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Layfield LJ, Freeman D, Crim JR. Left atrial tumor thrombus with emboli to the brain and distal extremities: A case report. Pathol Res Pract 2020; 216:152911. [PMID: 32178936 DOI: 10.1016/j.prp.2020.152911] [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: 12/04/2019] [Revised: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 11/27/2022]
Abstract
Cardiac metastases are an uncommon phenomenon associated with neoplasms from a variety of primary sites. Pulmonary involvement often accompanies metastases involving the left atrium or ventricle and clinical presentation may be associated with stroke or emboli involving distal sites. We report a patient who presented acutely to the Emergency Department with symptoms of a cerebrovascular accident and bilateral cold pulseless lower extremities. Computerized Tomographic (CT) angiogram of the chest, abdomen, pelvis and lower extremities disclosed pulmonary veins with large filling defects in the right superior and inferior vessels as well as the left atrium and atrial appendage. Mediastinal and hilar adenopathy was detected. The patient had a history of tonsillar squamous cell carcinoma eighteen months prior. The patient underwent operative intervention with removal of a large left intra-atrial mass, histologic evaluation of which demonstrated groups of malignant squamous cells meshed in fibrin clot. The patient died three days post operatively due to multiple brain infarctions.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, United States of America.
| | - Douglas Freeman
- Department of Pathology and Anatomical Sciences, United States of America
| | - Julia R Crim
- Department of Radiology University of Missouri, Columbia, MO, United States of America
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2
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Qu Y, Zheng Q, Ni C, Cui Z, Guo X. Metastatic leiomyosarcoma presenting as a lung mass with left atrial extension: case report and anesthetic management. Ther Clin Risk Manag 2018; 14:141-147. [PMID: 29403281 PMCID: PMC5783153 DOI: 10.2147/tcrm.s153484] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction Lung metastasis of leiomyosarcoma that protrudes into the left atrium is an extremely rare condition. Severe complications may occur that prominently increase the mortality during the perioperative period. Currently, the anesthetic management reports are limited and there is no generally acknowledged algorithm available. Case presentation A 67-year-old man presented with cough and dyspnea for 10 days. Workup revealed bilateral pulmonary effusion. Transthoracic echocardiography showed a large mass in the left atrium. Urgent surgical resection under cardiopulmonary bypass was performed. We focused on oxygenation improvement and cardiac function management by applying protective ventilation with low positive end expiratory pressure, low dose inotropic agents, and other methods to maintain stable homeostasis. Results of biopsy established a diagnosis of metastatic leiomyosarcoma. Conclusion We reported a case of metastatic leiomyosarcoma presenting as a lung mass with left atrial extension and anesthetic management during surgical resection. Treating acute heart failure and refractory hypoxemia was the key focus perioperatively.
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Affiliation(s)
| | | | | | - Zhongqi Cui
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, People's Republic of China
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Park YM, Shin JO, Kim M, Kang WC, Moon J, Chung WJ, Sung YM. Cardiac Metastasis of Leiomyosarcoma Complicated with Complete Atrio-Ventricular Block and Ventricular Tachycardia. Korean Circ J 2016; 46:260-3. [PMID: 27014358 PMCID: PMC4805572 DOI: 10.4070/kcj.2016.46.2.260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 06/25/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022] Open
Abstract
We described a case of a 54-year-old male who presented with dizziness and dyspnea due to cardiac metastasis of leiomyosarcoma. Cardiac metastasis of leiomyosarcoma caused both bradyarrhythmia and tachyarrhythmia in the patient. He was treated with implantation of a permanent pacemaker for management of complete atrio-ventricular block and anti-arrhythmic drug that suppressed ventricular tachycardia successfully.
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Affiliation(s)
- Yae Min Park
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Ouk Shin
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Minsu Kim
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Woong Chol Kang
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jeonggeun Moon
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wook-Jin Chung
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yon Mi Sung
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
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Nassif MO, Trabulsi NH, Bullard Dunn KM, Nahal A, Meguerditchian AN. Soft tissue tumors of the anorectum: rare, complex and misunderstood. J Gastrointest Oncol 2013; 4:82-94. [PMID: 23450454 DOI: 10.3978/j.issn.2078-6891.2012.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 08/27/2012] [Indexed: 12/28/2022] Open
Abstract
Anorectal soft tissue tumors are uncommon and often present both diagnostic and therapeutic challenges. Although many of these tumors are identified with imaging performed for unrelated reasons, most present with nonspecific symptoms that can lead to a delay in diagnosis. Historically, radical surgery (abdominoperineal resection) has been the mainstay of treatment for both benign and malignant anorectal soft tissue tumors. However, a lack of proven benefit in benign disease along with changes in technology has called this practice into question. In addition, the role of radiation and/or chemotherapy remains controversial. In this manuscript, we review the history and current status of anorectal soft tissue tumor management, with a particular focus on challenges in optimizing survival.
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Affiliation(s)
- Mohammed O Nassif
- Division of Experimental Surgery, McGill University, 845 Sherbrooke Street West Montreal, Quebec, Canada H3A 2T5; ; Department of Surgery, King Abdulaziz University, P.O. Box 80205, Zip Code 21589, Jeddah, Saudi Arabia
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5
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Shirzadi A, Drazin D, Shirzadi N, Westhout F, Drazin N, Fan X, Acosta FL. Metastatic Leiomyosarcoma to the Spine Complicated With Thrombocytopenia. World J Oncol 2012; 3:182-186. [PMID: 29147302 PMCID: PMC5649841 DOI: 10.4021/wjon481w] [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] [Accepted: 06/14/2012] [Indexed: 11/03/2022] Open
Abstract
Uterine leiomyosarcomas do not frequently metastasize to the bone, and spinal column metastases are even less common. Surgery is the treatment of choice. Adjuvant radiation with or without chemotherapy depending on the extent of disease can be beneficial. We present the case of leiomyosarcoma metastasis to the spine with a previous history of known primary disease complicated by thrombocytopenia. Thrombocytopenia can present surgical challenges, but can also be present concurrently unrelated to the primary disease. A thorough evaluation is needed to rule out any underlying lymphoproliferative disorder or microangiopathic phenomenon.
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Affiliation(s)
- Ali Shirzadi
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Neda Shirzadi
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Franklin Westhout
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Noam Drazin
- Department of Internal Medicine, Division of Hematology/Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Xuemo Fan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Frank L Acosta
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Bang JH, Woo JS, Choi PJ, Cho GJ, Kim SH, Park KJ. Clinical Experience of the Surgical Treatment of Cardiac Tumor. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.4.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jung Hee Bang
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Jong Soo Woo
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Pill Jo Choi
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Gwang Jo Cho
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Si-Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital
| | - Kwon-Jae Park
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
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Rossdale PD, Greet TRC, McGladdery AJ, Ricketts SW, Aqel N. Pulmonary leiomyosarcoma in a 13-year-old Thoroughbred stallion presenting as a differential diagnosis to recurrent airway obstruction. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2004.tb00263.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cuadrado M, García-Camarero T, Expósito V, Val-Bernal JF, Gómez-Román JJ, Garijo MF. Cardiac intracavitary metastasis of a malignant solitary fibrous tumor: case report and review of the literature on sarcomas with left intracavitary extension. Cardiovasc Pathol 2007; 16:241-7. [PMID: 17637433 DOI: 10.1016/j.carpath.2007.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 01/22/2007] [Accepted: 02/05/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) of the pleura with malignant progression occurs uncommonly. Cardiac intracavitary extension of tumors is rarely seen, with left side location being exceptional. METHODS AND RESULTS The authors report the first case of a malignant SFT metastatic to the heart occurring in a 74-year-old woman. The tumor first presented as a slow-growing pleural SFT that in 6 years reached a size of 16 cm. Two months after a complete surgical resection, the tumor was found to spread to the left atrium by intracavitary extension from the left upper pulmonary vein, simulating a cardiac myxoma. The primary tumor showed established features of malignancy including size greater than 10 cm; gross findings of necrosis; high cellularity, cytological atypia, and eight mitoses per 10 high-power fields. Immunohistochemical study revealed positivity of the tumor cells for CD34, bcl-2, and CD99. Aside from the present report, 52 previous cases of sarcoma with intracavitary extension to the left side of the heart have been described. Bone sarcoma is the type most frequently found. Peripheral arterial embolism can be a complication of advanced mesenchymal malignancy in 21% (11/53) of reported cases. CONCLUSION Accurate histopathologic recognition of this rare type of metastatic disease is important because of the adverse prognosis as compared to cardiac myxoma.
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Affiliation(s)
- Marta Cuadrado
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, ES-39008 Santander, Spain
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Cardioembolic Stroke in a Patient with Spindle Cell Sarcoma of the Left Atrium. J Am Soc Echocardiogr 2007; 20:438.e1-4. [DOI: 10.1016/j.echo.2006.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Indexed: 11/17/2022]
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Abstract
Intracardiac tumors are unusual and can originate within the heart or spread from other sites. This is a report of a patient who presented with a TIA, and during the subsequent stroke workup, a right hilar nonsmall cell lung carcinoma was discovered. The tumor had extended into the left atrium through a pulmonary vein. The hilar tumor as well as intracardiac extension were demonstrated by PET scanning using FDG.
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Affiliation(s)
- Gary F Gates
- Nuclear Medicine Department, Providence St. Vincent Medical Center, Portland, OR 97225, USA.
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Park BJ, Bacchetta M, Bains MS, Downey RJ, Flores R, Rusch VW, Girardi LN. Surgical management of thoracic malignancies invading the heart or great vessels. Ann Thorac Surg 2004; 78:1024-30. [PMID: 15337042 DOI: 10.1016/j.athoracsur.2004.02.043] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2004] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical resection of thoracic malignancies involving either the heart or great vessels is uncommonly performed because of the potential morbidity and mortality for an unknown probability of significant palliation or cure. We reviewed our experience of 10 patients treated surgically, either primarily or as a component of multimodality therapy, to assess feasibility and results. METHODS A retrospective review of the results in 10 patients who underwent resection of thoracic malignancies that included either great vessel or the heart was conducted. RESULTS Histologic diagnoses included soft tissue sarcoma (n = 7), squamous cell carcinoma (n = 1), malignant thymoma (n = 1), and mediastinal teratoma (n = 1). Three patients underwent induction chemotherapy. Cardiopulmonary bypass was used in 7 patients. Structures resected included superior vena cava (n = 5), left atrium (n = 4), right atrium (n = 2), descending aorta (n = 1), and main pulmonary artery (n = 1). Concomitant anatomic pulmonary resections were performed in 3 patients. Seven patients had an R0 or R1 resection. There were no perioperative deaths. All symptomatic patients had immediate and sustained palliation of their presenting symptoms. The median length of stay was 6 days (range, 4 to 43 days). Six patients underwent postoperative systemic therapy. The overall median survival was 21.7 months (range, 3.2 to 69 months) and was 33.3 months (range, 3.7 to 69 months) for patients who had an R0 or R1 resection. CONCLUSIONS Resection of the heart and great vessels involved by thoracic malignancies can be performed with acceptable morbidity and mortality and results in significant palliation and, in some cases, prolonged survival.
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Affiliation(s)
- Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Peng YJ, Hueng GG, Lee HS. Acute heart failure as manifestation of metastatic uterine leiomyosarcoma to the heart and lung. Heart Lung 2004; 33:46-9. [PMID: 14983139 DOI: 10.1016/j.hrtlng.2003.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Uterine leiomyosarcoma is an uncommon malignant neoplasm that frequently metastasizes through the bloodstream to distant organs such as the lung, bone, and brain. We report on and discuss a patient who had sudden onset of acute heart failure with pulmonary edema and bilateral pleural effusions, resulting from a high-grade uterine leiomyosarcoma metastatic to the left atrium. Surgical removal of the tumor terminated the acute heart failure and pulmonary edema. Other unusual features of this case include the metastatic leiomyosarcoma to the left atrium with expression of acute heart failure and the pulmonary tumor lesion obscured by the shadows of pleural effusion, pulmonary edema, and the breast.
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Affiliation(s)
- Yi-Jen Peng
- Department of Pathology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
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