuation and signs of metastatic lesions, suggesting a malignant process. This case stands out due to its uncommon presentation, considerable size, and extension from the right atrium into the right ventricle and the inferior vena cava. Although the exact etiology remains unclear because of the absence of a biopsy, it was presumed to be a type of sarcoma. Owing to significant cardiac obstruction, the patient's condition worsened rapidly, culminating in a fatal outcome mere days after the initial presentation. While there are multiple approaches to identify and treat CTs, their propensity to grow quietly until they reach a size large enough to cause fatal symptoms restricts opportunities for early detection and treatment.
Collapse
Affiliation(s)
- Eric A Schafer
- Radiology, A.T. Still University-School of Osteopathic Medicine in Arizona, Mesa, USA
| | | | - Peter A Iskander
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Mark M Aloysius
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| |
Collapse
|
20
|
Zhou M, Yao Y, Wang X, Zha L, Chen Y, Li Y, Wang M, Yu C, Zhou Y, Li Q, Cao Z, Wu J, Shi S, Jiang D, Long D, Wang J, Wang Q, Cheng X, Liao Y, Tu X. Crosstalk between KIF1C and PRKAR1A in left atrial myxoma. Commun Biol 2023; 6:724. [PMID: 37452081 PMCID: PMC10349109 DOI: 10.1038/s42003-023-05094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Cardiac myxoma (CM) is the most common benign cardiac tumor, and most CMs are left atrial myxomas (LAMs). Six variations of KIF1C, c.899 A > T, c.772 T > G, c.352 A > T, c.2895 C > T, c.3049 G > A, and c.*442_*443dup in left atrial myxoma tissues are identified by whole-exome sequencing (WES) and Sanger sequencing. RNA-seq and function experiments show the reduction of the expression of KIF1C and PRKAR1A caused by rare variations of KIF1C. KIF1C is observed to be located in the nucleus, bind to the promoter region of PRKAR1A, and regulate its transcription. Reduction of KIF1C decreases PRKAR1A expression and activates the PKA, which causes an increase in ERK1/2 phosphorylation and SRC-mediated STAT3 activation, a reduction of CDH1, TP53, CDKN1A, and BAX, and eventually promotes tumor formation both in vitro and in vivo. The results suggest that inhibition of KIF1C promotes the pathogenesis of LAM through positive feedback formed by the crosstalk between KIF1C and PRKAR1A.
Collapse
Affiliation(s)
- Mengchen Zhou
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
- National Demonstration Center for Experimental Basic Medical Education, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Xiangyi Wang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Lingfeng Zha
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yilin Chen
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yanze Li
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Mengru Wang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Chenguang Yu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yingchao Zhou
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Qianqian Li
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Zhubing Cao
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Jianfei Wu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Shumei Shi
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Dan Jiang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Qing Wang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xiang Cheng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuhua Liao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Xin Tu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China.
| |
Collapse
|
21
|
Lin YC, Liu HC, Hou JY, Shih BF, Yeh TC. Pediatric Cardiac Lymphoblastic Lymphoma: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2023; 45:281-284. [PMID: 37079907 DOI: 10.1097/mph.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/14/2023] [Indexed: 04/22/2023]
Abstract
Cardiac lymphoma is rare in children. Treatment typically includes chemotherapy, combination of radiotherapy, or surgery. We report a case of stage IV precursor B lymphoblastic lymphoma with secondary involvement of the heart in an 11-year-old girl who was treated with acute lymphoblastic leukemia-based chemotherapy. Also, we review the literature on this uncommon malignancy.
Collapse
Affiliation(s)
- Yi-Chen Lin
- Department of Pediatrics, MacKay Children's Hospital
| | - Hsi-Che Liu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, MacKay Children's Hospital and Mackay Medical College
| | - Jen-Yin Hou
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, MacKay Children's Hospital and Mackay Medical College
| | - Bing-Fu Shih
- Department of Nuclear Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, MacKay Children's Hospital and Mackay Medical College
| |
Collapse
|
22
|
Yang Z, Niu Y, Ma H, Gong W, Yu L, Liu L, Zheng M. Contrast-enhanced echocardiographic diagnosis of benign and malignant cardiac tumors and its correlation with pathology. Front Cardiovasc Med 2023; 10:1182334. [PMID: 37363101 PMCID: PMC10285073 DOI: 10.3389/fcvm.2023.1182334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background This study aimed to explore the diagnostic value of contrast-enhanced echocardiography (CEE) in benign and malignant cardiac tumors and detect the correlation of CEE parameters and immunohistochemistry (IHC) markers. Methods The data of 44 patients with cardiac tumors confirmed by pathology were reviewed. Lesions were examined before surgery using transthoracic echocardiography (TTE) and CEE with time-intensity curve analysis. The expression of CD31, VEGF and Ki67 was measured by IHC staining. Microvessel density (MVD) was quantified via IHC for CD31. The clinical variables, TTE, CEE and IHC parameters were compared between benign and malignant cardiac tumors. Receiver operating characteristic curve were used to analyze the value of factors in predicting malignant cardiac tumors. The correlation between CEE and IHC parameters was analyzed. Results Among 44 cardiac tumors, 34 were benign and 10 were malignant. There were significant differences in the TTE parameters (pericardial effusion, tumor boundary, diameter, basal width), CEE parameters (tumor peak intensity (TPI), peak intensity ratio of tumor to myocardium (TPI/MPI), area under time-intensity curve (AUTIC)) and IHC parameters (Ki67, MVD, CD31, VEGF) between the benign and malignant tumor groups (all P < 0.05). Receiver operating characteristic curve analysis showed that the CEE and IHC parameters had diagnostic value in malignant cardiac tumors. There was a correlation between TPI/MPI and Ki67 (r = 0.62), AUTIC and Ki67 (r = 0.50), and AUTIC and CD31 (r = 0.56). Conclusion TTE and CEE parameters were different between benign and malignant cardiac tumors. CEE is helpful to differentiate the properties of cardiac tumors. There is a correlation between CEE parameters and IHC markers. AUTIC and TPI/MPI can reflect the proliferation and invasion of tumors.
Collapse
Affiliation(s)
- Zihao Yang
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yicui Niu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Hui Ma
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Wenqing Gong
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Lu Yu
- Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Minjuan Zheng
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| |
Collapse
|
23
|
Sun Y, Li Z, Sun J, Ma D, Shan X, Chen X. Somatic Mutation of PRKAR1A in Four Cases of Sporadic Cardiac Myxoma. ARCHIVES OF IRANIAN MEDICINE 2023; 26:346-354. [PMID: 38310436 PMCID: PMC10685830 DOI: 10.34172/aim.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/02/2022] [Indexed: 02/05/2024]
Abstract
BACKGROUND Inactivating mutations of the protein kinase A regulatory subunit 1 alpha (PRKAR1A) gene have been reported in familial cardiac myxoma. However, the role of PRKAR1A mutation in sporadic cardiac myxoma remains unknown. METHODS Targeted next-generation sequencing (NGS) was performed to identify mutations with the PRKAR1A gene in seven cases of sporadic cardiac myxomas. Sanger sequencing of DNA from cardiac myxoma specimens and matched peripheral blood samples was performed to verify the identified mutations. RESULTS Targeted NGS of myxoma DNA revealed 232 single nucleotide variants in 141 genes and 38 insertion-deletion mutations in 13 genes. Six PRKAR1A mutations were identified in four of the seven cardiac myxoma cases, and thus, the PRKAR1A inactivating mutation rate was 57.2% (4/7, 95% CI=0.44-0.58, P<0.05). The PRKAR1A variants identified by Sanger sequencing analysis were consistent with those from the NGS analysis for the four myxoma specimens. All of the pathogenic PRKAR1A mutations led to premature termination of PRKAR1A, except for one synonymous mutation. Moreover, none of the nonsense and missense mutations found in the myxoma specimens were found in the matched peripheral blood samples. CONCLUSION Pathogenic mutations of the PRKAR1A gene were identified in tumor specimens from four cases of sporadic cardiac myxoma, and the absence of these mutations in peripheral blood samples demonstrated that they were somatic mutations.
Collapse
Affiliation(s)
- Yunpeng Sun
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Zhiping Li
- Department of Pharmacology, Basic Medical College of Jilin University, Changchun, Jilin, 130021, China
| | - Jingnan Sun
- Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Dashi Ma
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xue Shan
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xia Chen
- Department of Pharmacology, Basic Medical College of Jilin University, Changchun, Jilin, 130021, China
| |
Collapse
|
24
|
Șerban A, Dădârlat-Pop A, Tomoaia R, Trifan C, Molnar A, Manole S, Achim A, Suceveanu M. The Role of Multimodality Imaging in the Diagnosis and Follow-Up of Malignant Primary Cardiac Tumors: Myxofibrosarcoma-A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13101811. [PMID: 37238295 DOI: 10.3390/diagnostics13101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiac tumors are a very rare but heterogenous group of diseases that may reveal themselves through a variety of nonspecific cardiac symptoms that may pose a challenge to the diagnostic process. Myxofibrosarcoma is a particularly rare type of cardiac tumor that carries a poor prognosis, thus making accurate and timely diagnosis essential. A 61-year-old woman presented with fatigue and shortness of breath during mild exercise, symptoms that have progressively worsened during the previous year. Multimodality imaging consisting of transthoracic and transesophageal echocardiography (TTE and TEE), cardiac magnetic resonance (CMR), cardiac computer tomography (CCT), and fluorodeoxyglucose positron emission computer tomography (18F-FDG PET-CT) was used for the diagnosis and postoperative follow-up of a myxofibrosarcoma.
Collapse
Affiliation(s)
- Adela Șerban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alexandra Dădârlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
| | - Cătălin Trifan
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Adrian Molnar
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Simona Manole
- Radiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Mihai Suceveanu
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| |
Collapse
|
25
|
Stephens D, Pattock A, Mayfield J. Rare cause of ventricular calcification. Heart 2023; 109:845. [PMID: 37188393 DOI: 10.1136/heartjnl-2022-322162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- Daniel Stephens
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Andrew Pattock
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jacob Mayfield
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
26
|
Gao A, Yang J, Tian T, Wu Y, Sun X, Qi N, Tian N, Wang X, Wang J. Visual analysis based on CiteSpace software: a bibliometric study of atrial myxoma. Front Cardiovasc Med 2023; 10:1116771. [PMID: 37252126 PMCID: PMC10213645 DOI: 10.3389/fcvm.2023.1116771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Objective To use CiteSpace and VOSviewer visual metrology to analyze the research status, frontier hotspots, and trends in research on atrial myxoma. Methods The Web of Science core collection database was used to retrieve relevant literature on atrial myxoma from 2001 to 2022. CiteSpace software was used to analyze keywords with a co-occurrence network, co-polymerization class, and burst terms, and a corresponding visual atlas was drawn for analysis. Results A total of 893 valid articles were included. The country with the highest number of articles was the United States (n = 186). The organization with the highest number of articles was the Mayo Clinic (n = 15). The author with the highest number of articles was Yuan SM (n = 12). The highest cited author was Reynen K (n = 312). The highest cited journal was Annals of Thoracic Surgery (n = 1,067). The most frequently cited literature was published in the New England Journal of Medicine in 1995, which was cited 233 times. The keywords co-occurrence, copolymerization analysis, and Burst analysis revealed that the main research focuses were surgical methods, case reports, and genetic and molecular level studies on the pathogenesis of myxoma. Conclusions This bibliometric analysis revealed that the main research topics and hotspots in atrial myxoma included surgical methods, case reports, genetic and molecular studies.
Collapse
Affiliation(s)
- Ang Gao
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jinghua Yang
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tongru Tian
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Wu
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoting Sun
- Department of Orthopedics, Zhengzhou Orthopedic Hospital, Zhengzhou, China
| | - Na Qi
- Department of Encephalology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Nan Tian
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jisheng Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
27
|
Ballout JA, Arshia A, Palm DS, Reda HK, London TE, O’Connor W, Gupta VA. Multimodal Imaging and Management of a Metastatic Cardiac Intimal Sarcoma. CASE (PHILADELPHIA, PA.) 2023; 7:163-167. [PMID: 37325462 PMCID: PMC10264199 DOI: 10.1016/j.case.2023.01.008] [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: 06/17/2023]
Abstract
Echocardiography is the modality of choice for initial cardiac tumor diagnosis. CMR aids in tissue characterization, perfusion assessment, and delineating anatomy. Intimal sarcomas are the most common primary cardiac sarcomas. All intimal sarcomas exhibit MDM-2 gene overexpression and amplification. Overall prognosis of intimal sarcomas is dismal.
Collapse
Affiliation(s)
- Jad A. Ballout
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Asma Arshia
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Denada S. Palm
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Hassan K. Reda
- Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
| | - Tessa E. London
- Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
| | - William O’Connor
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Vedant A. Gupta
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
28
|
Angeli F, Bergamaschi L, Rinaldi A, Paolisso P, Armillotta M, Stefanizzi A, Sansonetti A, Amicone S, Impellizzeri A, Bodega F, Canton L, Suma N, Fedele D, Bertolini D, Tattilo FP, Cavallo D, Di Iuorio O, Ryabenko K, Casuso Alvarez M, Galiè N, Foà A, Pizzi C. Sex-Related Disparities in Cardiac Masses: Clinical Features and Outcomes. J Clin Med 2023; 12:jcm12082958. [PMID: 37109293 PMCID: PMC10142943 DOI: 10.3390/jcm12082958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Cardiac masses (CM) represent a heterogeneous clinical scenario, and sex-related differences of these patients remain to be established. PURPOSE To evaluate sex-related disparities in CMs regarding clinical presentation and outcomes. MATERIAL AND METHODS The study cohort included 321 consecutive patients with CM enrolled in our Centre between 2004 and 2022. A definitive diagnosis was achieved by histological examination or, in the case of cardiac thrombi, with radiological evidence of thrombus resolution after anticoagulant treatment. All-cause mortality at follow-up was evaluated. Multivariable regression analysis assessed the potential prognostic disparities between men and women. RESULTS Out of 321 patients with CM, 172 (54%) were female. Women were more frequently younger (p = 0.02) than men. Regarding CM histotypes, females were affected by benign masses more frequently (with cardiac myxoma above all), while metastatic tumours were more common in men (p < 0.001). At presentation, peripheral embolism occurred predominantly in women (p = 0.03). Echocardiographic features such as greater dimension, irregular margin, infiltration, sessile mass and immobility were far more common in men. Despite a better overall survival in women, no sex-related differences were observed in the prognosis of benign or malignant masses. In fact, in multivariate analyses, sex was not independently associated with all-cause death. Conversely, age, smoking habit, malignant tumours and peripheral embolism were independent predictors of mortality. CONCLUSIONS In a large cohort of cardiac masses, a significant sex-related difference in histotype prevalence was found: Benign CMs affected female patients more frequently, while malignant tumours affected predominantly men. Despite better overall survival in women, sex did not influence prognosis in benign and malignant masses.
Collapse
Affiliation(s)
- Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrea Rinaldi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, 80131 Naples, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Lisa Canton
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Damiano Fedele
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Davide Bertolini
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Francesco Pio Tattilo
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Daniele Cavallo
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Ornella Di Iuorio
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Khrystyna Ryabenko
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Marcello Casuso Alvarez
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| |
Collapse
|
29
|
Ehrhardt MJ, Dixon SB, Belsky J, Hochberg J. Late effects and frontline treatment selection for children with non-Hodgkin lymphoma. Best Pract Res Clin Haematol 2023; 36:101443. [PMID: 36907640 DOI: 10.1016/j.beha.2023.101443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Approximately 1 in 640 adults between 20 and 40 years of age is a survivor of childhood cancer. However, survival has often come at the expense of increased risk of long-term complications, including chronic health conditions and higher mortality rates. Similarly, long-term survivors of childhood non-Hodgkin lymphoma (NHL) experience significant morbidity and mortality related to prior cancer treatments, highlighting the importance of primary and secondary prevention strategies to mitigate late toxicity. As a result, effective treatment regimens for pediatric NHL have evolved to reduce both short- and long-term toxicity through cumulative dose reductions and elimination of radiation. The establishment of effective regimens facilitates shared decision-making opportunities for frontline treatment selection that considers efficacy, acute toxicity, convenience, and late effects of treatments. The current review seeks to merge current frontline treatment regimens with survivorship guidelines to enhance understanding of potential long-term health risks to facilitate best treatment practices.
Collapse
Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Belsky
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
30
|
Fioretti AM, Leopizzi T, La Forgia D, Scicchitano P, Oreste D, Fanizzi A, Massafra R, Oliva S. Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature. World J Clin Cases 2023; 11:1206-1216. [PMID: 36874413 PMCID: PMC9979295 DOI: 10.12998/wjcc.v11.i5.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/30/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.
CASE SUMMARY We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.
CONCLUSION This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.
Collapse
Affiliation(s)
| | - Tiziana Leopizzi
- Cardiology and Intensive Care Unit, Ospedale SS. Annunziata, Taranto 74121, Italy
| | - Daniele La Forgia
- Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Pietro Scicchitano
- Cardiology and Intensive Care Unit, Ospedale “Fabio Perinei”, Altamura (Bari) 70022, Italy
| | - Donato Oreste
- Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Annarita Fanizzi
- Department of Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Raffaella Massafra
- Department of Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Stefano Oliva
- Cardio-Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| |
Collapse
|
31
|
Wang Q, Jiang Y, Lin L, Li S, Lv J, Chen J. Clinical characteristics of primary atrial tumor and their diagnostic value: A retrospective study of 10 years. Front Surg 2023; 10:1097287. [PMID: 36865623 PMCID: PMC9971564 DOI: 10.3389/fsurg.2023.1097287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
Background Primary atrial tumors are relatively rare and predominantly benign. However, some atrial tumors may be malignant and are associated with poor outcome. Currently, it is hard to determine the malignance of atrial tumors by preoperative clinical presentation or by echocardiography. We aimed to report the difference in the clinical characteristics of patients with benign and malignant atrial tumor. Methods This was a single-center retrospective study. A total of 194 patients with primary atrial tumor admitted to our center between 2012 and 2021 were included. The clinical characteristics of patients with benign and malignant tumor were compared. Results Benign and malignant tumor accounted for 93% (n = 180) and 7% (n = 14) of the total patients, respectively. Malignant atrial tumor tended to occur in younger patients (P < 0.05), was more likely to be located at the right atrium (P < 0.05), and tended to attach to the atrial wall or valve instead of the atrial septum. Fever symptoms were more common in patients with malignant tumors than in patients with benign tumors (P < 0.05). Compared to benign tumor, patients with malignant atrial tumor also demonstrated higher rates of fever, lower rates of increasing fibrinogen, increased blood glucose (P < 0.05), significantly longer prothrombin time, and lower prothrombin activity (P < 0.05). Patients with malignant primary atrial tumor had higher mortality rate, tumor metastasis rate, and tumor recurrence rate than patients with benign primary atrial tumor (P < 0.05). Conclusion We compared the clinical characteristics of patients with benign and malignant atrial tumor. These findings provide valuable information to preoperatively determine the malignance of atrial tumor and thus guide surgical treatment.
Collapse
Affiliation(s)
- Qian Wang
- Department of Internal Medicine, Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Jiang
- Department of Internal Medicine, Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Lin
- Department of Internal Medicine, Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Li
- Department of Internal Medicine, Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiagao Lv
- Department of Internal Medicine, Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Chen
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Jun Chen
| |
Collapse
|
32
|
Khalilian MR, Shamsian BS, Baghaei Tehrani R, Kharaz L, Talebian N. Inflammatory myofibroblastic tumor of the pericardium in an 11-month-old infant: A case report. Clin Case Rep 2023; 11:e6949. [PMID: 36789298 PMCID: PMC9913176 DOI: 10.1002/ccr3.6949] [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: 12/08/2021] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Primary cardiac tumors are very rare in infants. Here we present an 11-month-old infant with a pericardial inflammatory myofibroblastic tumor who presented with symptoms of respiratory distress and cardiac tamponade. The tumor was surgically removed, and the patient received medical treatment; the patient had no problem with follow-up.
Collapse
Affiliation(s)
- Mohammad Reza Khalilian
- Department of Pediatrics, School of Medicine, Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Bibi Shahin Shamsian
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Childern's HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Ramin Baghaei Tehrani
- Cardiac Surgery, Modarres Hospital, School of MedicineShahid Beheshti University of Medical sciencesTehranIran
| | - Ladan Kharaz
- Department of Pediatrics, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Niki Talebian
- Department of Pediatrics, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| |
Collapse
|
33
|
Domínguez-Massa C, Doñate-Bertolín L, Blanco-Herrera ÓR, Heredia-Cambra T, Pérez-Guillén M, Martínez-Cózar V, Mayordomo-Aranda E, Hornero-Sos F. Inflammatory myofibroblastic tumor: A rare entity with a complex diagnosis. Rev Port Cardiol 2023; 42:169.e1-169.e4. [PMID: 36526128 DOI: 10.1016/j.repc.2022.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/06/2019] [Indexed: 12/15/2022] Open
Abstract
Inflammatory myofibroblastic tumor is a neoplasm with uncertain behavior. We describe a case in a 66-year-old female who underwent resection of a left atrial tumor suspected to be a cardiac myxoma which was subsequently diagnosed as an inflammatory myofibroblastic tumor. After three years' follow-up the patient underwent a second operation to remove tumoral occurrence in the right atrium, diagnosed as an intimal sarcoma. It cannot be confirmed whether the tumoral recurrence with a different diagnosis (intimal sarcoma) was a progression from the primary tumor or the metachronous appearance of a spontaneous sarcoma.
Collapse
Affiliation(s)
- Carlos Domínguez-Massa
- Department of Cardiovascular Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Lucía Doñate-Bertolín
- Department of Cardiovascular Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Óscar R Blanco-Herrera
- Department of Cardiovascular Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Tomás Heredia-Cambra
- Department of Cardiovascular Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Pérez-Guillén
- Department of Cardiovascular Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicent Martínez-Cózar
- Department of Pathology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Fernando Hornero-Sos
- Department of Cardiovascular Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
34
|
Qiang Y, Zeng K, Zhang B, Guan R, Liu Y, Liu Z, Xu H, Zhang X, Ren Y, Deng B, Yang Y. Atypical location of primary cardiac lymphoma in the left heart with atypical clinical presentation: A case report and literature review. Front Surg 2023; 9:1036519. [PMID: 36726943 PMCID: PMC9885797 DOI: 10.3389/fsurg.2022.1036519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/24/2022] [Indexed: 01/18/2023] Open
Abstract
Background Primary cardiac lymphoma (PCL) is a rare and aggressive cardiac tumor with very poor prognosis that occurs mostly in the right cardiac cavity. Early diagnosis and treatment may improve its prognosis. In the present report, we describe the diagnosis and treatment of a primary cardiac diffuse large B-cell lymphoma (PC-DLBCL) with atypical location and clinical presentation. Additionally, a literature review was conducted to summarize the current knowledge of the disease. Case Presentation A 71-year-old man visited his local hospital because of syncope, recurrent chest tightness, shortness of breath, palpitations, and profuse sweating for more than 20 days. Chest radiography revealed a mediastinal mass. Cardiac computed tomography (CT) showed multiple enlarged mediastinal lymph nodes. Transthoracic echocardiography (TTE) showed a cardiac mass in the posterior-inferior wall of the left atrium. He was then transferred to our hospital for positron emission tomography-CT (PET-CT) which showed active uptake of fluorodeoxyglucose both in the cardiac mass and in the multiple enlarged mediastinal lymph nodes. Biopsy of the enlarged mediastinal lymph nodes was carried out by using video-assisted thoracic surgery (VATS) technique, and pathological examination confirmed the subtype of PC-DLBCL, Stage IV, NCCN IPI 3. Therefore, the patient received a combination of chemotherapy and immunotherapy with R-CDOP (rituximab, cyclophosphamide, liposome doxorubicin, vincristine, and prednisone). After four courses of treatment in 4 months, the cardiac lymphoma and the enlarged mediastinal lymph nodes achieved complete remission with mild side effects of the chemotherapy. Conclusion Early diagnosis and a precise choice of chemotherapy and immunotherapy based on cardiac imaging and pathological examination may improve the prognosis of PC-DLBCL in an atypical location.
Collapse
Affiliation(s)
- Yongjia Qiang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Kuan Zeng
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Bin Zhang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China,Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Ruicong Guan
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China,Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Yuqiang Liu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Zhuxuan Liu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Haohua Xu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Xinyi Zhang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Yanting Ren
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Baoping Deng
- Department of Vascular Surgery, The Fifth Affiliated Hospital, Southern Medical University, Guangdong, China,Correspondence: Yanqi Yang Baoping Deng
| | - Yanqi Yang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China,Department of Cardiothoracic Surgery, University Hospital, Linköping University, Linköping, Sweden,Correspondence: Yanqi Yang Baoping Deng
| |
Collapse
|
35
|
Paolisso P, Foà A, Bergamaschi L, Graziosi M, Rinaldi A, Magnani I, Angeli F, Stefanizzi A, Armillotta M, Sansonetti A, Fabrizio M, Amicone S, Impellizzeri A, Tattilo FP, Suma N, Bodega F, Canton L, Gherbesi E, Tuttolomondo D, Caldarera I, Maietti E, Carugo S, Gaibazzi N, Rucci P, Biagini E, Galiè N, Pizzi C. Echocardiographic Markers in the Diagnosis of Cardiac Masses. J Am Soc Echocardiogr 2023; 36:464-473.e2. [PMID: 36610495 DOI: 10.1016/j.echo.2022.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The echocardiographic parameters required for a comprehensive assessment of cardiac masses (CMs) are still largely unknown. The aim of this study was to identify and integrate the echocardiographic features of CMs that can accurately predict malignancy. METHODS An observational cohort study was conducted among 286 consecutive patients who underwent standard echocardiographic assessment for suspected CM at Bologna University Hospital between 2004 and 2022. A definitive diagnosis was achieved by histologic examination or, in the case of cardiac thrombi, with radiologic evidence of thrombus resolution after appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of six echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numeric score, ranging from 0 to 6, with a cutoff of ≥3 balancing sensitivity and specificity with respect to the histologic diagnosis of malignancy. Classification tree analysis was used to determine the ability of echocardiographic parameters to discriminate subgroups of patients with differential risk for malignancy. RESULTS Benign masses were more frequently pedunculated, mobile, and adherent to the interatrial septum (P < .001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (P < .001). Infiltration, moderate to severe pericardial effusion, nonleft localization, sessile implantation, polylobate shape, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted score of ≥3 was very high (>0.90) and similar to that of the previously published weighted score. Classification tree analysis generated an algorithm in which infiltration was the best discriminator of malignancy, followed by nonleft localization and sessile implantation. The percentage correctly classified by classification tree analysis as malignant was 87.5%. Agreement between observer readings and CM histology ranged between 85.1% and 91.5%. The presence of at least three echocardiographic parameters was associated with lower survival. CONCLUSIONS In the approach to CMs, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.
Collapse
Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Alberto Foà
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Luca Bergamaschi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Maddalena Graziosi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Rinaldi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Ilenia Magnani
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesco Angeli
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Stefanizzi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Matteo Armillotta
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Angelo Sansonetti
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Michele Fabrizio
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Sara Amicone
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Impellizzeri
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesco Pio Tattilo
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Nicole Suma
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesca Bodega
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Lisa Canton
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Elisa Gherbesi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | | | - Ilaria Caldarera
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Elisa Maietti
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | | | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elena Biagini
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Nazzareno Galiè
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Carmine Pizzi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy.
| |
Collapse
|
36
|
Nakata A, Takamatsu H, Eguchi Y, Izumida T, Aburadani I, Hirota S, Takagawa K. Primary Cardiac Lymphoma Arising from Both Sides of the Heart. Intern Med 2022; 61:3377-3381. [PMID: 35491130 PMCID: PMC9751723 DOI: 10.2169/internalmedicine.8936-21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Primary cardiac lymphomas (PCLs) are extremely rare tumors with a poor prognosis. They usually involve the pericardium and the right side of the heart. PCLs arising from the left side of the heart are relatively rare, with bilateral cases being even rarer. We herein report a case of PCL arising from both the right and left sides of the heart in a 65-year-old man. Multiple imaging modalities clearly demonstrated the tumors at the initial evaluation. The pathological diagnosis was diffuse large B-cell lymphoma.
Collapse
Affiliation(s)
- Akio Nakata
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | | | - Yuya Eguchi
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | | | - Isao Aburadani
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | - Satoshi Hirota
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | | |
Collapse
|
37
|
Chen J, Gong X, Xie L, Wu Q, Zhao T, Hu S. Atrial septal defect with a rare occupying lesion in heart. BMC Cardiovasc Disord 2022; 22:482. [PMID: 36371149 PMCID: PMC9652894 DOI: 10.1186/s12872-022-02919-9] [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: 12/14/2021] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cardiac epicardium hemangiomas are exceedingly rare; however, they can cause significant hemodynamic impairment and large pericardial effusions. On rare occasion, cardiac tumors coexist with malformations of the heart. Case presentation We present the case of a 10-month-old female infant with a rare cardiac surface hemangioma coexisting with malformations of the heart. It revealed an atrial septal defect (ASD) coexisting with an abnormal occupying lesion with high echogenicity. It was 35*12*9 mm in size and was found in the anterior atrioventricular junction to the posterior atrioventricular junction at the bottom of the ventricular septum by transthoracic echocardiography. We performed surgical treatment of the atrial septal defect and performed biopsy with the occupying lesion. The histopathological examination reported a benign tumor as hemangioma. As far as we know, this is the first case in which cardiac surface hemangioma was found to coexist with an atrial septal defect. Conclusions Cardiac epicardium hemangiomas is a rare solid tumor of the heart. If the mass is impossible to resect and does not cause hemodynamic impairment, only mass biopsy is possible.
Collapse
|
38
|
Development and Validation of a Diagnostic Echocardiographic Mass Score in the Approach to Cardiac Masses. JACC Cardiovasc Imaging 2022; 15:2010-2012. [PMID: 36357143 DOI: 10.1016/j.jcmg.2022.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022]
|
39
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 684] [Impact Index Per Article: 342.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
40
|
Zhang S, Xu Z, Zou C, Zhang G. Cardiac venous malformation concurrent with multiple hepatic venous malformations: A case report. Front Cardiovasc Med 2022; 9:1001996. [DOI: 10.3389/fcvm.2022.1001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
A 50-year-old woman who had previously undergone right radical mastectomy presented with chest tightness and shortness of breath after physical activities. A cardiac mass and multiple hepatic lesions were successively detected. We first performed hepatic puncture biopsy. Histopathologic examination confirmed that the multiple hepatic lesions were venous malformations. Based on the imaging findings and previous reports in the literature, we boldly speculated that the cardiac mass was also a venous malformation. The cardiac venous malformation was successfully resected, and the postoperative pathology confirmed our suspicion.
Collapse
|
41
|
Sheng C, Yang C, Cheng Y, Li YM. Current status of diagnosis and treatment of primary benign cardiac tumors in children. Front Cardiovasc Med 2022; 9:947716. [PMID: 36337871 PMCID: PMC9635942 DOI: 10.3389/fcvm.2022.947716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/05/2022] [Indexed: 11/20/2022] Open
Abstract
Primary cardiac tumors in children are exceedingly rare overall, which benign account for most part. The onset of the disease is occult, while the clinical manifestations are non-specific-patients may be asymptomatic or show a range of obstructive, arrhythmic, embolic or systemic symptoms. The clinical presentations generally depend on the tumors’ size, localization, and pace of growth of the tumor. Moreover, the diagnosis needs comprehensive judgment based on imaging results and pathological examination. With advances in cardiac imagining and the introduction of cardiopulmonary support, the diagnosis and treatment of these rare tumors have improved the prognosis and outlook for benign tumors. To sum up the above, we sought to integrate articles from recent years for the latest comprehensive review of the clinical manifestations, imaging characteristics, clinic pathologic features and treatment of benign cardiac tumors in children to provide a broader idea for pediatricians to recognize and treat such diseases.
Collapse
|
42
|
Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.
Collapse
|
43
|
de la Fuente J, Wang Y, Tan N, Kandlakunta H, Tse CS, Click RL. Cardiac Masses (from a 15-Year Experience With 389 Surgical Cases). Am J Cardiol 2022; 185:100-106. [DOI: 10.1016/j.amjcard.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/19/2022] [Accepted: 09/09/2022] [Indexed: 11/01/2022]
|
44
|
Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
Collapse
Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
| |
Collapse
|
45
|
Liu E, Huang J, Dong H, Chen Z, Liu C, Xie Q, Xu W, Wang S, Liu Z. Diagnostic challenges in primary cardiac lymphoma, the opportunity of 18F-FDG PET/CT integrated with contrast-enhanced CT. J Nucl Cardiol 2022; 29:2378-2389. [PMID: 34318397 DOI: 10.1007/s12350-021-02723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to retrospectively evaluate the value of 18F-FDG PET/CT integrated with contrast-enhanced CT (CECT) in the differential diagnosis of primary cardiac lymphomas (PCLs) and primary cardiac angiosarcomas (PCAs). METHODS Clinical and imaging data of patients with PCLs and PCAs were collected. All patients underwent preoperative 18F-FDG PET/CT and thoracic CECT. The enhancement pattern and tumor morphology were analyzed using CECT images. The intensity- and volume-based PET parameters of cardiac lesions were analyzed. The performance characteristics of all parameters were assessed. RESULTS Nine patients with PCL and eight patients with PCA were analyzed. There were significant differences in SUVmax (t = 3.790, P = .002), SUVmean (t = 4.273, P = .001), metabolic tumor volume (U = 13.00, P = .027), tumor-to-liver ratio (U = 10.00, P = .011), and total lesion glycolysis (U = 4.0, P = .001) between PCLs and PC18As. There were significant differences in the enhancement pattern of tumors (P = .002) and tumor morphology (P = .015). The combination of F-FDG PET/CT and CECT improved the diagnostic accuracy, and the combination cutoff (SUVmean > 5.17) could reach 100%, but the difference was not statistically significant (P > .05). CONCLUSION The intensity- and volume-based PET parameters of PCL were significantly higher than those of PCA. The enhancement pattern and tumor morphology were also different. According to these characteristics, the two most common types of primary cardiac malignancies can be differentiated.
Collapse
Affiliation(s)
- Entao Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia Huang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Room 201, 2/F, WeiLun Building of Guangdong Provincial People's Hospital, 106 Zhongshan ER Road, Guangzhou, 510080, China
| | - Haojian Dong
- Department of Cardiology, Vascular Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zerui Chen
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao Liu
- Department of Pathology and Laboratory Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiu Xie
- Division of Adult Echocardiography, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weiping Xu
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuxia Wang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zaiyi Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Room 201, 2/F, WeiLun Building of Guangdong Provincial People's Hospital, 106 Zhongshan ER Road, Guangzhou, 510080, China.
| |
Collapse
|
46
|
Camoni L, Albano D. Contrast-enhanced 18F-FDG PET/CT to differentiate primary cardiac lymphoma from primary cardiac angiosarcoma. J Nucl Cardiol 2022; 29:2390-2392. [PMID: 34414553 DOI: 10.1007/s12350-021-02767-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Luca Camoni
- Nuclear Medicine, University of Brescia, Brescia, Italy.
| | | |
Collapse
|
47
|
Li Y, Ren W, Wang X, Xiao Y, Feng Y, Shi P, Sun L, Wang X, Yang H, Song G. The diagnostic accuracy of contrast echocardiography in patients with suspected cardiac masses: A preliminary multicenter, cross-sectional study. Front Cardiovasc Med 2022; 9:1011560. [PMID: 36187014 PMCID: PMC9523017 DOI: 10.3389/fcvm.2022.1011560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate the diagnostic accuracy of contrast echocardiography (CE) in patients with suspected cardiac masses. Methods A multicenter, prospective study involving 108 consecutive patients with suspected cardiac masses based on transthoracic echocardiography performed between November 2019 and December 2020 was carried out. CE examinations were performed in all patients. The echocardiographic diagnosis was established according to the qualitative (echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility) and quantitative (area of the masses and peak intensity ratio of the masses and adjacent myocardium A1/A2) evaluations. Results Final confirmed diagnoses were as follows: no cardiac mass (n = 3), pseudomass (n = 3), thrombus (n = 36), benign tumor (n = 30), and malignant tumor (n = 36). ROC analysis revealed the optimal A1/A2 with cutoff value of 0.295 for a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.958 (95% confidence interval (CI): 0.899–0.988), 100, 91.7, 95.7, and 100%, respectively. CE was able to distinguish malignant from benign tumors with an AUC of 0.953 (95% CI: 0.870–0.990). Multivariate logistic regression analysis revealed that tumor area, base, and A1/A2 were associated with the risk of malignant tumor (OR = 1.003, 95% CI: 1.00003–1.005; OR = 22.64, 95% CI: 1.30–395.21; OR = 165.39, 95% CI: 4.68–5,850.94, respectively). When using A1/A2 > 1.28 as the only diagnostic criterion to identify the malignant tumor, AUC, sensitivity, specificity, PPV, and NPV were 0.886 (95% CI: 0.784–0.951), 80.6, 96.7, 96.7, and 80.7%, respectively. Conclusion CE has the potential to accurately differentiate cardiac masses by combining qualitative and quantitative analyses. However, more studies with a large sample size should be conducted to further confirm these findings. Clinical trial registration http://www.chictr.org.cn/, identifier: ChiCTR1900026809.
Collapse
Affiliation(s)
- Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yueqin Feng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengli Shi
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lijuan Sun
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiao Wang
- Department of Ultrasound, Anshan Central Hospital, Anshan, China
| | - Huan Yang
- Department of Ultrasound, Yingkou Central Hospital, Yingkou, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Guang Song
| |
Collapse
|
48
|
Huang S, Wang S, Tang Z, Dai Y, Song L. Case report: Right ventricular outflow tract obstruction caused by multicomponent mesenchymal tumor. Front Cardiovasc Med 2022; 9:988271. [PMID: 36176997 PMCID: PMC9513130 DOI: 10.3389/fcvm.2022.988271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Right ventricular outflow tract obstruction (RVOTO) is a cause of hemodynamic instability that can lead to right ventricular dysfunction. Cardiac tumors located in the right ventricle or surrounding structures can cause RVOTO. Herein, we present a rare case of a 21-year-old male with palpitations due to RVOTO caused by a cardiac multicomponent mesenchymal tumor. The tumor was localized in the right ventricular outflow tract, resulting in right side heart enlargement, tricuspid regurgitation, and RVOTO. Hence, tumor resection was performed. The patient was in a stable condition and discharged home on the 6th post-operative day. However, histopathological examination of the tumor specimen suggested a three-component mesenchymal tumor containing mucinous components, formed blood vessels, and fibrous tissue, which is like an atypical capillary hemangioma. After seven years of follow-up, the patient had no right heart enlargement, tricuspid regurgitation, and tumor recurrence. We believe surgical treatment is effective, and this case will provide a reference for clinicians to treat and evaluate the prognosis of similar three-component mesenchymal cardiac tumor cases in the future.
Collapse
Affiliation(s)
- Shengyuan Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shiye Wang
- Clinical Nursing Teaching and Research Section, Operation Room, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhixiang Tang
- Department of Cardiovascular Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yinghuan Dai
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Long Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Long Song
| |
Collapse
|
49
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
50
|
Santos RR, Abecasis J, Gomes DA, Paiva MS, Rocha B, Ribeiras R, Freitas P, Abecasis M, Trabulo M. An Incidental Finding of a Cardiac Sarcoma. Arq Bras Cardiol 2022; 119:349-352. [PMID: 35946698 PMCID: PMC9363064 DOI: 10.36660/abc.20210703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rita Reis Santos
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - João Abecasis
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal.,Hospital Lusíadas, Lisboa - Portugal.,Nova Medical School, Lisboa - Portugal
| | - Daniel A Gomes
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Mariana Sousa Paiva
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Bruno Rocha
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Regina Ribeiras
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Pedro Freitas
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Miguel Abecasis
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Marisa Trabulo
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| |
Collapse
|