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Robak T, Kasprzak JD, Jesionek-Kupnicka D, Soin M, Robak P. Small lymphocytic lymphoma in the heart twenty years after lymphoma diagnosis. Leuk Lymphoma 2023; 64:884-888. [PMID: 37061955 DOI: 10.1080/10428194.2023.2181657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
| | | | | | - Michał Soin
- Department of Hematology, Medical University of Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
| | - Paweł Robak
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
- Department of Experimental Hematology, Medical University of Lodz, Poland
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2
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Robak T, Kasprzak JD, Jesionek-Kupnicka D, Chudobiński C, Robak P. Cardiac Involvement in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. J Clin Med 2022; 11:6983. [PMID: 36498556 PMCID: PMC9737627 DOI: 10.3390/jcm11236983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiac involvement of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is recognized extremely rarely. In addition, most CLL/SLL patients with heart infiltration are asymptomatic. In this review, we present the results of a literature search for English language articles concerning CLL/SLL or Richter transformation with symptomatic cardiac involvement. In total, 18 well-described cases with CLL/SLL and heart infiltration were identified. Only three patients were not diagnosed with CLL/SLL before the cardiac manifestation. In other patients, cardiac CLL/SLL was diagnosed between 5 months and 20 years from CLL/SLL diagnosis. All patients in these series had a diagnosis of secondary cardiac CLL/SLL. In addition, we identified four reported cases with Richter transformation in the heart. The treatment of patients with CLL/SLL and cardiac infiltration is variable and depends on the previous history and clinical characteristics of heart infiltration. In addition, no recommendations exist on how to treat patients with CLL/SLL and cardiac involvement.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, 93-510 Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, 93-510 Lodz, Poland
| | | | | | - Cezary Chudobiński
- Department of Radiology, Copernicus Memorial Hospital, 93-510 Lodz, Poland
| | - Paweł Robak
- Department of Oncohematology, Copernicus Memorial Hospital, 93-510 Lodz, Poland
- Department of Experimental Hematology, Medical University of Lodz, 93-510 Lodz, Poland
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3
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Ikram C, Nesrine A, Rania K, Bellalah A, Chokri K, Asma A, Sameh J, Faouzi M. Case Report: Mitral valve obstruction by metastatic malignant phyllodes tumor. F1000Res 2022; 11:309. [PMID: 35967976 PMCID: PMC9346307 DOI: 10.12688/f1000research.110022.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
Cardiac metastases are rare. Herein, we report a case of a 37-year-old female patient with a history of borderline breast phyllodes tumor (PT) treated by surgery, admitted to our department for concomitant cardiac and pulmonary metastases of malignant PT. Cardiac metastasis occurred through direct extension from pulmonary metastasis to the left atrium via the right inferior pulmonary vein, causing severe mitral valve obstruction. Although the total surgical removal of metastases, the patient had a huge relapse of the mediastinal metastasis resulting in her death.
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Affiliation(s)
- Chamtouri Ikram
- cardiology B department, Fattouma Bourguiba University Hospital, Monastir, MONASTIR, 5000, Tunisia
| | - Amdouni Nesrine
- cardiology B department, Fattouma Bourguiba University Hospital, Monastir, MONASTIR, 5000, Tunisia
| | - Kaddoussi Rania
- pneumology, Fattouma Bourguiba University Hospital, Monastir, MONASTIR, 5000, Tunisia
| | - Ahlem Bellalah
- anatomic pathology, Fattouma Bourguiba University Hospital, Monastir, MONASTIR, 5000, Tunisia
| | - Kortas Chokri
- cardiovascular surgery, Sahloul University Hospital, MONASTIR, 5000, Tunisia
| | - Achour Asma
- radiology, Fattouma Bourguiba University Hospital, Monastir, MONASTIR, 5000, Tunisia
| | - Joober Sameh
- pneumology, Fattouma Bourguiba University Hospital, Monastir, MONASTIR, 5000, Tunisia
| | - Maatouk Faouzi
- cardiology B department, Fattouma Bourguiba University Hospital, Monastir, MONASTIR, 5000, Tunisia
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4
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Maleszewski JJ, Basso C, Bois MC, Glass C, Klarich KW, Leduc C, Padera RF, Tavora F. The 2021 WHO Classification of Tumors of the Heart. J Thorac Oncol 2021; 17:510-518. [PMID: 34774791 DOI: 10.1016/j.jtho.2021.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Carolyn Glass
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charles Leduc
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Robert F Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fabio Tavora
- Department of Pathology, Argos Laboratory/Messejana Heart and Lung Hospital, Fortaleza, Brazil
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5
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Cardiovascular effects of Hodgkin’s lymphoma: a review of literature. J Cancer Res Clin Oncol 2017; 144:99-107. [DOI: 10.1007/s00432-017-2560-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/11/2017] [Indexed: 01/09/2023]
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6
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Tower-Rader A, Kwon D. Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging. Prog Cardiovasc Dis 2017; 59:389-397. [PMID: 28062266 DOI: 10.1016/j.pcad.2016.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
Pericardial masses/tumors, cysts, and diverticula are quite rare. Presentation is variable and often patients may be asymptomatic with pericardial involvement initially only detected at time of autopsy. When patients do present with symptoms they are often non-specific and often mimic other conditions of the pericardium such as pericarditis, pericardial effusion, constriction or tamponade. Therefore, echocardiography and cross-sectional imaging are essential in identifying and characterizing pericardial disease. Imaging findings vary in specificity depending on the type of tumor. The purpose of this review is to describe the role of multi-modality imaging and characteristic findings in patients with pericardial masses/tumors, cysts, and diverticula.
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7
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Pericardial Nodular Metastasis from Carcinoma Cervix Uteri. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Chisté M, Vrotsos E, Zamora C, Martinez A. Chronic lymphocytic leukemia/small lymphocytic lymphoma involving the aortic valve. Ann Diagn Pathol 2013; 17:295-7. [DOI: 10.1016/j.anndiagpath.2012.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
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9
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Advanced Stages of Melanoma: Role of Structural Imaging. PET Clin 2011; 6:37-54. [DOI: 10.1016/j.cpet.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Metastatic adenocarcinoma of pericardium of unknown origin—a case report. Indian J Thorac Cardiovasc Surg 2011. [DOI: 10.1007/s12055-010-0078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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O'Leary SM, Williams PL, Williams MP, Edwards AJ, Roobottom CA, Morgan-Hughes GJ, Manghat NE. Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography. Br J Radiol 2010; 83:194-205. [PMID: 20197434 DOI: 10.1259/bjr/55699491] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Multidetector row computed tomography (MDCT) with its high spatial and temporal resolution has now become an established and complementary method for cardiac imaging. It can now be used reliably to exclude significant coronary artery disease and delineate complex coronary artery anomalies, and has become a valuable problem-solving tool. Our experience with MDCT imaging suggests that it is clinically useful for imaging the pericardium. It is important to be aware of the normal anatomy of the pericardium and not mistake normal variations for pathology. The pericardial recesses are visible in up to 44% of non-electrocardiogram (ECG)-gated MDCT images. Abnormalities of the pericardium can now be identified with increasing certainty on 64-detector row CT; they may be the key to diagnosis and therefore must not be overlooked. This educational review of the pericardium will cover different imaging techniques, with a significant emphasis on MDCT. We have a large research and clinical experience of ECG-gated cardiac CT and will demonstrate examples of pericardial recesses, their variations and a wide variety of pericardial abnormalities and systemic conditions affecting the pericardium. We give a brief relevant background of the conditions and reinforce the key imaging features. We aim to provide a pictorial demonstration of the wide variety of abnormalities of the pericardium and the pitfalls in the diagnosis of pericardial disease.
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Affiliation(s)
- S M O'Leary
- Department of Clinical Radiology, Derriford Hospital, Plymouth PL6 8DH, UK.
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12
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Kondo T, Kitazawa R, Kawata E, Mori K, Kitazawa S. Diffuse cardiac lymphatic involvement by metastatic neuroendocrine carcinoma mimicking hypertrophic cardiomyopathy: a case report. CASES JOURNAL 2009; 2:9127. [PMID: 20062644 PMCID: PMC2803924 DOI: 10.1186/1757-1626-2-9127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 12/02/2009] [Indexed: 11/10/2022]
Abstract
We describe an autopsy case of non-functioning pancreatic neuroendocrine carcinoma metastasizing to the myocardium. A 63-year-old Japanese man was admitted to the hospital presenting with dyspnea. Echocardiography revealed marked left ventricular hypertrophy and diffuse myocardial thickening with pericardial effusion. The patient died of heart failure. An autopsy revealed that the whole pancreas, weighing 400 g, was occupied by tumor cells with neuroendocrine differentiation. The heart, weighing 780 g, showed numerous metastatic nodules and diffuse myocardial thickening. Histopathologically, the tumor was diagnosed as non-functioning pancreatic neuroendocrine carcinoma. Immunohistochemical analysis for D2-40 disclosed severe lymphatic infiltration of tumor cells, characterized by diffuse thickening of the myocardium.
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Affiliation(s)
- Takeshi Kondo
- Division of Pathology (Diagnostic Molecular Pathology Unit), Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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13
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Díaz ML, Villanueva A, Bastarrika G, Zudaire B, del Barrio LG, Noguera JJ. Non-Electrocardiogram-Gated Multidetector-Row Computed Tomography Findings of Cardiac Pathology in Oncologic Patients. Curr Probl Diagn Radiol 2009; 38:206-17. [DOI: 10.1067/j.cpradiol.2008.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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14
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O'Mahony D, Debnath I, Janik J, Aisner D, Jaffe E, Waldmann T, Morris J. Cardiac involvement with human T-cell lymphotrophic virus type-1-associated adult T-cell leukemia/lymphoma: The NIH experience. Leuk Lymphoma 2009; 49:439-46. [DOI: 10.1080/10428190701809164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Bashir H, Hudson MM, Kaste SC, Howard SC, Krasin M, Metzger ML. Pericardial involvement at diagnosis in pediatric Hodgkin lymphoma patients. Pediatr Blood Cancer 2007; 49:666-71. [PMID: 16874767 DOI: 10.1002/pbc.20993] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Because most cases are clinically silent, the incidence, clinical course, and outcome of pericardial involvement in Hodgkin lymphoma are unknown. METHODS Records of all patients with newly diagnosed Hodgkin lymphoma treated at our institution between 1991 and 2004 were reviewed. Pericardial involvement was identified by computerized tomography (CT) as focal thickening or nodularity present at the time of diagnosis, and by echocardiography as pericardial effusion. Outcomes measured were incidence of pericardial involvement, relapse-free survival, and overall survival. RESULTS Thirteen of 273 patients (5%) had pericardial involvement. All patients with pericardial involvement had nodular sclerosing tumors versus 183 of 260 patients without pericardial involvement (P = 0.02); 9 (67%) had a bulky mediastinal mass versus 27% (P = 0.002). Two patients required pericardial drainage to drain very large effusions (n = 2). Both patients were symptomatic with either shortness of breath or superior vena cava syndrome. In the 11 cases that did not undergo surgical drainage, the effusion resolved within days after starting chemotherapy. Two patients experienced distant relapse but underwent successful salvage therapy. All 13 patients remain alive and free of disease at a median follow-up of 9.7 years (range, 1.7-12.9 years) with normal cardiac function. CONCLUSIONS Pericardial involvement by lymphoma is usually asymptomatic unless accompanied by substantial pericardial effusion. In most cases, pericardial involvement resolves with treatment of the underlying malignancy, but close observation for hemodynamic complications is required. A symptomatic effusion, once treated, does not affect survival.
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Affiliation(s)
- Hamid Bashir
- Departments of Internal Medicine and Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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16
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Altbach MI, Squire SW, Kudithipudi V, Castellano L, Sorrell VL. Cardiac MRI is Complementary to Echocardiography in the Assessment of Cardiac Masses. Echocardiography 2007; 24:286-300. [PMID: 17313646 DOI: 10.1111/j.1540-8175.2007.00392.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Despite the fact that the incidence of cardiac tumors is low, the prompt evaluation and adequate intervention of these is highly important. Although most tumors of the heart are considered histologically benign, there are significant risks associated with these "benign" tumors. These are associated with significant morbidity and mortality due to obstruction of blood flow, alterations of conduction, propagation of arrhythmias, and thromboembolism, depending on their size, location, and nature. With the advent of noninvasive imaging modalities--traditionally echocardiography; but more recently using cross-sectional imaging with cardiac computed tomography and magnetic resonance imaging--cardiac tumors can be optimally assessed providing a greater opportunity for curative treatments by cardiothoracic surgery.
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Affiliation(s)
- Maria I Altbach
- Department of Radiology, Section of Cardiology, University of Arizona, Sarver Heart Center, Tucson, Arizona 85724, USA
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17
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Yap CH, Hair C, Foy S, Sewak S, Francis M, Kenny JF. Resection of right atrial metastatic large-cell neuroendocrine carcinoma. Asian Cardiovasc Thorac Ann 2007; 15:e20-2. [PMID: 17244909 DOI: 10.1177/021849230701500131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of cardiac metastases is rising due to increasingly sensitive diagnostic investigations and longer patient survival as a result of improved treatment for malignancies. We report a rare case of right atrial metastasis from a large cell neuroendocrine carcinoma successfully resected with cardiopulmonary bypass. The surgical management of advanced cardiac malignancy is discussed. In appropriately selected cases surgical resection of cardiac metastases can be beneficial, allowing improvement in quality of life, and prolongation of life.
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Affiliation(s)
- Cheng-Hon Yap
- St. Vincent's Hospital, Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia.
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18
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Restrepo CS, Largoza A, Lemos DF, Diethelm L, Koshy P, Castillo P, Gomez R, Moncada R, Pandit M. CT and MR imaging findings of malignant cardiac tumors. Curr Probl Diagn Radiol 2005; 34:1-11. [PMID: 15644858 DOI: 10.1067/j.cpradiol.2004.10.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article reviews CT and MRI features of malignant cardiac and pericardial tumors, most of which originate from the lung, breast, melanoma, leukemia, or lymphoma through lymphatic, hematogenous, transvenous, and direct pathways. Although echocardiography establishes the diagnosis in most cases, CT and MRI provide additional physical, spatial, and functional information that further aids the evaluation of metastases. For instance, CT provides superior resolution for detecting calcification or fat, while MRI with its direct multiplanar ability more completely characterizes the heart, pericardium, mediastinum, and lungs. MRI also helps elucidate the pathophysiological effects of these tumors on cardiac function through gated cine-loop sequences. Beyond tumor characterization, both modalities can help confirm diagnosis through the addition of contrast, which helps distinguish tumor from myocardium, thrombus, and blood flow artifact. Ultimately, MRI best facilitates surgical planning and posttreatment follow-up in large part because of its unparalleled ability to locate and delimit these tumors.
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19
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Tesolin M, Lapierre C, Oligny L, Bigras JL, Champagne M. Cardiac Metastases from Melanoma. Radiographics 2005; 25:249-53. [PMID: 15653599 DOI: 10.1148/rg.251045059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Maude Tesolin
- Department of Medical Imaging, Hôpital Sainte-Justine, University of Montreal, 3175 Côte Ste-Catherine Rd, Montreal, Quebec H3T 1C5, Canada
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20
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Abstract
Although carcinoid heart disease has been well described in the literature, metastatic implantation in the heart is rare. We describe a 79-year-old man with no previous history of cancer who presented with progressive dyspnea. He was found to have a septal implantation of a previously undiagnosed metastatic carcinoid tumor. He underwent successful resection with an uneventful postoperative course.
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Affiliation(s)
- Jon O Wee
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Wang ZJ, Reddy GP, Gotway MB, Yeh BM, Hetts SW, Higgins CB. CT and MR Imaging of Pericardial Disease. Radiographics 2003; 23 Spec No:S167-80. [PMID: 14557510 DOI: 10.1148/rg.23si035504] [Citation(s) in RCA: 348] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the evaluation of pericardial disease, computed tomography (CT) and magnetic resonance (MR) imaging traditionally have been used as adjuncts to echocardiography. However, CT and MR imaging are particularly useful as sensitive and noninvasive methods for evaluating loculated or hemorrhagic pericardial effusion, constrictive pericarditis, and pericardial masses. Both CT and MR imaging provide excellent delineation of the pericardial anatomy and can aid in the precise localization and characterization of various pericardial lesions, including effusion, constrictive pericarditis and pericardial thickening, pericardial masses, and congenital anomalies such as partial or complete absence of the pericardium. Both modalities provide a larger field of view than does echocardiography, allowing the examination of the entire chest and detection of associated abnormalities in the mediastinum and lungs. Soft-tissue contrast on CT scans and MR images also is superior to that on echocardiograms. Given the many potential applications of these modalities in the evaluation of pericardial diseases, familiarity with the CT and MR imaging features of these diseases is important.
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Affiliation(s)
- Zhen J Wang
- Department of Radiology, Box 0628, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA
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22
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Abstract
The accurate evaluation of cardiac masses by MR imaging was established in the infancy of cardiac MR imaging. From its advent, MR imaging was believed to be diagnostically superior to echocardiography in the evaluation of suspected cardiac masses. Though excellent in its assessment of the left side of the heart, echocardiography is limited in its evaluation of the right heart, mediastinum, and paracardiac structures. It is also of limited use in patients with emphysema and chest wall deformities. With the advent of ECG gating, MR imaging's ability to assess the presence and anatomy of cardiac and paracardiac masses was well established by a number of studies. This research also demonstrated MR imaging's capacity to exclude a cardiac mass when the echocardiogram was equivocal.
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Affiliation(s)
- Robert C Gilkeson
- Radiology University Hospitals of Cleveland Case Western Reserve University, 11100 Euclid Avenue, Cleveland OH 44106, USA.
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23
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Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics 2001; 21:439-49. [PMID: 11259706 DOI: 10.1148/radiographics.21.2.g01mr15439] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma. Tumor may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. Impairment of cardiac function occurs in approximately 30% of patients and is usually attributable to pericardial effusion. The clinical presentation includes shortness of breath, which may be out of proportion to radiographic findings in patients with pericardial effusion or may be the result of associated pleural effusion. Patients may also present with cough, anterior thoracic pain, pleuritic chest pain, or peripheral edema. The differential diagnosis of pericardial effusion in a patient with known malignancy includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis. Any disease process that causes thickening or nodularity of the pericardium or myocardium or masses within the cardiac chambers can mimic metastatic disease.
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Affiliation(s)
- C Chiles
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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24
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Abstract
There has been intense interest in the roles catecholamines may play in compensatory myocardial hypertrophy. This article reviews the following: (1) chronic infusions of catecholamines in experimental animals result in cardiac hypertrophy, but in many of the studies mechanical factors have played a role; (2) experiments using isolated papillary muscles and isolated hearts, stretched isolated myocytes, and denervated hearts in vivo demonstrate that mechanical activity is sufficient to cause increased protein synthesis and cell growth; (3) in neonatal myocyte cell cultures, alpha-adrenergic agonists are powerful stimulants for protein synthesis and cell growth. Beta-adrenergic stimulation of nonmyocyte myocardial cells causes release of a factor that promotes protein synthesis in neonatal myocytes. Either alpha or beta stimulation, probably through different mechanisms, appears to have growth-promoting effects on isolated adult myocytes in culture; (4) alpha stimulation is transduced through the Gq pathway and its activation of phospholipase C, cleavage of phosphatidylinositol (4,5)-bisphosphate, and then further through the ras/raf, mitogen-activated protein (MAP) kinase system; (5) transgenic mice with upregulation of catecholamine-related systems have not clarified the independent role of either the alpha- or beta-adrenergic pathway; and (6) observations in humans suggest that mechanical factors predominate in the development and regression of cardiac hypertrophy. Humoral mechanisms, including catecholamines, may play a role, but their quantitative importance has not been determined. It is hypothesized that catecholamines may play a role in transition from the adaptive to the maladaptive state.
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Affiliation(s)
- J Scheuer
- Albert Einstein College of Medicine, Department of Medicine, Bronx, New York 10461, USA
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25
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Calzas J, Lianes P, Cortés-Funes H. [Heart pathology of extracardiac origin. VII. Heart and neoplasms]. Rev Esp Cardiol 1998; 51:314-31. [PMID: 9608805 DOI: 10.1016/s0300-8932(98)74751-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiac alterations of neoplastic diseases can be due to direct invasion produced by primary cardiac tumors or more frequently secondary to local compression of vascular structures by extracardiac neoplasms, such as superior vena cava syndrome. One of the most important alterations is the cardiotoxicity of anticancer treatments, either chemotherapy drugs or radiotherapy techniques. These treatments cause acute and/or chronic cardiotoxicity that the oncologist and the cardiologist must be aware of. For instance, 4.5% to 7% of patients that have been treated with anthracyclines may suffer cardiac failure in their lifetime. The pathogenesis is still not clear. There is currently a lot of research on cardioprotectors, but nowadays the only one approved by the FDA is dexrazoxane, which is used on breast cancer patients treated with adriamycin.
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Affiliation(s)
- J Calzas
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid
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