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Lima NA, Cwikla K, Byers-Spencer K, Crumm I, Patel D, Huffman C, McGoff TN, Young J, Melgar TA, Helmstetter N. Malignant cardiac neoplasms and associated malignancies over 16 years in the USA. J Cardiol 2024; 83:377-381. [PMID: 37714265 DOI: 10.1016/j.jjcc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Malignant cardiac neoplasms (MCNs), both primary and metastatic, are rare with few epidemiologic studies. METHODS This retrospective study used the Healthcare Utilization Project/Nationwide Inpatient Sample database from 2002 to 2018 to evaluate the co-occurrences with other malignancies, and mortality of MCNs in the USA. RESULTS The data contained 7207 weighted discharges of MCN. Median patient age was 51.4 years, 52.29 % were male, in-hospital mortality was 10.51 %, mean cost of hospitalization was $34,280 USD. Lung, mediastinum, and airways were the most common primary cancers associated with metastatic MCN. CONCLUSIONS MCN are rare in the USA, however they carry a high in-hospital mortality, high morbidity, and hospital cost.
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Affiliation(s)
- Neiberg A Lima
- Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit, MI, USA.
| | - Kamil Cwikla
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Kristina Byers-Spencer
- Departments of Internal Medicine and Pediatrics, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Ian Crumm
- Departments of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Dhruvil Patel
- Wayne State University, School of Medicine, Detroit, MI, USA
| | - Cuyler Huffman
- Department of Epidemiology and Biostatistics, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Theresa N McGoff
- Department of Biomedical Informatics, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Jeffrey Young
- Department of Biomedical Informatics, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Thomas A Melgar
- Departments of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Nicholas Helmstetter
- Departments of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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2
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Madan U, Mahadevia H, Sharma P, Gunta SP, Tawfik O, Fritchie K, Magadan J. A bleeding heart: case report and review of pericardial angiosarcoma. Autops Case Rep 2024; 14:e2024488. [PMID: 38803483 PMCID: PMC11129860 DOI: 10.4322/acr.2024.488] [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: 12/22/2023] [Accepted: 04/12/2024] [Indexed: 05/29/2024]
Abstract
Primary cardiac tumors are rare. The cardiac sarcomas are the most common malignant cardiac tumors. These tumors have a dismal prognosis with an overall median survival of 25 months. Clinical features include dyspnea, arrhythmias, pericardial effusions, heart failure, and sudden cardiac death. The diagnosis is often challenging. Therefore, the cardiac imaging workup plays a central role in addition to a high clinical suspicion in the setting of atypical presentations that do not respond to standard therapies. The echocardiography, computed tomography, and cardiac MRI are crucial in clinching the diagnosis. Multimodal treatment with surgery, chemotherapy, and radiotherapy has been shown to improve outcomes, as opposed to using either of these modalities alone. We describe the case of a 30-year-old gentleman with COVID-19 infection who developed recurrent hemorrhagic pericardial effusions refractory to standard treatment and was eventually diagnosed as a case of pericardial angiosarcoma after his biopsy revealed the diagnosis and staging was performed using PET-CT-FDG scan. Our case re-emphasizes the importance of considering a malignant etiology early in the course of the disease presentation, especially in recurrent hemorrhagic effusions despite an inflammatory cytologic diagnosis of fluid. It also highlights the place for cardiac CT and MRI to ascertain the location and spread and to plan the further course of treatment. If diagnosed early, the estimated survival time can be prolonged by instituting a multimodal approach.
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Affiliation(s)
- Ujjwal Madan
- University of Missouri Kansas City, Division of Internal Medicine, Kansas City, MO, USA
| | - Himil Mahadevia
- University of Missouri Kansas City, Division of Internal Medicine, Kansas City, MO, USA
| | - Parth Sharma
- University of Missouri Kansas City, Division of Internal Medicine, Kansas City, MO, USA
| | | | - Ossama Tawfik
- MAWD Pathology Group, Cytopathologist, Kansas City, MO, USA
| | - Karen Fritchie
- Cleveland Clinic, Department of Pathology, Cleveland, OH, USA
| | - Julian Magadan
- University of Missouri Kansas City, Division of Rheumatology, Kansas City, MO, USA
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3
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Shu H, Xiao D, Han S, Du Y, Lin J, Li Q. A case of left atrial intimal sarcoma with rhabdomyosarcoma differentiation: a case report and literature review. Front Oncol 2024; 14:1340115. [PMID: 38835391 PMCID: PMC11148456 DOI: 10.3389/fonc.2024.1340115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
Primary cardiac malignancies are rare, with cardiac sarcomas being the main type. Among these, intimal sarcomas are the most common. However, they tend to occur in the great vessels and are rare in the heart, with only a few isolated cases reported. We report a challenging case of a patient with left atrial intimal sarcoma with rhabdomyosarcoma differentiation. The patient was admitted after a physical examination detected left heart occupancy, and initial imaging suspected a left atrial thrombus. The patient then underwent extracorporeal circulation-assisted open cardiac surgery with resection of an atrial mass. The postoperative pathological findings were suggestive of an arterial intimal sarcoma, which included areas of rhabdomyosarcoma differentiation within the tumor tissue. Unfortunately, the patient's tumor recurred 4 months later, and she died due to treatment failure. This case highlights the rarity and risk of misdiagnosis of cardiac intimal sarcoma. Additionally, we aim to improve the understanding of intimal sarcoma through a review of immunohistochemistry and gene amplification techniques.
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Affiliation(s)
- Hongyun Shu
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Duan Xiao
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sisi Han
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Yongkang Du
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Jinduan Lin
- Department of Laboratory Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Qiaowen Li
- Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China
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4
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Evbayekha E, Rao AK, Leidenfrost J, Reiss CK. Isolated primary cardiac angiosarcoma. Curr Probl Cardiol 2024; 49:102472. [PMID: 38369202 DOI: 10.1016/j.cpcardiol.2024.102472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
Cardiac angiosarcoma (CAS) is the most prevalent malignant primary cardiac tumor in adults, often affecting young males. We present a case of this rare entity in a young female, highlighting the multidisciplinary team's role and multimodality imaging in the diagnosis and management.
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Affiliation(s)
- Endurance Evbayekha
- St. Luke's Hospital, 232 S Woods Mill Rd, Suite 400 South, Chesterfield, MO 63017, USA.
| | - Anupama K Rao
- St. Luke's Hospital, 232 S Woods Mill Rd, Suite 400 South, Chesterfield, MO 63017, USA
| | - Jeremy Leidenfrost
- St. Luke's Hospital, 232 S Woods Mill Rd, Suite 400 South, Chesterfield, MO 63017, USA
| | - Craig K Reiss
- St. Luke's Hospital, 232 S Woods Mill Rd, Suite 400 South, Chesterfield, MO 63017, USA
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5
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Mulisa MD, Bekele SK, Woldemichael SB, Gaito SG, Abrar FN, Hailu BG. Primary Cardiac Sarcoma, Diagnostic and Therapeutic Challenges in Resource Limited Setting: Case Report. Int Med Case Rep J 2024; 17:57-61. [PMID: 38293614 PMCID: PMC10825581 DOI: 10.2147/imcrj.s436528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
Left atrial masses are commonly caused by atrial myxomas and metastatic tumors. Primary cardiac sarcomas are rare. Patients present with symptoms related to the tumor location. There are only a few case reports on this rare disease. We report the case of a 17 years old male patient presented with shortness of breath for 2-month duration. Echocardiography revealed a left atrial mass that was later surgically excised and histopathology confirmed a primary cardiac sarcoma. We discuss the diagnostic and therapeutic challenges encountered in the management of this rare disease. To the best of our knowledge, this is the first case reported in East Africa.
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Affiliation(s)
- Merga Daba Mulisa
- Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shalom Kassahun Bekele
- Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Fadil Nuredin Abrar
- Department of Pathology, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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6
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Chauhan A, Mudey A, Singh H. MRI and CT Appearances in Various Cardiac Tumours. Cureus 2024; 16:e51488. [PMID: 38304651 PMCID: PMC10831205 DOI: 10.7759/cureus.51488] [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: 08/23/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
While primary cardiac malignancies are infrequent, the heart often serves as a site for metastases. Myxomas are recognized as among the most prevalent primary benign tumours globally, while sarcomas represent the most common malignant primary tumours. The diverse range of potential clinical presentations depends on factors such as location, size, and the aggressiveness of the disease. The majority of diagnoses rely on medical imaging, making it crucial to familiarize oneself with their distinctive characteristics. When a cardiac mass is suspected, MRI of the heart has emerged as the preferred diagnostic method, surpassing previous techniques. CT is a valuable tool for assessing cardiac morphology and improving electrocardiography gating by providing enhanced details. This article conducts a comprehensive review of the MRI and CT characteristics of both primary and secondary cardiac malignancies, emphasizing crucial distinctions and common diagnostic pitfalls. Despite their rarity, cardiac masses continue to hold significance in the realm of cardio-oncology. Furthermore, this article explores conditions such as thrombus, Lambl's excrescences, and pericardial cysts, which can mimic tumours. Multimodal imaging has played a pivotal role in identifying the origin of cardiac masses in numerous cases, particularly when combined with the clinical context. This article offers an in-depth examination of the frequency, clinical indicators, imaging, diagnostic procedures, available treatments, and prognoses related to cardiac masses.
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Affiliation(s)
- Aayush Chauhan
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Mudey
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshit Singh
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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7
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Chen X, Chen Y, Xiao F, Liu M, Gu Z, Li Y, Hong M. Survival and analysis of prognostic factors for primary malignant cardiac tumors based on the SEER database. J Cancer Res Clin Oncol 2023; 149:15687-15696. [PMID: 37665405 DOI: 10.1007/s00432-023-05351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this study was to use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the survival rate of primary malignant cardiac tumors (PMCTs), assess the risk factors affecting survival, and calculate the number of PMCT cases in recent years. METHODS SEER 22 registries were used to calculate the number of cases PMCT. Data on age, sex, race, marital status, tumor size, the American Joint Committee on Cancer (AJCC) stage, lymph node involvement, metastasis, treatment, and survival were collected to analyze the survival and prognostic factors of SEER 17 registries. Using the Kaplan-Meier estimation method, a survival curve was obtained according to the influencing factors, and a multivariable Cox regression model was established. RESULTS In recent years, the average annual number of PMCT cases was 20.56 ± 7.12, significantly higher than the average before 2004 (P = 0.015; 95% CI 1.14-8.98). The 1-, 3-, and 5-year survival rates were 45.6%, 18.8%, and 11.2%, respectively. Multivariate analysis revealed that age (risk ratio [HR], 2.047; 95% CI 1.381-3.034), AJCC stage III (HR, 1.786; 95% CI 1.123-2.839), AJCC staging with distant metastasis (HR, 2.666; 95% CI 1.509-4.709), no chemotherapy (HR, 2.011; 95% CI 1.561-2.590), and tumor size larger than 99 mm (HR, 1.766; 95% CI 1.132-2.756) were independent risk factors for poor prognosis. Only age over 76 years and distant metastasis were independent risk factors for prognosis in the chemotherapy group. CONCLUSION In recent years, the annual number of patients with PMCT has increased significantly. Due to developments in chemotherapy, we should re-evaluate the traditional tumor staging and prognostic risk indicators to improve clinical applications.
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Affiliation(s)
- Xiaoxiao Chen
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Yizhou Chen
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Fangping Xiao
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Meng Liu
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Zhan Gu
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Yi Li
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Mei Hong
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China.
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8
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Molina G, Contreras R, Alvarez M, Goodman J, Yekta A. Atypical Presentation of a Right Atrial Myxoma. Cureus 2023; 15:e47084. [PMID: 38022078 PMCID: PMC10646150 DOI: 10.7759/cureus.47084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Primary cardiac tumors are exceptionally rare and predominantly located in the left atrium with occasional involvement on the right side of the heart. We present the case of a 52-year-old man who presented with chest pain, leading to suspicion of acute coronary syndrome. However, further investigation revealed a right atrial tumor measuring 6.3 cm. After surgical removal, the pathology analysis of the mass confirmed the histology of myxoma. Differential diagnoses for atrial myxomas include thrombus and other tumors, such as rhabdomyomas. More than half of these tumors arise in the left atrium and may be complicated by neurologic symptoms secondary to embolization. Right atrial myxomas are rare and described in the literature with a myriad of symptoms (signs of right heart failure [i.e., fatigue, peripheral edema, hepatomegaly, ascites], a diastolic murmur, and symptoms of pulmonary emboli). In other cases, they may be asymptomatic. Due to the low incidence and variety in their clinical picture, careful documentation of these cases is suggested for early recognition and directed management.
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9
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Gaisendrees C, Schlachtenberger G, Walter S, Gerfer S, Djordjevic I, Krasivskyi I, Cagman B, Weber C, Jaeger D, Kosmopoulos M, Luehr M, Mader N, Wahlers T. Long-term outcomes after minimal right lateral thoracotomy for the resection of cardiac tumors. Surg Oncol 2023; 49:101952. [PMID: 37285759 DOI: 10.1016/j.suronc.2023.101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/15/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Cardiac tumors are a rare and heterogeneous entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts for long-term outcomes after minimally-invasive cardiac surgery using right-anterior thoracotomy and femoral cardiopulmonary bypass (CPB) cannulation. METHODS Between 2009 and 2021, patients who underwent minimally-invasive cardiac tumor removal at our department were included. The diagnosis was confirmed postoperatively by (immune-) histopathological analysis. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. RESULTS Between 2009 and 2021, 183 consecutive patients underwent surgery for a cardiac tumor at our department. Of these, n = 74 (40%) were operated on using a minimally-invasive approach. The majority, n = 73 (98.6%), had a benign cardiac tumor, and 1 (1.4%) had a malignant cardiac tumor. The mean age was 60 ± 14 years, and n = 45 (61%) of patients were female. The largest group of tumors was myxoma (n = 62; 84%). Tumors were predominantly located in the left atrium in 89% (n = 66). CPB-time was 97 ± 36min and aortic cross-clamp time 43 ± 24 min s. The mean hospital stay was 9.7 ± 4.5 days. The perioperative mortality was 0%, and all-cause mortality after ten years was 4.1%. CONCLUSION Minimally-invasive tumor excision is feasible and safe, predominantly in benign cardiac tumors, even in combination with concurrent procedures. Patients who require cardiac tumor removal should be evaluated for minimally-invasive cardiac surgery at a specialized center, as it is highly effective and associated with good long-term survival.
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Affiliation(s)
- Christopher Gaisendrees
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany.
| | - Georg Schlachtenberger
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Sebastian Walter
- University Hospital Cologne, Department of Orthopaedics, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ihor Krasivskyi
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Burak Cagman
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Carolyn Weber
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA
| | - Maximilian Luehr
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
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10
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Bangolo A, Fwelo P, Iyer KM, Klinger S, Tavares L, Dey S, Chacko AA, Hein M, Gudena S, Lawal G, Sivasubramanian BP, Rimba Z, Hirpara K, Merajunnissa M, Veliginti S, Arana G, Sathyarajan DT, Singh S, Shetty T, Bhardwaj K, Hashemy S, Duran RL, Kim SH, Hipolito CM, Yoon K, Patel V, Alshimari A, Inban P, Yasmeen S, Devanaboyina K, Kumar G, Preet S, Akhtar M, Abdi A, Nalajala N, Rizvi SFM, Gupta B, Weissman S. Primary Cardiac Sarcoma: Clinical Characteristics and Prognostic Factors over the Past 2 Decades. Diseases 2023; 11:diseases11020074. [PMID: 37218887 DOI: 10.3390/diseases11020074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Primary cardiac sarcomas (PCS) are extremely rare malignant tumors involving the heart. Only isolated case reports have been described in the literature over different periods of time. This pathology has been associated with a dismal prognosis and given its rarity; treatment options are very limited. Furthermore, there are contrasting data about the effectiveness of current treatment modalities in improving the survival of patients with PCS, including surgical resection which is the mainstay of therapy. There is a paucity of data on the epidemiological characteristics of PCS. This study has the objective of investigating the epidemiologic characteristics, survival outcomes, and independent prognostic factors of PCS. METHODS A total of 362 patients were ultimately registered in our study from the Surveillance, Epidemiology, and End Results (SEER) database. The study period was from 2000 to 2017. Demographics such as clinical characteristics, overall mortality (OM), and PCS-specific mortality (CSM) were taken into account. A p value of <0.1 in the univariate analysis leads to the incorporation of the variable into multivariate analysis adjusting for covariates. Adverse prognostic factors were represented by a Hazard Ratio (HR) greater than one. The five-year survival analysis was carried out using the Kaplan-Meier method and the log-rank test was used to compare survival curves. RESULTS Crude analysis revealed a high OM in age 80+ (HR = 5.958, 95% CI 3.357-10.575, p < 0.001), followed by age 60-79 (HR = 1.429, 95% CI 1.028-1.986, p = 0.033); and PCS with distant metastases (HR = 1.888, 95% CI 1.389-2.566, p < 0.001). Patients that underwent surgical resection of the primary tumor and patients with malignant fibrous histiocytomas (HR = 0.657, 95% CI 0.455-0.95, p = 0.025) had a better OM (HR = 0.606, 95% CI 0.465-0.791, p < 0.001). The highest cancer-specific mortality was observed in age 80+ (HR = 5.037, 95% CI 2.606-9.736, p < 0.001) and patients with distant metastases (HR = 1.953, 95% CI 1.396-2.733, p < 0.001). Patients with malignant fibrous histiocytomas (HR = 0.572, 95% CI 0.378-0.865, p = 0.008) and those who underwent surgery (HR = 0.581, 95% CI 0.436-0.774, p < 0.001) had a lower CSM. Patients in the age range 80+ (HR = 13.261, 95% CI 5.839-30.119, p < 0.001) and advanced disease with distant metastases (HR = 2.013, 95% CI 1.355-2.99, p = 0.001) were found to have a higher OM in the multivariate analyses adjusting for covariates). Lower OM was found in patients with rhabdomyosarcoma (HR = 0.364, 95% CI 0.154-0.86, p = 0.021) and widowed patients (HR = 0.506, 95% CI 0.263-0.977, p = 0.042). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups, and lower mortality in patients with Rhabdomyosarcoma. CONCLUSION In this United States population-based retrospective cohort study using the SEER database, we found that cardiac rhabdomyosarcoma was associated with the lowest CSM and OM. Furthermore, as expected, age and advanced disease at diagnosis were independent factors predicting poor prognosis. Surgical resection of the primary tumor showed lower CSM and OM in the crude analysis but when adjusted for covariates in the multivariate analysis, it did not significantly impact the overall mortality or the cancer-specific mortality. These findings allow for treating clinicians to recognize patients that should be referred to palliative/hospice care at the time of diagnosis and avoid any surgical interventions as they did not show any differences in mortality. Surgical resection, adjuvant chemotherapy, and/or radiation in patients with poor prognoses should be reserved as palliative measures rather than an attempt to cure the disease.
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Affiliation(s)
- Ayrton Bangolo
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Pierre Fwelo
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Kritika M Iyer
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Sarah Klinger
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Lorena Tavares
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Shraboni Dey
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Angel Ann Chacko
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Myat Hein
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Samyukta Gudena
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Gbenga Lawal
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Barath P Sivasubramanian
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Zekordavar Rimba
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Kinjal Hirpara
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Merajunnissa Merajunnissa
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Swathi Veliginti
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Georgemar Arana
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Dily T Sathyarajan
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Sachin Singh
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Tanvi Shetty
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Kshitij Bhardwaj
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Sayed Hashemy
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Roberto L Duran
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Sung H Kim
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Candice M Hipolito
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Kibo Yoon
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Vrusha Patel
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Aseel Alshimari
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Pugazhendi Inban
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Saaniya Yasmeen
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Krushika Devanaboyina
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Gulshan Kumar
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Saran Preet
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Mishgan Akhtar
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Ayanleh Abdi
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Navya Nalajala
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Syed F M Rizvi
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Bhavna Gupta
- Department of Hematology and Oncology, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
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11
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Garg N, Pandey S, Madan S, Yadav S, Majumdar G, Jain N, Jain M. Isolated Cardiac Paraganglioma Encasing Right Coronary Artery With Evidence of Succinyl Dehydrogenase Gene Mutation: Successful Management Using Multimodality Imaging. Tex Heart Inst J 2023; 50:490667. [PMID: 36745744 PMCID: PMC9969784 DOI: 10.14503/thij-21-7639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This report involves a young woman with isolated cardiac paraganglioma that was diagnosed using 68Gallium-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-octreotide positron emission tomographic scintigraphy. For the preoperative evaluation, multimodality imaging accurately described the anatomic location of the tumor and its relationship with the surrounding tissues. The patient underwent successful surgical resection of the tumor along with right coronary artery bypass grafting. The 2-month follow-up scintigraphy was normal. Next-generation sequencing evaluation revealed a novel germline mutation for the succinate dehydrogenase subunit B gene.
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Affiliation(s)
- Naveen Garg
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Shashank Pandey
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Shiva Madan
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Subhash Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gurango Majumdar
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neeraj Jain
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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12
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D’Anna C, Villani A, Ammirati A, Francalanci P, Ragni L, Cecconi G, Secinaro A, Chinali M, Santilli A, Guccione P, Galletti L, Brancaccio G. New Onset Cardiac Murmur and Exertional Dyspnea in an Apparently Healthy Child: A Rare Localization of Obstructive Myxoma in the Right Ventricle Outflow Tract without Pulmonary Embolization-A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12888. [PMID: 36232202 PMCID: PMC9566503 DOI: 10.3390/ijerph191912888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Myxomas are slowly growing benign neoplasms which are rare in children. Up to 80% can be located in the left atrium and generate symptoms such as embolism, cardiac failure, fever and weight loss. Rarely, myxomas can be detected in the right ventricle outflow tract, causing arrhythmias, pulmonary emboli and sudden death. We report the case of a 13-year-old healthy child brought to the Emergency Department (ED) of the Children's Hospital Bambino Gesù, Rome, for recent dyspnea, chest pain on exertion and new onset cardiac murmur. Patient underwent medical examination and echocardiogram with the finding of a rounded and lobulated voluminous mass in the right ventricle outflow tract (RVOT) which caused severe obstruction. The contrast computed tomography (CT) scan confirmed the presence of a heterogeneously enhancing soft-tissue mass occupying the RVOT with no evidence of pulmonary embolization. The mass was surgically excised, and the pathologic examination confirmed our suspicion of myxoma. Our experience suggests that myxoma can have mild clinical symptoms, the presentation may be non-specific, and diagnosis can be a challenge Careful examination and a diagnostic imaging workup, primarily with the transthoracic echocardiogram, are needful to make a rapid differential diagnosis and to better manage surgical treatment and follow-up.
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Affiliation(s)
- Carolina D’Anna
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Alberto Villani
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonio Ammirati
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Francalanci
- Department of Pathological Anatomy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Laura Ragni
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Cecconi
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Marcello Chinali
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonella Santilli
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paolo Guccione
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Gianluca Brancaccio
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
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13
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Mishra R, Shemmeri E, Pani S, Tribble M. Primary cardiac sarcoma presenting with easy bruising: a case report. Eur Heart J Case Rep 2022; 6:ytac331. [PMID: 36131906 PMCID: PMC9486904 DOI: 10.1093/ehjcr/ytac331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
Background Primary cardiac sarcomas are rare, aggressive types of malignancies with poor prognoses and can rarely present with thrombocytopenia. Sarcomas account for 65% of primary malignant cardiac tumours. Clinical symptoms often present with constitutional symptoms such as shortness of breath, weight loss, and fatigue. In addition, the tumour’s location determines treatment options and prognosis. Multimodal imaging facilitates the detection and assessment of cardiovascular tumours. This case study presents a rare primary right heart cardiac sarcoma presenting with thrombocytopenia. Case summary An 80-year-old male presented to the emergency department with complaints of worsening dyspnoea, ease of bruising, and chest pain. An extensive investigation into the cause of thrombocytopenia was performed. A transthoracic echocardiogram, computed tomography scan, and cardiac magnetic resonance (CMR) image revealed a large mass affecting the right atrium and right ventricle. Myocardial biopsy showed high-grade angiosarcoma. Due to his advanced age and intraventricular septal involvement of the mass, the multidisciplinary team decided to proceed with palliative chemotherapy. Discussion Many cardiac tumours remain asymptomatic, and the diagnosis is made at an advanced stage of the disease. Differential diagnoses of the intramural masses include haemangiomas, lipomas, rhabdomyomas, lymphomas, and sarcomas. Multiple treatment options should be considered to address thrombocytopenia. Tumour diagnosis and identification consist of laboratory tests and multimodal imaging. Complete surgical resection with neoadjuvant and adjuvant purposes is the mainstay of cardiac sarcoma therapy. A multidisciplinary, individualized care approach should be performed.
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Affiliation(s)
- Rina Mishra
- Department of Medicine, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
| | - Ealaf Shemmeri
- Department of Cardiothoracic Surgery, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
| | - Saroj Pani
- Department of Anesthesiology, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
| | - Matthew Tribble
- Department of Anesthesiology, Albany Medical Center , 43 New Scotland Ave, Albany, NY 12208 , USA
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14
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Hooda Z, Ramaprasad G, Cerda L, Zuberi J, Connolly M. Rare case of papillary fibroelastoma resection with concomitant cox-maze IV procedure. J Surg Case Rep 2022; 2022:rjac371. [PMID: 35975229 PMCID: PMC9375653 DOI: 10.1093/jscr/rjac371] [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: 05/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary cardiac tumors represent 0.1% of all cardiac tumors, making them a rare pathologic phenomenon. The second most common cardiac tumors are papillary fibroelastomas, which also represent the most common valvular tumors. This report examines a rare case of a patient that underwent resection of papillary fibroelastoma with simultaneous Cox-Maze IV procedure for treatment of atrial fibrillation. This 67-year-old male patient was initially scheduled for transcatheter ablation for treatment of rate-controlled atrial fibrillation. During a pre-procedural trans-thoracic echocardiogram, it was discovered that the patient had a moderately sized pedunculated mass on the aortic valve, suspicious of papillary fibroelastoma. Despite the patient having no history of embolic events or aortic insufficiency from the papillary fibroelastoma, the transcatheter ablation procedure was canceled. He was referred to cardiothoracic surgery for further evaluation, and it was determined that this patient was a candidate for papillary fibroelastoma resection along with Cox-Maze IV procedure for atrial fibrillation.
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Affiliation(s)
- Zamaan Hooda
- Department of Surgery, St. Joseph’s University Medical Center , Paterson 07503, New Jersey, USA
| | - Ganesh Ramaprasad
- Department of Surgery, St. Joseph’s University Medical Center , Paterson 07503, New Jersey, USA
| | - Luis Cerda
- Department of Surgery, St. Joseph’s University Medical Center , Paterson 07503, New Jersey, USA
| | - Jamshed Zuberi
- Department of Surgery, St. Joseph’s University Medical Center , Paterson 07503, New Jersey, USA
| | - Mark Connolly
- Department of Surgery, St. Joseph’s University Medical Center , Paterson 07503, New Jersey, USA
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15
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Azeez H, Abdulrahman ZA, Nguyen T, Tofano M. Left Atrial Myxoma Presenting as Persistent Dizziness. Cureus 2022; 14:e26321. [PMID: 35911261 PMCID: PMC9310553 DOI: 10.7759/cureus.26321] [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] [Accepted: 06/25/2022] [Indexed: 12/03/2022] Open
Abstract
Cardiac masses are divided into benign tumors and malignant tumors. The tumor can cause valvular obstruction and embolization phenomenon. To elucidate the etiology of cardiac masses, we rely on the use of echocardiograms in combination with the clinical picture of the patient. We describe an interesting case report of a 71-year-old woman who presented with persistent dizziness for one day. MRI brain showed multiple, small, scattered foci of acute infarction. The patient was treated with aspirin and atorvastatin. Transthoracic echocardiography showed a mass in the left atrium. Afterward, the tumor was removed surgically and histopathology was consistent with atrial myxoma.
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16
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Alirezaei T, Ansari Aval Z, Jafari Tadi M, Mollasharifi T. Primary cardiac synovial sarcoma presenting with brain metastases. Future Cardiol 2022; 18:553-559. [PMID: 35699251 DOI: 10.2217/fca-2022-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary cardiac synovial sarcoma is a very rare primary cardiac tumor that usually arises in the right side of the heart. Brain metastases in primary cardiac sarcomas are not uncommon. Because of the wild nature of these tumors, they usually have poor outcomes. This study describes a 29-year-old female who presented with blurred vision, headache, nausea, vomiting and brain lesions in the radiologic study. Incidentally, two-dimensional echocardiography revealed a left atrial lesion. The patient underwent emergency cardiac surgery to resect the left atrial mass that arose from the atrial free wall and pulmonary veins. The diagnosis of the lesion was primary synovial sarcoma in the histopathologic examination.
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Affiliation(s)
- Toktam Alirezaei
- Cardiology department of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 1989934148, Iran
| | - Zahra Ansari Aval
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, 1998734383, Iran
| | - Mehrdad Jafari Tadi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 1985717443, Iran
| | - Tahmineh Mollasharifi
- Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 1998734383, Iran
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17
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Newell P, Zogg CK, Kusner J, Hirji S, Kerolos M, Kaneko T. National outcomes following benign cardiac tumor resection: A critical sex-based disparity. J Card Surg 2022; 37:2653-2660. [PMID: 35662249 DOI: 10.1111/jocs.16654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment of benign primary cardiac tumors involves surgical resection, but reported outcomes from multi-institutional or national databases are scarce. This study examines contemporary national outcomes following surgical resection of benign primary atrial and ventricular tumors. METHODS The 2016-2018 Nationwide Readmissions Database was queried for all patients ≥18 years with a primary diagnosis of benign neoplasm of the heart who underwent resection of the atria, ventricles, or atrial/ventricular septum. Primary outcomes were 30-day mortality, readmission, and composite morbidity (defined as stroke, permanent pacemaker implantation, bleeding complication, or acute kidney injury). Multivariable analysis was used to identify independent predictors of worse outcomes. RESULTS A weighted total of 2557 patients met inclusion criteria. Mean age was 61 years, 67.9% were female, and patients had relatively low comorbidity burdens (mean Charlson Comorbidity Index 1.39). The majority of patients underwent excision of the left atrium (71.5%), followed by the intra-atrial septum (26.6%), right atrium (2.9%). There was no difference in 30-day mortality (2.1% vs. 1.3%, p = .550), 30-day readmission (7.0% vs. 9.1%, p = .222), or 30-day composite morbidity (56.8% vs. 53.8%, p = .369) between females and males, respectively. However, on multivariable analysis, female sex was independently associated with increased risk of 30-day mortality (adjusted odds ratio = 2.65, p = .028). Tumor location (atria, ventricles, septum) was not predictive of mortality. CONCLUSION Benign atrial and ventricular tumors are uncommon, but disproportionately impact female patients, with female sex being an independent predictor of 30-day mortality. Root-cause analysis is necessary to determine the ultimate cause of this disparity.
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Affiliation(s)
- Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Boston, Massachusetts, USA
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Boston, Massachusetts, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Jonathan Kusner
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mariam Kerolos
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Pournazari M, Assar S, Mohamadzadeh D, Mahdian M, Soltani S. Cardiac angiosarcoma: a case report of a young female with pulmonary metastasis. Egypt Heart J 2022; 74:40. [PMID: 35596835 PMCID: PMC9124257 DOI: 10.1186/s43044-022-00277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Angiosarcoma is a malignant rare tumor that originates from vascular endothelial cells that cover lymphatic or blood vessels. Cardiac angiosarcoma is the most prevalent sarcoma entail the heart. It has low incidence rate and poor prognosis. Our effort through this report was raising awareness of uncommon manifestations of this disease and showing the importance of appropriate diagnosis and treatment. Case presentation We present a case of cardiac angiosarcoma in a young female whose symptoms included dyspnea and hemoptysis with a history of pericardial effusion and a past history of cardiac surgery for suspected atrial Myxoma. She had history of several hospitalizations and relapse of symptoms a few months after each hospital discharge. Conclusions The unspecific symptoms of cardiac angiosarcoma made it difficult to make in time diagnose and appropriate treatment. Awareness of unspecific presentations of cardiac angiosarcoma is necessary for proper diagnosis and treatment while delayed diagnosis may worsen the prognosis and even lead to death.
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Affiliation(s)
- Mehran Pournazari
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shirin Assar
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Dena Mohamadzadeh
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Mahdian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Setareh Soltani
- Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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19
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Expansive intracardiac leiomyosarcoma - a combined therapeutic approach resulting in survival with complete remission. A literature review and case report. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022. [PMID: 35296871 DOI: 10.5507/bp.2022.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary cardiac sarcomas are extremely rare and often with dismal prognosis. Only a few case series and retrospective studies regarding its biological characteristics, diagnostics, and treatment were reported. The multi-modality therapeutic strategy has been discussed in the published literature, but often with contradictory results. There is thus, no consensus on the optimal therapeutic approach to date. We present the case report of the 66-year old female endangered by a large primary leiomyosarcoma expanding in the right-sided heart chambers with imminent risk of acute obstruction of blood flow. The patient was managed by urgent surgical resection. After the histological confirmation of incomplete R1 resection, the treatment was supplemented by adjuvant CT-targeted radiotherapy, resulting in extraordinary survival with complete remission over a 24-month follow-up period. Our case report aims to demonstrate a favorable result of an individually suited complex surgical and oncological treatment to support the multidisciplinary therapeutic approach to these patients. The article is supplemented by a detailed literature review providing a theoretical background and an overview of the acquired knowledge and possible strategies.
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20
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Rare Case of Cavernous Haemangioma of the Right Atrium with Probable Hepatic Haemangioma. Case Rep Cardiol 2022; 2022:9214196. [PMID: 35265379 PMCID: PMC8898869 DOI: 10.1155/2022/9214196] [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: 10/24/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiac haemangiomas are rare causes of atrial masses. This case report is of a 44-year-old male who presented with a right atrial mass that was found incidentally on a CT performed for renal colic. The mass was further investigated with a transthoracic echocardiogram that showed that it was echodense and arising from the Eustachian valve in the right atrium. Coronary angiogram revealed large well-developed atrial branches that crossed superiorly over the left atrium and entered the mass in the right atrium. Surgical resection was undertaken, and this confirmed that the mass had a fleshy, encapsulated appearance with a sessile stalk. Histology demonstrated a cavernous haemangioma. The patient had a residual small defect in the interatrial septum postoperatively but otherwise made a good recovery.
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21
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Chua CC, Wong TF, Ang CY, Yeap BT. Anaesthetic challenges in a morbidly obese man for cardiac myxoma resection: A case report. Ann Med Surg (Lond) 2021; 71:102998. [PMID: 34840753 PMCID: PMC8606837 DOI: 10.1016/j.amsu.2021.102998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac myxoma is a rare neoplasm with female preponderance. It is the commonest benign cardiac neoplasm. We report a case entailing the perioperative anaesthetic challenges in managing a young morbidly obese man with a huge left atrial myxoma, who presented to us with acute symptoms of heart failure. Case presentation A young morbidly obese man with a body mass index (BMI) of 43.3 kg/m2 presented to us with acute symptoms of heart failure. An urgent transthoracic echocardiogram showed a huge pedunculated mass which arise from the left atrium, which occasionally completely occludes the mitral valve during each diastole. He underwent a resection of cardiac myxoma, which was complicated with intraoperative hypotension. Fortunately, it was successfully managed by placing the patient in Trendelenburg position for optimum blood pressure control. Discussion Tumours of the heart are very rare. Common histopathological findings are myxomas, followed by uncommon types of rhabdomyosarcomas and angiosarcomas. Pedunculated cardiac tumours can cause partial to complete obstructions which may lead to devastating conditions. Anaesthesia for morbidly obese patients with pedunculated cardiac myxoma are extremely challenging. Cardiac anaesthetists should be vigilant in managing these patients as they posed many life-threatening complications. Conclusion Cardiac myxoma are uncommon benign tumor of the heart with higher preponderances on the left atrium. Pedunculated mass can cause obstruction by limiting left ventricular filling, mimicking severe mitral stenosis. Positioning the patient Trendelenburg can transiently reduce intracardiac obstruction, improve cardiac output and venous return to the heart. Optimum patient positioning and management will lead to excellent outcomes. Cardiac myxomas are rare benign tumours of the heart which has higher preponderances on the left atrium. Pedunculated myxomas can cause intracardiac obstruction that may lead to cardiovascular collapse. Surgical resection of cardiac myxoma remains the mainstay of treatment with excellent prognosis. Anaesthesia for obese patients with cardiac myxoma poses significant perioperative challenges.
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Affiliation(s)
- Chen Chen Chua
- Department of Cardiothoracic Anaesthesia and Perfusion, Hospital Queen Elizabeth 2, 88350, Kota Kinabalu, Sabah, Malaysia
| | - Teck Fui Wong
- Department of Cardiothoracic Anaesthesia and Perfusion, Hospital Queen Elizabeth 2, 88350, Kota Kinabalu, Sabah, Malaysia
| | - Chee Yee Ang
- Department of Cardiothoracic Anaesthesia and Perfusion, Hospital Queen Elizabeth 2, 88350, Kota Kinabalu, Sabah, Malaysia
| | - Boon Tat Yeap
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
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22
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Mhadgut H, Manthri S, Youssef B, Jaishankar D. The Rarest of the Rare: A Case of Primary Cardiac Osteosarcoma With a Review of the Literature. Cureus 2021; 13:e16492. [PMID: 34430107 PMCID: PMC8373439 DOI: 10.7759/cureus.16492] [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: 07/08/2021] [Indexed: 11/05/2022] Open
Abstract
A 54-year-old female presented with shortness of breath and cyanosis. Work up with chest X-ray and subsequent echocardiogram revealed an intracardiac bi-atrial mass leading to emergent cardiothoracic resection. Pathology was consistent with a primary cardiac high-grade osteosarcoma. Post-resection staging positron emission tomography-computed tomography (PET-CT) showed hypermetabolic mixed lytic and sclerotic lesion of T10 concerning for metastasis. She received five cycles of adriamycin and ifosfamide chemotherapy before discontinuation due to systolic dysfunction. Nine months later, she developed a high tumor burden with progressive disease and was treated with second-line gemcitabine/docetaxel with disappointing results. She is currently on treatment with cyclophosphamide and topotecan as third-line treatment with an excellent clinico-radiographic response. Osteosarcomas are aggressive with a high incidence of recurrence and metastasis. Fewer than 50 cases of primary cardiac osteosarcomas have been reported in the literature. Even though complete resection can be achieved in some cases, long-term results are usually poor. No standard therapy has been established.
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Affiliation(s)
- Hemendra Mhadgut
- Medical Oncology, East Tennessee State University, Johnson City, USA
| | - Sukesh Manthri
- Medical Oncology, East Tennessee State University, Johnson City, USA
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23
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Cohen A, Donal E, Delgado V, Pepi M, Tsang T, Gerber B, Soulat-Dufour L, Habib G, Lancellotti P, Evangelista A, Cujec B, Fine N, Andrade MJ, Sprynger M, Dweck M, Edvardsen T, Popescu BA. EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:e24-e57. [PMID: 33709114 DOI: 10.1093/ehjci/jeab008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
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Affiliation(s)
- Ariel Cohen
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20141, Milan, Italy
| | - Teresa Tsang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvainAv Hippocrate 10/2803, B-1200 Brussels, Belgium
| | - Laurie Soulat-Dufour
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Arturo Evangelista
- Servei de Cardiologia. Hospital Universitari Vall d'Hebron-VHIR. CIBER-CV. Pº Vall d'Hebron 119. 08035. Barcelona. Spain
| | - Bibiana Cujec
- Division of Cardiology, University of Alberta, 2C2.50 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, Alberta, Canada T6G 2B7
| | - Nowell Fine
- University of Calgary, Libin Cardiovascular Institute, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Maria Joao Andrade
- Maria Joao Andrade Cardiology Department, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos 2790-134 Carnaxide, Portugal
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Marc Dweck
- British Heart Foundation, Centre for Cardiovascular Science, Edinburgh and Edinburgh Imaging Facility QMRI, University of Edinburgh, United Kingdom
| | - Thor Edvardsen
- Faculty of medicine, Oslo University, Oslo, Norway and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila', Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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24
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Heaton JN, Dhaduk N, Okoh AK, Dang-Ho KP, Tayal R, Salemi A, Waxman S. Characteristics, management, and outcomes among admissions for primary cardiac tumors: Results from the National Inpatient Sample. J Card Surg 2021; 36:3586-3592. [PMID: 34314042 DOI: 10.1111/jocs.15862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Primary cardiac tumors (PCT) are rare, and their contemporary outcomes are not well characterized in the literature. We assessed temporal trends in patient characteristics and management of admissions for PCT in US hospitals. METHODS Admissions with the principal diagnoses of a PCT (benign neoplasm of heart: ICD-9 212.7, ICD-10 D15.1; malignant neoplasm of heart: ICD-9 164.1, ICD-10 C38.0) between 2006 and 2017 were extracted from the National Inpatient Sample. Trends in demographics and clinical profiles were evaluated. We conducted descriptive analyses on the cohort and compared outcomes between those managed medically and surgically. RESULTS Between 2006 and 2017, 19,111 admissions had the primary diagnosis of a PCT. Of these, 91.1% were benign. Admissions were mostly female (65.0%), caucasian (72.0%), and aged more than 50 years (76.0%). The annual admission rate for PCT was similar from 2006 to 2017 (p trend > .05) and associated with congestive heart failure, diabetes, renal failure, and valvular lesions. PCTs were managed surgically in 12,811 (67.0%) of overall cases, 70.8% for benign and 28.3% for malignant tumors. Overall, the in-hospital mortality rate was 2.3%. Medically managed cases reported a 2.5% higher mortality (p < .001) than those surgically managed. Admissions with malignant tumors were more likely to expire during hospitalization than those with benign tumors (odds ratio, 9.75; 95% confidence interval 6.34-14.99; p < .001). CONCLUSION Admissions for primary cardiac tumors were primarily women or in their fifth or sixth decade of life. Surgical intervention is more commonly practiced and is associated with better in-hospital survival.
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Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA.,Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Nehal Dhaduk
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Alexis K Okoh
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Khoi P Dang-Ho
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Rajiv Tayal
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Arash Salemi
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Sergio Waxman
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
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25
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Cardoso LF, Steffen SP, Gaspar SFD, Gaiotto FA, Bacal F, Jatene FB. Recurrent Cardiac Myxoma Treated by Heart Transplantation. Ann Thorac Surg 2021; 111:e387. [PMID: 33667457 DOI: 10.1016/j.athoracsur.2021.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Lucas Figueredo Cardoso
- Division of Cardiovascular Surgery, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
| | - Samuel Padovani Steffen
- Division of Cardiovascular Surgery, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Shirlyne Fabianni Dias Gaspar
- Division of Cardiovascular Surgery, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Fábio Antonio Gaiotto
- Division of Cardiovascular Surgery, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Fernando Bacal
- Clinical Unit of Heart Transplant, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Fabio Biscegli Jatene
- Division of Cardiovascular Surgery, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
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26
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Medhora J, Wilson G, Ronald A, Allen L. Use of focused intensive care echo in the diagnosis of primary cardiac angiosarcoma. Clin Case Rep 2020; 8:3058-3061. [PMID: 33363879 PMCID: PMC7752425 DOI: 10.1002/ccr3.3332] [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: 06/17/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 11/07/2022] Open
Abstract
Focused Intensive Care Echo can aid diagnosis in complex patients where initial investigations are non-diagnostic. FICE is an essential skill for critical care physicians, and bedside echocardiography should be a standard investigation for all critical care patients.
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Affiliation(s)
| | - Graham Wilson
- Intensive Care DepartmentAberdeen Royal InfirmaryAberdeenUK
| | - Andrew Ronald
- Anaesthetics DepartmentAberdeen Royal InfirmaryAberdeenUK
| | - Lee Allen
- Intensive Care DepartmentAberdeen Royal InfirmaryAberdeenUK
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27
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Siroky GP, Gold A, Tang D, Alam A, Simon M, Huang M, Kostis WJ. Left Pericardiophrenic Vein Pacing for Tachy-Brady Syndrome Due to an Obstructing Cardiac Angiosarcoma. JACC Case Rep 2020; 2:1771-1775. [PMID: 34317054 PMCID: PMC8312131 DOI: 10.1016/j.jaccas.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
We describe a case of a permanent pacemaker lead placement via the left pericardiophrenic vein for the treatment of tachy-brady syndrome due to a primary cardiac angiosarcoma. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Gregory P. Siroky
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Address for correspondence: Dr. Gregory P. Siroky, Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, New York 10025.
| | - Alex Gold
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Delphine Tang
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amit Alam
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mitchell Simon
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael Huang
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - William J. Kostis
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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28
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Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C, Westwood M, Ghosh AK, Guha A. Cardiac Tumors: JACC CardioOncology State-of-the-Art Review. JACC: CARDIOONCOLOGY 2020; 2:293-311. [PMID: 34396236 PMCID: PMC8352246 DOI: 10.1016/j.jaccao.2020.05.009] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl’s excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses. Cardiac tumors are rare and should be considered as part of the differential diagnosis of any space-occupying mass noted on cardiovascular and/or thoracic imaging modalities. It may be possible to get close to a diagnosis without biopsy using a structured imaging approach. The prognosis and treatment of each tumor is different, although early diagnosis is usually associated with a better outcome.
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Affiliation(s)
- Sara Tyebally
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Daniel Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Abdallah Mughrabi
- Jordan University of Science and Technology, Al Ramtha, Irbid, Jordan
| | - Zeeshan Hussain
- Division of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Charlotte Manisty
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Mark Westwood
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
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29
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Affiliation(s)
- Rajeev Gupta
- Department of CardiologyMediclinic Al‐Jowhara/Al Ain HospitalsAl AinUnited Arab Emirates
| | | | - Rupak Desai
- Division of CardiologyAtlanta VA Medical CenterDecaturGA
| | - Neelesh Gupta
- Department of Internal MedicineUniversity of South Alabama Medical CenterMobileAL
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30
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Ali L, Ghazzal A, Sallam T, Zaghlol R, Cuneo B. Crossing Boundaries: A Rare Case of Cardiac Dysfunction. Cureus 2020; 12:e7998. [PMID: 32523852 PMCID: PMC7274503 DOI: 10.7759/cureus.7998] [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: 11/25/2022] Open
Abstract
Cardiac tumors are relatively rare. Secondary cardiac tumors are by far more common than primary cardiac tumors. Cardiac involvement may occur secondary to hematogenous metastases, direct invasion, or tumor growth into the venous system and extension into the right atrium. Patients can present with a spectrum of conditions, including embolization, obstruction of ventricular outflow tracts, direct invasion of myocardium causing impaired myocardial function, invasion of surrounding tissue, interference with valvular function causing valvular regurgitation, or constitutional non-specific signs and symptoms. Imaging modalities are essential for diagnosis. Management is mostly surgical, but can include other medical strategies as well. We present a case of a 65-year-old male with hepatocellular carcinoma with direct invasion to the heart through the venous system.
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Affiliation(s)
- Laith Ali
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Amre Ghazzal
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Tariq Sallam
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Raja Zaghlol
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian Cuneo
- Critical Care/Pulmonary Medicine, MedStar Washington Hospital Center, Washington, DC, USA
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31
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Nemeth A, Schlensak C, Popov A. Extended resection of a cardiac paraganglioma-A rare neuroendocrine manifestation of the heart. J Card Surg 2020; 35:700-702. [PMID: 31981425 DOI: 10.1111/jocs.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac paragangliomas are rare tumors that develop from neural crest cells. They account for about 2% of all paragangliomas and there is only limited evidence of malignant transformation. CASE PRESENTATION We present a young woman with atypical symptoms, which are related to the mass effect of the 40 × 49mm cardiac tumor on top of the left atrium. The patient underwent an extensive resection of the tumor including the root of the pulmonary trunk, the ascending aorta, and the left main artery. CONCLUSIONS The present case is of great importance showing the need for multidisciplinary approach in the management of cardiac tumors that infiltrate multiple anatomic structures.
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Affiliation(s)
- Attila Nemeth
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - Aron Popov
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
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32
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Parwani P, Co M, Ramesh T, Akhter N, Iliescu C, Palaskas N, Kim P, Gladish G, Stojanovska J, Abramov D, Lopez-Mattei J. Differentiation of Cardiac Masses by Cardiac Magnetic Resonance Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-019-9522-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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33
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Kumar B, Sihag BK, Guleria VS. Left Atrial Myxoma from Anterior Mitral Valve. Int J Appl Basic Med Res 2019; 9:251-252. [PMID: 31681554 PMCID: PMC6822331 DOI: 10.4103/ijabmr.ijabmr_288_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/30/2019] [Accepted: 08/28/2019] [Indexed: 11/20/2022] Open
Abstract
Primary cardiac tumors are relatively rare, and myxoma, the most common variety, is found predominantly in the left atrium. Clinical presentation varies from asymptomatic incidental masses to serious life-threatening cardiovascular complications. Some cases are difficult to diagnose, as symptoms can be nonspecific. We present a case of a young female with 4 months of history of dyspnea, weight loss, and night sweats, eventually diagnosed as a case of large left atrial myxoma arising from the anterior mitral valve through transthoracic echocardiography.
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Affiliation(s)
- Basant Kumar
- Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhupendra Kumar Sihag
- Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Singh Guleria
- Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Intracardiac masses are classified as neoplastic or non-neoplastic. Prognosis varies based on the diagnosis of the mass since treatment options differ greatly. As novel imaging techniques emerge, a multimodality approach to the evaluation of intracardiac masses becomes an important part of non-invasive evaluation prior to potential surgical planning or oncological treatment. The purpose of this article is to compare the available imaging modalities-echocardiography, cardiovascular magnetic resonance, cardiac computed tomography, nuclear imaging, and emerging novel hybrid imaging techniques for future clinical applications-and to review the characteristic features seen on those modalities for the most common intracardiac masses.
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35
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Eren F, Inanır NT, Gurses MS, Eren B, Gundogmus UN, Ioan B. DEATH DUE TO CARDIAC ANGIOSARCOMA: AUTOPSY CASE REPORT. INTERNATIONAL JOURNAL OF MEDICINE AND MEDICAL RESEARCH 2019. [DOI: 10.11603/ijmmr.2413-6077.2019.1.10155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Primary tumors of the heart are rarely detected at autopsy, especially angiosarcomas which are primary malignant one. Objective. We presented autopsy case of cardic angiosarcoma with morphologic findings. Methods. We described adult man died in emergency service of the hospital. Results. Reported case was 33 year-old-man who was died in emergency service of hospital where he was taken when he was ill after leaving home. According the prosecution documents, and the expressions of family, it was reported that he had a heart disease; his symptoms repeated 3 day ago before he died, he thought to attend the Cardiology Clinic due to his symptoms. At autopsy on macroscopic internal examination, mass with rough surface in the right atrium, hematoma at the posterior of the right atrium, blood in the pericardia, nodular lesions in hemorrhagic appearance in the sections of lung, liver and spleen were detected. In histopathologic examination; in the heart angiosarcioma as primary malign heart tumor and metastatic masses in the liver, spleen and lung were detected. Conclusions. We aimed to discuss cardiac angiosarcoma case with autopsy and histopathologic findings in the aspect of medico legal literature.
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36
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Concha ST, Carrascosa MF, Pulitani I, Saiz-Pérez C. Cardiac tamponade as first manifestation of atrial angiosarcoma. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5396721. [PMID: 31449649 PMCID: PMC6601243 DOI: 10.1093/ehjcr/ytz027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/27/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Sergio Tapia Concha
- Radiology Department, Hospital of Laredo, Avda. Derechos Humanos s/n, Laredo, Cantabria, Spain
| | - Miguel F Carrascosa
- Internal Medicine Department, Hospital of Laredo, Avda. Derechos Humanos s/n, Laredo, Cantabria, Spain
| | - Ivana Pulitani
- Cardiovascular Surgery Department, University Hospital Marqués de Valdecilla, Avda. Valdecilla 25, Santander, Cantabria, Spain
| | - César Saiz-Pérez
- Emergency Department, Hospital of Laredo, Avda. Derechos Humanos s/n, Laredo, Cantabria, Spain
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38
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Mozafari R, Mohebbi Z, Shooshtarizadeh T, Sotoude H. Primary cardiac osteosarcoma: A rare cause of chest pain in a young man. Indian J Cancer 2019; 56:86-87. [PMID: 30950453 DOI: 10.4103/ijc.ijc_259_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Although primary cardiac osteosarcoma is uncommon, cardiac neoplasms should be in the differential diagnosis of cardiac complaints. We present a case of a 35 year old man with recurrent episodes of exertional chest pain and who was diagnosed with primary cardiac osteosarcoma. Cardiac osteosarcomas are rare but must be suspected.
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Affiliation(s)
- Rambod Mozafari
- Department of Hematology, Oncology, and Bone Marrow Transplantation, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohebbi
- Department of Internal Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Hamed Sotoude
- Department of Emergency Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Abstract
Atrial myxomas are a rare phenomenon and although benign, primary neoplasms of the heart can be burdensome depending on their location. Clinical symptoms are caused through a variety of mechanisms including conduction disturbances, obstruction, and valvular interference. Size and symptom development are strongly correlated and can almost always be detected by the use of echocardiography, magnetic resonance imaging or computed tomography. This is a case of a 62-year-old female with no significant past medical history presented to our facility with complaints of palpitations and associated dizziness for three months.
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Affiliation(s)
- George S Prousi
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Joseph V Moran
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Ross G Biggs
- Cardiology, Lehigh Valley Health Network, Allentown, USA
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40
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Zhang G, Gao Q, Chen S, Chen Y. Primary cardiac synovial sarcoma that was continuous with the mitral valve caused severe thrombocytopenia: a case report. J Cardiothorac Surg 2019; 14:30. [PMID: 30717777 PMCID: PMC6360734 DOI: 10.1186/s13019-019-0852-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Primary cardiac sarcomas are exceedingly rare, and they commonly result in nonspecific constitutional symptoms such as shortness of breath, weight loss, and anaemia-related fatigue and malaise. However, thrombocytopenia has very rarely been reported in association with cardiac tumours, either benign or malignant. We report one case of primary cardiac synovial sarcoma continuous with the mitral valve, which was accompanied by severe thrombocytopenia, and the platelet counts returned rapidly to a normal range early after tumour excision and without any special therapies. Case presentation A 52-year-old male diagnosed with atrial myxoma with severe thrombocytopenia was admitted to our hospital. Blood analysis showed severe thrombocytopenia, whereas erythrocyte and leucocyte counts were within the normal range. A 50 × 35 mm mobile mass continuous with the mitral valve was found to be present in the left atrium upon echocardiography. Bone marrow aspiration and related examinations excluded thrombocytopenia caused by haematologic malignancies. The patient received a platelet transfusion, but platelet counts decreased quickly. Glucocorticoid therapy and immunoglobulin transfusion were also used, but were ineffective. Although the operation risk was high, tumour resection was performed via a median sternotomy with a cardiopulmonary bypass system. The postoperative pathological diagnosis was biphasic cardiac synovial sarcoma. Surprisingly, the platelet counts returned rapidly to a normal range early after tumour excision without any special therapies. The disappearance of the tumour from the annular region was confirmed on transthoracic echocardiography 6 days after surgery, and an FDG-PET scan performed 8 days after surgery showed no abnormal accumulation. Unfortunately, the patient died suddenly 6 months later without unknown cause. Conclusions We report that a rare primary cardiac synovial sarcoma case continuous with the mitral valve caused severe thrombocytopenia; this provides further support for the awareness and diagnosis of primary cardiac synovial sarcoma. We also highlight that thrombocytopenia might be one rare symptom of a solid cardiac tumour but need more cases for support.
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Affiliation(s)
- Guodong Zhang
- Cardiac Surgery Department, Peking University People's Hospital, Beijing, 100044, China
| | - Qing Gao
- Cardiac Surgery Department, Peking University People's Hospital, Beijing, 100044, China
| | - Shenglong Chen
- Cardiac Surgery Department, Peking University People's Hospital, Beijing, 100044, China
| | - Yu Chen
- Cardiac Surgery Department, Peking University People's Hospital, Beijing, 100044, China.
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41
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Mondal S, Jubar J, Kostibas MP. Near Total Occlusion of Right Ventricle by Cardiac Mass. J Cardiothorac Vasc Anesth 2018; 33:2085-2090. [PMID: 30685150 DOI: 10.1053/j.jvca.2018.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 11/11/2022]
Abstract
The incidence of primary cardiac tumors is very rare (0.02%) with the majority being benign. Angiosarcoma is the most common malignant cardiac tumor. However, regardless of the histological nature of cardiac tumors, they can cause life-threatening mechanical obstruction. We present a case of urgent surgical removal of a right ventricular (RV) mass. Echocardiography was instrumental for confirmation of the diagnosis, delineation of the anatomical extent of the tumor, evaluation for associated structural involvement and assessment of repair along with constant hemodynamic monitoring.
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Affiliation(s)
- Samhati Mondal
- Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD.
| | - John Jubar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Megan P Kostibas
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
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42
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Imaging and Surgical Treatment of Primary Pulmonary Artery Sarcoma. Int J Cardiovasc Imaging 2018; 35:1429-1433. [PMID: 30535656 DOI: 10.1007/s10554-018-1489-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/30/2018] [Indexed: 02/08/2023]
Abstract
Primary pulmonary artery sarcoma is a rare tumor originating from the pulmonary artery tree. Given the low incidence, few centers have reported on more than a handful of cases. Because of its rarity it is also commonly misdiagnosed as pulmonary embolism. Multi-modality diagnostic imaging and recognition of specific imaging characteristics along with a high index of suspicion is required to make the correct diagnosis and expedite treatment. The primary imaging modality for most cardiac tumors such as primary pulmonary artery sarcoma is now MRI. It provides superb spatial resolution as well as functional assessment of the heart and pulmonary circulation. CT imaging also is part of routing imaging and remains as the most pertinent imaging modality to evaluate the lung parenchyma and presence of metastatic disease. Here we review the pertinent imaging modalities and tissue characteristics that facilitate recognition of primary pulmonary artery sarcoma. We also provide a short overview of surgical resection and reconstruction, which is the mainstay therapy, for this rare tumor.
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43
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Kumar V, Nanavati SM, Abuarqoub A, Rushdy A, Rahman M, Komal F, Michael P. Enigma of recurrent strokes with literature review. AME Case Rep 2018; 1:5. [PMID: 30263992 DOI: 10.21037/acr.2017.10.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/06/2022]
Abstract
Metastatic tumors are the most common tumors affecting the heart. Primary tumors are rare, with myxomas being the most common of the primary cardiac tumors. The incidence of primary cardiac tumors is 0.02%, about 200 cases has been reported in 1 million autopsies. Most of primary cardiac tumors have been detected incidentally on diagnostic modalities: computed tomography (CT), cardiac magnetic resonance imaging (MRI), or echocardiography. Majority of primary-origin cardiac tumors are benign, of which the most common type of primary tumor is cardiac myxoma. Fibroelastoma is a rare benign tumor and the 2nd most common cause of primary cardiac tumors. In the past fibroelastoma has been detected on autopsy findings. With the development of more advanced imaging modalities fibroelastoma is more frequently detected as a cause of stroke, myocardial infarction (MI), angina episodes, and systemic embolization. Echocardiogram is the best diagnostic modality to diagnose primary cardiac tumors although transthoracic echocardiogram (TTE) can miss primary cardiac tumors; transesophageal echocardiography (TEE) has been more labeled more accurate in the diagnosis of primary cardiac tumors. We present here a case of a 21-year-old male with the history of multiple strokes secondary to cardiac papillary fibroelastoma (CPF).
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Affiliation(s)
- Vinod Kumar
- Department of Internal Medicine, New York Medical College at St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Sushant M Nanavati
- Department of Internal Medicine, New York Medical College at St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Ahmad Abuarqoub
- Department of Cardiology, New York Medical College at St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Abanoub Rushdy
- Department of Internal Medicine, New York Medical College at St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Minhazur Rahman
- Department of Internal Medicine, New York Medical College at St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Fnu Komal
- Department of Internal Medicine, New York Medical College at St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Patrick Michael
- Department of Internal Medicine, New York Medical College at St Joseph's Regional Medical Center, Paterson, New Jersey, USA
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44
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Amari K, Tago M, Katsuki NE, Fukumori N, Yamashita SI. Cardiac Recurrence of Diffuse Large B-cell Lymphoma More Than a Decade After Attaining Complete Remission. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1057-1062. [PMID: 30177676 PMCID: PMC6135044 DOI: 10.12659/ajcr.910787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient: Female, 79 Final Diagnosis: Cardiac recurrence of DLBCL Symptoms: Cardiogenic shock Medication: — Clinical Procedure: Biopsy specimen Specialty: Cardiology/Hematology
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Affiliation(s)
- Kaori Amari
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan.,Department of Emergency Medicine, Saga-Ken Medical Centre, Koseikan, Saga City, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Norio Fukumori
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga City, Saga, Japan
| | - Shu-Ichi Yamashita
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
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45
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Pleural malignant mesothelioma versus pleuropulmonary synovial sarcoma: a clinicopathological study of 22 cases with molecular analysis and survival data. Pathology 2018; 50:629-634. [PMID: 30170702 DOI: 10.1016/j.pathol.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 01/02/2023]
Abstract
The aim of this study was to carry out a comparative analysis by transducin-like enhancer of split 1 (TLE1) immunohistochemistry and molecular analysis of SYT-SSX, for 16 pleural predominantly sarcomatoid mesotheliomas and six cases of pleuropulmonary synovial sarcoma (five pleural in distribution only, with one case of a predominantly subpleural upper lobe synovial sarcoma), all of which were solely or predominantly monophasic. Our comparison included survival and some clinical data. We consider that the following points emerged from this study.
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46
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Jayaprakash S. Clinical presentations, diagnosis, and management of arrhythmias associated with cardiac tumors. J Arrhythm 2018; 34:384-393. [PMID: 30167009 PMCID: PMC6111472 DOI: 10.1002/joa3.12030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 08/23/2017] [Indexed: 12/16/2022] Open
Abstract
Cardiac tumors are a rare cause of arrhythmias in clinical practice. They can cause a broad spectrum of arrhythmias, from low-grade ectopics to incessant ventricular tachycardias, including sudden cardiac arrest. Both primary and secondary cardiac tumors can produce arrhythmias, but not all tumors cause arrhythmias. Although cardiac tumors can cause arrhythmias in fetuses and older adults alike, only specific cardiac tumors are the underlying cause of arrhythmia in different age groups. This article reviews various cardiac tumors that are associated with arrhythmias, their clinical presentations, diagnostic features, and management.
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Affiliation(s)
- Shenthar Jayaprakash
- Electrophysiology UnitDepartment of CardiologySri Jayadeva Institute of Cardiovascular Sciences and ResearchBangaloreIndia
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47
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Primary Cardiac Lymphoma: Importance of Tissue Diagnosis. Case Rep Hematol 2018; 2018:6192452. [PMID: 30147970 PMCID: PMC6083489 DOI: 10.1155/2018/6192452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/03/2018] [Indexed: 01/12/2023] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare disease entity that can present with severe cardiac and cardioembolic symptoms. We present a 79-year-old male with history of polymalgia rheumatica on chronic prednisone who presented with a two-week history of progressively worsening dyspnea, cough, and a 10 pound weight loss. Transthoracic echocardiogram (TTE) and computed tomography (CT) of the chest showed a large mediastinal mass with invasion of the pericardium. A biopsy of an abdominal soft-tissue mass confirmed the diagnosis of PCL. The patient was treated with two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) which was complicated by progressive heart failure requiring substitution of liposomal doxorubicin. The epidemiology, presentation, diagnosis, and treatment options of PCL are discussed.
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48
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Right Atrial Tumor Thrombus: A New Mechanism for Neuroendocrine Tumor-Induced Heart Complications. Pancreas 2018; 47:e26-e27. [PMID: 29702532 DOI: 10.1097/mpa.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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49
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AbuHalimeh B, Desai MY, Tonelli AR. Effect of abnormal right heart structures on the diagnosis of pulmonary hypertension. Pulm Circ 2018; 8:2045894018773053. [PMID: 29671686 PMCID: PMC5946618 DOI: 10.1177/2045894018773053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The diagnosis of pulmonary hypertension (PH) requires a right heart catheterization (RHC) that reveals a mean pulmonary artery pressure ≥ 25 mmHg. The pulmonary artery catheter traverse the right atrium and ventricle on its way to the pulmonary artery. The presence of abnormal right heart structures, i.e. thrombus, vegetation, benign or malignant cardiac lesions, can lead to complications during this procedure. On the other hand, avoidance of RHC delays the diagnosis and treatment of PH, an approach that might be associated with worse outcomes. This paper discusses the impact of right heart lesions on the diagnosis of PH and suggests an approach on how to manage this association.
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Affiliation(s)
- Batool AbuHalimeh
- 1 2569 Pathobiology Division, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Milind Y Desai
- 2 2569 Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Adriano R Tonelli
- 1 2569 Pathobiology Division, Lerner Research Institute, Cleveland Clinic, OH, USA.,3 Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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50
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Rajagopalan S, Khan F, Lee S, Palvadi RR. Giant Thebesian Valve Appearing As a Right Atrial Mass. J Cardiothorac Vasc Anesth 2018; 32:445-447. [DOI: 10.1053/j.jvca.2017.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Indexed: 11/11/2022]
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