Pulmonary tumor embolism syndrome from occult colonic adenocarcinoma

COVID-19 infection and cardiac angiosarcoma: a dangerous combination-a case report

Background

The COVID-19 pandemic has strained all medical systems, especially in countries like Ecuador, where health services were already limited. These conditions, combined with a deadly and unusual disease, like primary heart angiosarcoma, can lead to severe outcomes. Angiosarcomas represent the most common and aggressive primary malignant heart tumor; regretfully, its clinical manifestations are vague and can be easily missed. Most patients become symptomatic when there is local invasion, embolization, or metastases, leading to late diagnosis and poor survival. High clinical awareness, adequate diagnosis, and prompt treatment are vital in these rare diseases, in which time is of paramount importance.

Case presentation

We report the case of a 28-year-old female who had cough, hemoptysis, and ground-glass opacities in the CT (computed tomography). Since Ecuador is in the middle of this pandemic, she was misdiagnosed and mistreated. Primary heart angiosarcoma was diagnosed, and regretfully, the patient suffered multiple complications due to diagnosis and died.

Conclusion

To this day, most cardiac angiosarcomas are found in a late-stage with distal metastasis and advanced local invasion. Sadly, this tumor is frequently missed due to its incidence and broad-spectrum of clinical symptoms. Considering that its manifestations can be misleading, misdiagnosis can occur, especially in pandemic times. Therefore, knowledge of other pathologies prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43057-021-00042-7.

The diagnostic challenge in pulmonary tumour embolism in cancer: a case report and literature review

Pulmonary tumour embolism is a rare condition without specific symptoms or pathognomonic features. Pulmonary tumour embolism can occur as the first manifestation of cancer, but because of diagnostic difficulties, it is often wrongly recognised as a more common cardiopulmonary disease. We present a case of a 46-year-old Caucasian male with no prior malignancy diagnosis, admitted because of progressing dyspnoea and cough. Based on radiological and clinical presentations, sarcoidosis, silicosis and lymphangitic carcinomatosis were considered in the differential diagnosis. Histopathological analysis of lung biopsy revealed that multiple emboli of atypical epithelial cells found in the pulmonary vessels were of gastrointestinal origin. Further pathological examination of the gastric biopsy led to the final diagnosis of the signet-ring cells gastric adenocarcinoma. The patient was referred for chemotherapy. After a short-term partial remission, he died within two months after the final diagnosis. The presented case illustrates challenges posed by the diagnostic process of pulmonary tumour embolism.

Neoplastic embolization to systemic and pulmonary arteries

OBJECTIVE

Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens.

METHODS

Pathology archives from a single tertiary care institution were queried to identify cases of surgically resected arterial emboli containing neoplasm (1998-2014). Histopathology was reviewed for confirmation of diagnosis. Patient demographics and oncologic history were abstracted from the medical record. Comprehensive literature review documented 332 patients in 275 reports (1930-2016).

RESULTS

Eleven patients (six men) with a median age of 63 years (interquartile range, 42-71 years) were identified through institutional archives. Embolism was the primary form of diagnosis in seven (64%) cases. Cardiac involvement (primary or metastasis) was present in more than half of the cohort. Comprehensive literature review revealed that pulmonary primaries were the most common anatomic origin of arterial neoplastic emboli, followed by gastrointestinal neoplasia. Cardiac involvement was present in 18% of patients, and sentinel identification of neoplasia occurred in 30% of cases. Postmortem evaluation was the primary means of diagnosis in 27%.

CONCLUSIONS

This study highlights the importance of routine histopathologic evaluation of embolectomy specimens in patients with and without documented neoplasia.