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An KR, Marshall TC, Cusimano RJ. Vasculitic rash and cerebral emboli in an adolescent with left atrial myxoma. BMJ Case Rep 2024; 17:e258822. [PMID: 38417930 PMCID: PMC10900332 DOI: 10.1136/bcr-2023-258822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
A previously healthy woman in late adolescence presented to the emergency department with stroke-like symptoms following a two-month history of bilateral foot pain and oedema, accompanied by a macular rash and progressive lower extremity weakness. On further investigation, she was found to have multiple cerebral emboli and a left atrial myxoma fixed to the interatrial septum. The patient subsequently underwent urgent surgical excision of the myxoma. On follow-up, her cutaneous and neurological symptoms were significantly improved. This case suggests that, in the presence of a vasculitic rash without evident or obvious cause, cardiac myxoma should be included in the differential diagnosis.
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Affiliation(s)
- Kevin R An
- Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Terrel C Marshall
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert J Cusimano
- Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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2
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Stoklosa K, Dvirnik N, Cusimano RJ. Modified autotransplantation technique for surgical resection of complex pericardial synovial sarcoma. J Card Surg 2022; 37:1445-1449. [PMID: 35254688 DOI: 10.1111/jocs.16360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Technical details for complex cardiac tumor resection are sparse. We describe the operative technique of modified autotransplantation for resection of a complex pericardial synovial sarcoma in a 63-year-old, Caucasian female. Surgical exposure demonstrated tumor origin at the superior cavoatrial junction and invasion of the aorta, main pulmonary artery, superior pulmonary veins, and left atrial roof. Full macroscopic surgical resection was achieved. The patient received adjuvant radiation for microscopic positive margins and remains alive and with no tumor progression at one year postoperatively. We conclude that modified autotransplantation is a challenging but effective surgical technique when performed with careful patient selection and availability of skilled, cardiothoracic surgeons at a cardiac center of excellence.
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Affiliation(s)
- Klaudiusz Stoklosa
- Faculty of Medicine, University of Toronto Medical School, Toronto, Ontario, Canada
| | - Nazari Dvirnik
- Division of Cardiac Surgery, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Cusimano
- Division of Cardiac Surgery, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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3
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Menegazzo WR, Alvarez J, Cusimano RJ, Geib G, Torres FS, Clausell N, Goldraich LA. Modified autotransplant with three-dimensional printing for treatment of primary cardiac sarcoma. J Thorac Cardiovasc Surg 2018; 157:e41-e43. [PMID: 30366749 DOI: 10.1016/j.jtcvs.2018.08.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Willian R Menegazzo
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juglans Alvarez
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Robert J Cusimano
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Guilherme Geib
- Oncology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Felipe S Torres
- Radiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Nadine Clausell
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Livia A Goldraich
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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4
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Metastasis to the Heart: A Radiologic Approach to Diagnosis With Pathologic Correlation. AJR Am J Roentgenol 2016; 207:764-772. [DOI: 10.2214/ajr.16.16148] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sef D, Turina MI. Septectomy and biatrial resection for extensive septal lipomatosis. J Card Surg 2016; 31:683-685. [PMID: 27679421 DOI: 10.1111/jocs.12850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe the resection for lipomatous hypertrophy of the interatrial septum which necessitated complete reconstruction of the right atrium with Dacron grafts connecting the superior and inferior vena cava with the tricuspid orifice, and connection of the pulmonary veins to the mitral orifice with xenopericardium.
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Affiliation(s)
- Davorin Sef
- Department of Cardiovascular Surgery, "Magdalena"-Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.
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Trimble CR, Burke A, Kligerman S. Primary Cardiac Osteosarcoma: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2015; 35:1352-7. [PMID: 26371582 DOI: 10.1148/rg.2015140265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher R Trimble
- From the Department of Diagnostic Radiology and Nuclear Medicine (C.R.T., S.K.) and Department of Pathology (A.B.), University of Maryland School of Medicine, 22 S Greene St, Room N2E23, Baltimore, MD 21201
| | - Allen Burke
- From the Department of Diagnostic Radiology and Nuclear Medicine (C.R.T., S.K.) and Department of Pathology (A.B.), University of Maryland School of Medicine, 22 S Greene St, Room N2E23, Baltimore, MD 21201
| | - Seth Kligerman
- From the Department of Diagnostic Radiology and Nuclear Medicine (C.R.T., S.K.) and Department of Pathology (A.B.), University of Maryland School of Medicine, 22 S Greene St, Room N2E23, Baltimore, MD 21201
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7
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Ostrowski S, Marcinkiewicz A, Kośmider A, Jaszewski R. Sarcomas of the heart as a difficult interdisciplinary problem. Arch Med Sci 2014; 10:135-48. [PMID: 24701226 PMCID: PMC3953983 DOI: 10.5114/aoms.2014.40741] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/10/2011] [Accepted: 03/20/2011] [Indexed: 12/17/2022] Open
Abstract
Cardiac tumors are assumed to be a rare entity. Metastases to the heart are more frequent than primary lesions. Sarcomas make up the majority of cardiac malignant neoplasms. Among them angiosarcoma is the most common and associated with the worst prognosis. Malignant fibrous histiocytoma comprises the minority of cardiac sarcomas and has uncertain etiology as well as pathogenesis. Transthoracic echocardiography remains the widely available screening examination for the initial diagnosis of a cardiac tumor. The clinical presentation is non-specific and the diagnosis is established usually at an advanced stage of the disease. Sarcomas spread preferentially through blood due to their immature vessels without endothelial lining. Surgery remains the method of choice for treatment. Radicalness of the excision is still the most valuable prognostic factor. Adjuvant therapy is unlikely to be effective. The management of cardiac sarcomas must be individualized due to their rarity and significant differences in the course of disease.
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Affiliation(s)
- Stanisław Ostrowski
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Anna Marcinkiewicz
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Anna Kośmider
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Ryszard Jaszewski
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
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Roeltgen D, Kidwell CS. Neurologic complications of cardiac tumors. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:209-22. [PMID: 24365298 DOI: 10.1016/b978-0-7020-4086-3.00015-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cardiac tumors are an uncommon cause for neurologic disease, but if undiagnosed can be associated with devastating neurologic consequences. Primary cardiac tumors, both benign and neoplastic, and metastatic tumors occur. Primary cardiac tumors are more likely to be associated with neurologic embolic complications. Metastatic cardiac tumors are more likely to be associated with valvular distraction, arrhythmia, diminished cardiac output and indirect neurological dysfunction. Primary and metastatic cardiac tumors may result in cerebral metastatic disease. Atrial myxoma, a benign primary cardiac tumor, is the most common cardiac tumor associated with neurologic disease, and most commonly causes cerebral embolization and stroke. The use of thrombolytic therapy for these strokes is controversial. Additionally, delayed manifestations, including aneurysm formation and intracranial hemorrhage, are possible. Aneurysm formation has been described as occurring after removal of the primary tumor. The availability of noninvasive cardiac imaging has significantly helped decrease the neurologic morbidity of cardiac tumors and has led to frequent successful intervention.
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Affiliation(s)
- David Roeltgen
- Cape Physicians Associates, Cape May Court House, NJ, USA.
| | - Chelsea S Kidwell
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
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Isambert N, Ray-Coquard I, Italiano A, Rios M, Kerbrat P, Gauthier M, Blouet A, Chaigneau L, Duffaud F, Piperno-Neumann S, Kurtz JE, Girard N, Collard O, Bompas E, Penel N, Bay JO, Guillemet C, Collin F, Blay JY, Le Cesne A, Thariat J. Primary cardiac sarcomas: a retrospective study of the French Sarcoma Group. Eur J Cancer 2013; 50:128-36. [PMID: 24135684 DOI: 10.1016/j.ejca.2013.09.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Primary cardiac sarcomas (PCS) are rare tumours of dismal prognosis. METHODS Data of 124 patients with PCS referred to institutions of the French Sarcoma Group (FSG) from 1977 and 2010 were reviewed. RESULTS Median age was 48.8years. PCS were poorly-differentiated sarcomas (N=45, 36.3%), angiosarcomas (N=40, 32.3%), leiomyosarcomas (N=16, 12.9%) and others (N=23, 18.6%). At diagnosis, 100 patients (80.6%) were localised and 24 (19.4%) metastatic. Tumours were located in the right (N=47, 38.8%), left atrial cavities (N=45, 37.2%) or encompassed several locations in nine cases (7.4%). Surgery was performed in 81 cases (65.3%). Heart transplant was performed in five patients. Radiotherapy adjuvant (N=18, 14.5%) or alone (N=6, 4.8%) was performed in non-metastatic patients only (N=24, 19.4%). With a median follow-up of 51.2months, median overall survival (OS) was 17.2months for the entire cohort, 38.8months after complete resection versus 18.2 after incomplete resection and 11.2months in non-resected patients. Radiotherapy was associated with improved progression-free survival (PFS) on multivariate analysis. Chemotherapy was significantly associated with better OS only in non-operated patients but not in operated patients. In non-metastatic patients, surgery (hazard ratio [HR]=0.42, p<0.001), male gender (HR=0.56, p=.032) was associated with better OS and surgery (HR=0.61; p=.076), radiotherapy (HR=0.43; p=.004) and chemotherapy (HR=0.30, p=.003) improved PFS. CONCLUSION Only surgical resection is associated with a perspective of prolonged survival. Chemotherapy is associated with a better outcome in non-resected patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Olivier Collard
- Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Emmanuelle Bompas
- Institut de Cancérologie de l'Ouest René Gauducheau, Saint Herblain, France
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Baumwol J, Delgado DH, Cusimano RJ, Rao V, Kozuszko S, Butany J, Ross HJ. Atrial masses post cardiac transplantation: diagnostic and treatment dilemmas. Am J Transplant 2012; 12:2237-41. [PMID: 22682076 DOI: 10.1111/j.1600-6143.2012.04129.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Atrial masses postcardiac transplant are not well reported and their diagnosis and treatment can be challenging. In the asymptomatic patient, differentiating thrombus from cardiac tumor can sometimes be difficult and the use of multiple imaging modalities is recommended. Accurate diagnosis is imperative to inform a treatment plan that balances the benefits and risks of a medical versus surgical approach. We present three cases of atrial masses postcardiac transplant to illustrate this clinical dilemma.
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Affiliation(s)
- J Baumwol
- Division of Cardiology and Heart Transplant, Toronto General Hospital, Toronto, Ontario, Canada
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