1
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Garcia JJB, Pascual JLV. Cancer-associated stroke from progressive acinic cell carcinoma. BMJ Case Rep 2024; 17:e260385. [PMID: 38789271 DOI: 10.1136/bcr-2024-260385] [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] [Indexed: 05/26/2024] Open
Abstract
Cancer-associated stroke is an evolving subgroup of embolic strokes of undetermined source. A man in his mid-20s with progressive follicular variant acinic cell carcinoma of the parotid was admitted because of new onset left-sided weakness. Neuroimaging confirmed a right middle cerebral artery infarction. After extensive diagnostics, stroke aetiology was deemed from cancer-induced hypercoagulability. Questions which arose regarding his management included (1) What was the best antithrombotic for secondary stroke prevention? (2) What was his risk for intracranial or tumorous bleeding once antithrombotics had been started? (3) How many days post-stroke could the antithrombotic be initiated? and (4) When could he be cleared for palliative chemotherapy and whole brain irradiation? The approach to address the abovementioned questions in the management of a rare cancer complicated by stroke is presented. Although treatments are guided by known pathomechanisms, additional studies are needed to further support current treatment strategies for this subgroup of patients.
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Affiliation(s)
- Jao Jarro Borromeo Garcia
- Department of Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Metro Manila, Philippines
| | - Jose Leonard Vr Pascual
- Department of Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Metro Manila, Philippines
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2
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Ohtaka K, Ohtake S, Ishii Y, Kaku S, Takeuchi Y, Mizota T, Yamamura Y, Ichinokawa M, Yoshioka T, Tamoto E, Murakawa K, Ono K. Metastatic lung tumor from hepatocellular carcinoma with tumor thrombus invasion in the pulmonary vein: a case report. J Cardiothorac Surg 2023; 18:167. [PMID: 37118823 PMCID: PMC10148522 DOI: 10.1186/s13019-023-02230-4] [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: 11/07/2022] [Accepted: 04/02/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Metastatic lung tumor with a tumor thrombus in the peripheral pulmonary vein is very rare. We present a case of a metastatic lung tumor from hepatocellular carcinoma (HCC) with tumor thrombus invasion in the pulmonary vein that was diagnosed preoperatively and underwent complete resection by segmentectomy. CASE PRESENTATION A 77-year-old man underwent laparoscopic lateral segment hepatectomy for HCC eight years ago. Protein induced by vitamin K absence or antagonist-II remained elevated from two years ago. Contrast-enhanced chest computed-tomography (CT) showed a 27 mm nodule in the right apical segment (S1). He was pathologically diagnosed with a metastatic lung tumor from HCC via transbronchoscopic biopsy. We planned to perform right S1 segmentectomy. Before surgery, contrast-enhanced CT in the pulmonary vessels phase for three-dimensional reconstruction showed that the tumor extended into the adjusting peripheral pulmonary vein, and we diagnosed tumor thrombus invasion in V1a. The surgery was conducted under 3-port video-assisted thoracic surgery. First, V1 was ligated and cut. A1 and B1 were cut. The intersegmental plane was cut with mechanical staplers. Pathological examination revealed moderately-differentiated metastatic HCC with tumor thrombus invasions in many pulmonary veins, including V1a. No additional postoperative treatments were performed. CONCLUSIONS As malignant tumors tend to develop a tumor thrombus in the primary tumor, it might be necessary to perform contrast-enhanced CT in the pulmonary vessel phase to check for a tumor thrombus before the operation for metastatic lung tumors.
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Affiliation(s)
- Kazuto Ohtaka
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan.
| | - Setsuyuki Ohtake
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Yu Ishii
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Saya Kaku
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Yuta Takeuchi
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Tomoko Mizota
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Yoshiyuki Yamamura
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Masaomi Ichinokawa
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Tatsuya Yoshioka
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Eiji Tamoto
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Katsuhiko Murakawa
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
| | - Koichi Ono
- Department of Surgery, Obihiro Kosei General Hospital, West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan
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3
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Sato A, Matsumoto A, Naruse S, Isono Y, Maeda Y, Yamada M, Ikeda T, Sasajima Y, Jinno H. Acute arterial occlusive disease due to tumor thrombus from lung metastasis of breast cancer with cartilaginous and osseous metaplasia: a case report. Surg Case Rep 2023; 9:13. [PMID: 36723693 PMCID: PMC9892396 DOI: 10.1186/s40792-023-01598-8] [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: 10/04/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Tumor embolization due to venous infiltration of breast cancer pulmonary metastases is very rare. CASE PRESENTATION A 72-year-old female was diagnosed with triple-negative breast cancer. Neoadjuvant chemotherapy was discontinued because of progressive disease, and a right mastectomy with sentinel lymph node biopsy was performed. The pathological analysis of surgical specimens revealed carcinoma with cartilaginous and/or osseous metaplasia. At 22 months after surgery, lung metastasis was observed, and 6 months after initiating treatment for lung metastases, she complained of sudden numbness in the left-lower limb with trouble walking. Ultrasonography showed an embolism in the left popliteal artery, and contrast computed tomography showed enlarged lung metastases and infiltration of the left-upper lobe disease into the left superior pulmonary vein and left atrium. Acute arterial occlusive disease in the left-lower limb caused by the tumor embolism was suspected, so an endovascular thrombectomy was performed. Tumor emboli were removed by embolectomy catheter. CONCLUSION This report of lung metastasis from breast cancer with cartilaginous and/or osseous metaplasia and acute lower-limb artery occlusion due to a tumor thrombus adds useful information to the literature on these extremely rare cases.
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Affiliation(s)
- Ayana Sato
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Akiko Matsumoto
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Saki Naruse
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Yuka Isono
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Yuka Maeda
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Miki Yamada
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Tatsuhiko Ikeda
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Yuko Sasajima
- grid.264706.10000 0000 9239 9995Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
| | - Hiromitsu Jinno
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606 Japan
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An extensive surgical resection in stage T4 small cell lung cancer with cardiac invasion: A case report and literature review. Ann Med Surg (Lond) 2022; 81:104448. [PMID: 36147174 PMCID: PMC9486634 DOI: 10.1016/j.amsu.2022.104448] [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: 07/08/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction and importance We report a rare case of a patient with a mass involving both the hilum and the heart, but its specific nature could not be determined. SCLC was confirmed by postoperative pathology. It revealed that radical surgical resection for T4 SCLC should be considered an important part of multimodality treatment. Case presentation A 49-year-old gentleman complained of mild chest tightness for a week. Two large mass lesions were detected on CECT in the left atrium and left hilum. After an MDT discussion, an extended resection was recommended. Postoperative pathology denoted a complete excision with no residuals and negative lymph nodes. Clinical discussion Due to the rarity of lung metastases to the heart, it is vital to determine the homology between the hilar mass and the cardiac mass. Based on this, simultaneous surgical treatment is done and it is very beneficial for patients by eliminating those hazards, such as acute mechanical cardiac obstruction, and cardiac embolism. Our literature review demonstrates that the SCLC tumour progresses rapidly after cardiac metastasis, limiting the chance of a complete resection. Furthermore, complete resection of T4 tumours in NSCLC has been attempted many times, so it should also be tried on SCLC. Conclusion It is common for SCLC tumours to progress rapidly once they havemetastasized to the heart. An aggressive operation such as radical resection can reduce tumor burdens, minimize the risk of sudden acute death and improve patient follow-up treatment, all of which may prolong the survival of patients. In most cases, cardiac metastasis occurs in small-cell lung cancer with distant metastasis elsewhere. There are few cases in which there is no distant metastasis except lung and heart just like our case. Cases of extended resection of T4 stage NSCLC have been reported, but cases of extended resection of T4 stage SCLC are rare. We believe that the occurrence of cardiac metastasis in SCLC may indicate that the tumour enters the stage of accelerated growth. An extensive resection reduces the risks of embolism and cardiac pumping disorders brought by cardiac tumours to patients and is conducive to better acceptance of radiotherapy and chemotherapy in later stages.
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5
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Bando T, Ueno Y, Kuroyama T, Shimo D, Mikami K, Hori S, Tanaka Y, Hirai O. Histopathological diagnosis of clot tissues collected by mechanical thrombectomy provides understanding of cerebral infarction pathology in cancer associated thrombosis: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Uygur B, Celik O, Birant A, Demir AR, Erturk M. Echocardiographic detection of left atrium and left ventricle tumoral invasion via the left upper pulmonary vein, leading to the diagnosis of lung cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:565-568. [PMID: 32170864 DOI: 10.1002/jcu.22824] [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: 01/08/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
Left atrial (LA) invasion by lung cancer via hematogenous pathways is relatively uncommon. Herein we report the case of a 68-year-old male without any medical history, in whom lung cancer was diagnosed by transesophageal echocardiographic detection of the LA and left ventricle tumoral invasion via the left upper pulmonary vein. The primary source of tumor was found out by computed tomography.
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Affiliation(s)
- Begum Uygur
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Celik
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Birant
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali R Demir
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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7
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Talukder S, Murphy MO, Lyon A, Rosendahl AU. Metastasectomy of left atrial mesenchymal chondrosarcoma. Eur J Cardiothorac Surg 2020; 58:861-863. [PMID: 32413904 DOI: 10.1093/ejcts/ezaa116] [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: 01/05/2020] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 11/12/2022] Open
Abstract
Metastasis of chondrosarcoma of skeletal origin to the heart is uncommonly reported in the literature, with the majority of cases involving right atrial metastases. Surgical resection remains the mainstay of treatment, and the literature has shown improved median survival with this form of therapy, possibly by reducing thromboembolic risk in this patient population. We report the case of a patient with metastatic mesenchymal chondrosarcoma of the left atrium who underwent resection, following a lack of response to anticoagulation therapy. This is the first report of surgical resection of left atrial metastatic disease prior to the onset of thromboembolic sequelae.
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Affiliation(s)
| | - Michael O Murphy
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
| | - Alexander Lyon
- Department of Cardio-Oncology, Royal Brompton Hospital, London, UK
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8
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Yoshikawa S, Kamide T, Kasakura S, Arai N, Osada T, Mouri A, Hamada M, Kawasaki T, Takao M, Kohyama S. A case of cerebral infarction due to pleomorphic carcinoma of the lung. Surg Neurol Int 2020; 11:217. [PMID: 32874720 PMCID: PMC7451184 DOI: 10.25259/sni_37_2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022] Open
Abstract
Background: With the increase in endovascular treatment, reports of embolism other than thrombus are scattered, but intracranial tumorigenic embolism is rare and difficult to diagnose. Here, we describe a case of a tumorigenic embolism in a patient with lung cancer whose invasion into the vascular system was not detected on preoperative whole-body imaging. Case Description: A 66-year-old man who was hospitalized to undergo radiotherapy for pulmonary carcinoma suddenly developed left hemiplegia. He exhibited atrial fibrillation, and emergent radiographic examination revealed a right middle cerebral artery occlusion. Urgent mechanical embolectomy was performed, with successful revascularization. The excised embolus had a unique morphology and was pathologically diagnosed as a cerebral embolism caused by pleomorphic pulmonary carcinoma. Conclusion: Tumor-derived cerebral embolism is extremely rare, but it is necessary to consider it as a potential source of embolism during differential diagnosis in patients with malignant tumors.
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Affiliation(s)
- Shinichiro Yoshikawa
- Stroke Center, Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.,Stroke Center, Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomoya Kamide
- Stroke Center, Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shigen Kasakura
- Stroke Center, Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Noriko Arai
- Stroke Center, Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takashi Osada
- Stroke Center, Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Atsuto Mouri
- Department of Respiratory Medicine, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Mei Hamada
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masaki Takao
- Stroke Center, Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shinya Kohyama
- Stroke Center, Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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9
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Do YW, Lee Y, Kim GJ, Cho JY, Lee DH. Complete resection of primary pulmonary malignancy extending into the left atrium via the left pulmonary vein using cardiopulmonary bypass and single incision: A case series. Thorac Cancer 2019; 10:1260-1262. [PMID: 30916374 PMCID: PMC6500958 DOI: 10.1111/1759-7714.13028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 11/25/2022] Open
Abstract
If the best treatment for a patient with a primary pulmonary tumor extending into the left atrium via the left pulmonary vein is surgical resection, it is necessary to determine the appropriate approach, that is, whether cardiopulmonary bypass (CPB) or complete resection, would be more suitable. Lung resections under CPB are rarely performed because of the unpredictable prognosis. We report two successful cases of safe and rapid complete resection of primary pulmonary malignancy extending into the left atrium with the support of CPB via median sternotomy. Our experiences support the application of CPB in extended left pulmonary resections to achieve complete resection.
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Affiliation(s)
- Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Youngok Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
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10
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Pham N, Bonnen MD, Ghebre YT. Silent Neoplastic Cardiac Invasion in Small Cell Lung Cancer: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:619-622. [PMID: 29844305 PMCID: PMC6004049 DOI: 10.12659/ajcr.908374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Female, 66 Final Diagnosis: Small cell lung cancer Symptoms: Impaired memory Medication: — Clinical Procedure: Chest X-ray • computed tomography • magnetic resonance imaging • electrocardiogram Specialty: Oncology
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Affiliation(s)
- Ngoc Pham
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Mark D Bonnen
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Yohannes T Ghebre
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA.,Department of Medicine, Section on Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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11
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Left Atrial Mass Invasion from Pulmonary Neoplasm Extension via the Right Upper Pulmonary Vein Presenting as Ipsilateral Stroke. Case Rep Med 2016; 2016:7084234. [PMID: 28053605 PMCID: PMC5178349 DOI: 10.1155/2016/7084234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/15/2016] [Accepted: 11/20/2016] [Indexed: 11/21/2022] Open
Abstract
Left atrial invasion by lung cancer via haematogenous pathways is a relatively uncommon but potentially life-threatening event. While several cardiac complications of cardiac involvement have been previously described, the evolution towards cerebral stroke has been rarely reported. In this case report, we describe an atypical case of haematogenous metastatic invasion of the left atrium from pulmonary neoplasm extension presenting as an ipsilateral stroke whose ASCO classification changed during the clinical management.
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12
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Spácil J, Hradec J, Král J. Recurrent Peripheral Arterial Embolism from Metastatic Lung Choriocarcinoma. Angiology 2016; 57:127-9. [PMID: 16444469 DOI: 10.1177/000331970605700120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A patient with choriocarcinoma, most likely of ovarian origin, with lung metastasis is presented. The disease manifested itself by recurrent embolism into the peripheral arteries. Literature on this topic is reviewed.
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Affiliation(s)
- Jirí Spácil
- 3rd Department of Internal Medicine, General Teaching Hospital, and Charles University School of Medicine I, Prague, Czech Republic.
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13
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Li Y, Lou J, Qiu S, Guo Y, Pan M. Stereotactic radiotherapy for the treatment of lung cancer with a giant left atrial tumor thrombus: A case report and literature review. Oncol Lett 2016; 11:2229-2232. [PMID: 26998153 DOI: 10.3892/ol.2016.4215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 12/16/2015] [Indexed: 11/06/2022] Open
Abstract
Lung cancer presenting with a giant atrial tumor thrombus is particularly rare. Surgical resection, aided by a cardiopulmonary bypass, is the standard treatment of choice if there is no distant metastasis. However, this form of surgery carries a high risk, with the subsequent patient prognosis being extremely poor. The current study describes the case of a 52-year-old man presenting with left lung squamous cell carcinoma that had extended into the left atrium. The patient was treated with stereotactic radiotherapy, and regarding the atrial disease, a complete response was achieved within 12 months. The present case demonstrates that stereotactic radiotherapy may be a beneficial palliative treatment for patients with stage IV lung cancer invading the left atrium.
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Affiliation(s)
- Yong Li
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
| | - Jinrong Lou
- Department of Cardiology, Jiading Central Hospital, Shanghai 201800, P.R. China
| | - Shujun Qiu
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
| | - Yutian Guo
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
| | - Mianshun Pan
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
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14
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Lv L, Wang X, Zhang Y. Right atrial tumor embolism from thoracic chondrosarcoma: A case report. Oncol Lett 2015; 10:2807-2811. [PMID: 26722246 PMCID: PMC4665264 DOI: 10.3892/ol.2015.3713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 06/04/2015] [Indexed: 12/13/2022] Open
Abstract
Chondrosarcoma accounts for ~15% of all primary malignant bone tumors. Chondrosarcoma of the spine is rare, while intra-atrial tumor embolisms as a result of chondrosarcoma are extremely rare. In the present study, the case of a 70-year-old male with thoracic chondrosarcoma, who presented with a fever and exertional dyspnea, is reported. Following anti-infection treatment with cefoperazone sodium and sulbactam sodium, the patient developed shock and a mass was identified in the right atrium by echocardiogram. The patient subsequently developed acute circular breathing failure and succumbed to the disease. To the best of our knowledge, this is the first case of thoracic chondrosarcoma with a tumor embolism in the right atrium to be reported in the literature.
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Affiliation(s)
- Liyuan Lv
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P.R. China
| | - Xueqian Wang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P.R. China
| | - Ying Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P.R. China
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15
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Porres DV, Morenza OP, Pallisa E, Roque A, Andreu J, Martínez M. Learning from the pulmonary veins. Radiographics 2014; 33:999-1022. [PMID: 23842969 DOI: 10.1148/rg.334125043] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this article is to review the basic embryology and anatomy of the pulmonary veins and the various imaging techniques used to evaluate the pulmonary veins, as well as the radiologic findings in diseases affecting these structures. Specific cases highlight the clinical importance of the imaging features, particularly the findings obtained with multidetector computed tomography (CT). Pulmonary vein disease can be broadly classified into congenital or acquired conditions. Congenital disease, which often goes unnoticed until patients are adults, mainly includes (a) anomalies in the number or diameter of the vessels and (b) abnormal drainage or connection with the pulmonary arterial tree. Acquired disease can be grouped into (a) stenosis and obstruction, (b) hypertension, (c) thrombosis, (d) calcifications, and (e) collateral circulation. Pulmonary vein stenosis or obstruction, which often has important clinical repercussions, is frequently a result of radiofrequency ablation complications, neoplastic infiltration, or fibrosing mediastinitis. The most common cause of pulmonary venous hypertension is chronic left ventricular failure. This condition is difficult to differentiate from veno-occlusive pulmonary disease, which requires a completely different treatment. Pulmonary vein thrombosis is a rare, potentially severe condition that can have a local or distant cause. Calcifications have been described in rheumatic mitral valve disease and chronic renal failure. Finally, the pulmonary veins can act as conduits for collateral circulation in cases of obstruction of the superior vena cava. Multidetector CT is an excellent modality for imaging evaluation of the pulmonary veins, even when the examination is not specifically tailored for their assessment.
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Affiliation(s)
- Diego Varona Porres
- Department of Radiology, Hospital Vall d'Hebrón, Passeig Vall d'Hebrón 119, 08035 Barcelona, Spain.
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16
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Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR. Tumors of the pulmonary artery and veins. Semin Ultrasound CT MR 2013; 33:580-90. [PMID: 23168066 DOI: 10.1053/j.sult.2012.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pulmonary vasculature may be involved by different primary and secondary tumors. Poorly differentiated and undifferentiated sarcomas are the most common primary tumors of the pulmonary arteries. They tend to affect the large caliber pulmonary vessels and present with predominantly intraluminal growth. Pulmonary and mediastinal metastasis are common, and prognosis is poor. Clinical and imaging manifestations may mimic those of pulmonary embolism. Dyspnea, chest pain, cough, and hemoptysis are the most common presenting symptoms. Primary sarcomas arising from the central pulmonary veins are less common than their arterial counterpart. Secondary involvement of the pulmonary arteries and veins by primary and metastatic pulmonary malignancies is more common. Tumoral embolism may also affect the pulmonary arteries. They may develop from different intrathoracic and extrathoracic malignancies and may be indistinguishable from venous thromboembolism. It may manifest as cor pulmonale with right cardiac strain and dilated pulmonary arteries. Computed tomography, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography may help in the differentiation between these 2 conditions.
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Affiliation(s)
- Carlos S Restrepo
- Division of Thoracic and Cardiovascular Radiology, Department of Radiology, The University of Texas, Health Science Center, San Antonio, TX 78258, USA.
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Lee P, Kishan AU. Radiotherapy is effective for a primary lung cancer invading the left atrium. BMJ Case Rep 2012; 2012:bcr-2012-006667. [PMID: 22814990 DOI: 10.1136/bcr-2012-006667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Atrial involvement is an uncommon feature of advanced non-small-cell lung cancer, occurring in up to 10% of patients with bronchogenic carcinoma. Additionally, cardiac metastases from other sources are documented in up to 7% of cancer patients at autopsy. Because atrial invasion can lead to systemic embolisation and/or outflow obstruction, it is treated regardless of the overall prognosis. While the gold standard treatment has historically been surgical resection, advances in radiotherapy allow for the safe treatment of cardiac disease. Here we present the case of a woman with pulmonary adenocarcinoma of the left lower lobe that progressed to invade the pulmonary vein and left atrium while maintained on standard chemotherapy. She was treated with intensity-modulated radiotherapy and had a complete response in terms of her atrial disease within 3 months. She suffered no acute toxicity or complications as a result of the radiation therapy.
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Affiliation(s)
- Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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18
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Funakoshi Y, Mukohara T, Kataoka T, Tomioka H, Chayahara N, Fujiwara Y, Kiyota N, Shirasaka T, Oka T, Okada K, Okita Y, Hara S, Itoh T, Fumita S, Nakagawa K, Minami H. Left atrial extension of metastatic lung tumor via pulmonary vein: report on the first case of Ewing sarcoma. Rare Tumors 2010; 2:e53. [PMID: 21139968 PMCID: PMC2994530 DOI: 10.4081/rt.2010.e53] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 08/04/2010] [Accepted: 08/06/2010] [Indexed: 11/22/2022] Open
Abstract
Extension of metastatic lung tumors into the left atrium via pulmonary veins is rare. Here, we report the first case of Ewing sarcoma exhibiting such extension. A 31-year-old man with pulmonary metastasis from Ewing sarcoma presented with a mass in the left lung, extending to the left atrium through the left inferior pulmonary vein. As the patient was considered to be at risk of tumor embolism, the mass was excised surgically.
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Oizumi H, Tanaka R, Shimura H, Sasaki K, Koike H, Hattori N, Tanaka S. A case of cerebral embolism with metastatic chondrosarcoma in the left atrium. J Stroke Cerebrovasc Dis 2010; 20:79-81. [PMID: 20807491 DOI: 10.1016/j.jstrokecerebrovasdis.2009.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 10/14/2009] [Accepted: 10/14/2009] [Indexed: 12/01/2022] Open
Abstract
Cardiac tumor is a rare, but clinically important source of cerebral embolism. We report a case of metastatic chondrosarcoma in the left atrium with multiple cerebral emboli. A computed tomography scan of the chest revealed a large mass in the left atrium and pulmonary vein. The patient underwent heart surgery to remove the metastatic chondrosarcoma in the left atrium, to prevent the formation of further systemic emboli and possible sudden death. The cardiac tumor resection was successful, and the patient was discharged from the hospital without any handicap. This is a rare case of metastatic cardiac tumor that was a source of emboli into the brain and was eradicated.
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Affiliation(s)
- Hideki Oizumi
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ryota Tanaka
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.
| | - Hideki Shimura
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kumi Sasaki
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiroyuki Koike
- Department of Cardiosurgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeki Tanaka
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
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20
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Mehta RS, Schubbert T, Marshall J, Carpenter PM. Rational and successful use of carboplatin and albumin-bound paclitaxel in a patient with recurrent metaplastic carcinoma who presented with multi-organ tumor emboli. Clin Breast Cancer 2009; 9:56-9. [PMID: 19299243 DOI: 10.3816/cbc.2009.n.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We demonstrate successful treatment of recurrent chondroid-metaplastic breast cancer. Breast cancer recurrence was diagnosed when a patient with a history of metaplastic breast cancer presented with recurrent acute strokes. A diagnosis of tumor embolism was suspected when a chest radiograph performed as part of a work-up for stroke demonstrated several lung nodules, with 1 lung nodule invading the pulmonary vein and extending into the left atrium-the source of tumor emboli. This was followed by timely surgery to remove the embolizing metastatic lesion and local radiation to prevent growth and recurrent embolization. Subsequently, the patient received carboplatin and albumin-bound paclitaxel and experienced complete remission.
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Affiliation(s)
- Rita S Mehta
- Department of Internal Medicine, University of California, Irvine, CA, USA.
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21
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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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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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23
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Chen WH, Liu JS. Chondrosarcoma, lupus anticoagulant and cerebral ischaemia. J Clin Neurosci 2005; 12:305-7. [PMID: 15851089 DOI: 10.1016/j.jocn.2004.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 05/04/2004] [Indexed: 10/25/2022]
Abstract
Chondrosarcoma is a malignant disease of cartilage. Systemic embolisation usually arises from cancerous invasion of pulmonary vessels or the left atrium but cerebral embolisation or ischaemia is rarely recognised. We report a man with left leg amputation for tibial myxoid chondrosarcoma who suffered multiple cerebral embolisms one year later. Cerebral angiography and aortogram did not reveal luminal stenosis and a cardiac survey was normal. Lupus anticoagulant (LAC) and a prolonged activated partial thromboplastin time were detected. A molecular mimicry between prothrombin and paracrine hormones may have accounted for his LAC. A procoagulant autoantibody reacting against metastatic cancer cells may contribute to cancerous thrombosis, such as in chondrosarcoma.
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Affiliation(s)
- Wei Hsi Chen
- Stroke Biology Research Laboratory, Department of Neurology, Chang Gung Memorial Hospital, Niao Sung Hsiang, Kaohsiung, Taiwan
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Sebire NJ, Ramsay AD, Malone M, Sheppard MN, Roebuck D, Elliott MJ. Massive cardiac chondroma presenting with heart failure and superior vena cava obstruction in a teenage boy. Fetal Pediatr Pathol 2004; 23:325-31. [PMID: 16137169 DOI: 10.1080/15227950490952460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Histologically benign soft-tissue chondromas have been reported at many anatomical sites but are an uncommon cause of soft tissue mass lesions in childhood, accounting for less than 1% of cases. The most frequent sites for extraosseous soft-tissue chondromas are the hands and feet. For the extremely rare visceral chondromas, the site can be lung, where they may represent a component of Carney's syndrome of extra-adrenal paraganglioma, pulmonary chondroma, and epithelioid leiomyosarcoma of the gastrointestinal tract. Primary cardiac chondromas are exceptionally rare in patients of any age although cardiac chondrosarcoma, both primary and metastatic, is well reported. We present a case of a teenage boy with a fatal cardiac chondroma
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Affiliation(s)
- N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London, UK WC1N 3JH.
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Abstract
Most primary tumors of the pulmonary vasculature are sarcomas arising in the main pulmonary arteries and veins with high mortality rates. Pulmonary artery sarcoma is far more prevalent than its venous counterpart, though both are rare. Pulmonary capillary hemangiomatosis is a rare low-grade tumor or tumor-like lesion of the pulmonary capillaries that causes severe pulmonary hypertension. Secondary involvement of pulmonary vasculature by malignant tumors may rarely mimic a primary vascular tumor or clinically present as unexplained pulmonary hypertension associated with thrombotic microangiopathy.
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Affiliation(s)
- Eunhee S Yi
- Department of Clinical Pathology, University of California, San Diego School of Medicine, 200 West Arbor Drive, San Diego, CA 92103-8720, USA.
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Sibon I, Baudouin G, Orgogozo JM. Accidents vasculaires cérébraux et néoplasie : évoquer la thrombose veineuse pulmonaire. Rev Neurol (Paris) 2004; 160:462-4. [PMID: 15103274 DOI: 10.1016/s0035-3787(04)70931-5] [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: 10/28/2022]
Abstract
Stroke in patients with malignant tumor are associated with various aetiologies. We report a case of lung adnocarcinoma with pulmonary vein thrombosis appending into the left atrial revealed by multiple cerebral infarcts.
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Affiliation(s)
- I Sibon
- Fédération de Neurosciences Cliniques, CHU Bordeaux, Bordeaux.
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Newkirk L, Vater Y, Oxorn D, Mulligan M, Conrad E. Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection. Can J Anaesth 2003; 50:886-90. [PMID: 14617583 DOI: 10.1007/bf03018733] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Chondroblastic osteosarcoma requiring surgical intervention is associated with a high risk of pulmonary tumour embolism. Rapid intraoperative diagnosis with transesophageal echocardiography (TEE) allowed changing the management plan and treatment of a life-threatening pathology. CLINICAL FEATURES A 32-yr-old female with right pelvic chondrosarcoma presented for right hemipelvectomy. Two hours into the operation during ligation of the iliac blood vessels the patient's hemodynamic condition deteriorated and was followed by cardiac arrest. TEE was performed immediately and revealed massive tumour embolism in the right and left pulmonary arteries. Large tumour emboli were removed from the right and left pulmonary arteries after median sternotomy under cardiopulmonary bypass and moderate hypothermia. The hemipelvectomy was completed on the next day after fluid and inotropic agent resuscitation. An inferior vena cava filter was placed below the renal veins. The patient was discharged from hospital ten days after the surgery. CONCLUSION This case report illustrates the important role TEE can play in the early diagnosis and subsequent surgical treatment of noncardiac emergencies. Intraoperative TEE can have a significant impact on the decision making process in life threatening emergencies.
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Affiliation(s)
- Lee Newkirk
- Department of Anesthesiology, University of Washington Medical Center, Seattle, Washington, USA
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