1
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Terui Y, Suzuki H, Chikata A, Hanaki Y, Komatsu Y, Ota H, Fujishima F, Umezawa R, Ouchi K, Sato H, Satoh T, Miyamichi-Yamamoto S, Yaoita N, Hayashi H, Nochioka K, Takahama H, Nogami A, Saiki Y, Yasuda S. Intractable Ventricular Tachycardia Prior to an Overt Cardiac Tumor Mass of Metastatic Cardiac Rhabdomyosarcoma (Spindle-cell Type). Intern Med 2024; 63:1725-1731. [PMID: 37926544 PMCID: PMC11239244 DOI: 10.2169/internalmedicine.2568-23] [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: 07/07/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023] Open
Abstract
We herein report a 37-year-old man who experienced recurrence of metastatic cardiac rhabdomyosarcoma along with intractable ventricular tachycardia (VT) 7 years after resection of rhabdomyosarcoma in his right elbow. At 36 years old, he developed VT unresponsive to radiofrequency catheter ablation (RFCA). Initially, the cardiac tumor was not detected, but it gradually grew in size at the RFCA site. A surgical biopsy confirmed the diagnosis of metastatic cardiac rhabdomyosarcoma. Despite radiation therapy, cardiac tumor progression and VT instability could not be prevented. Ultimately, the patient died 27 months after the initial documentation of VT.
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Affiliation(s)
- Yosuke Terui
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hideaki Suzuki
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Akio Chikata
- Department of Cardiology, Toyama Prefectural Central Hospital, Japan
| | - Yuichi Hanaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
| | - Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Japan
| | | | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan
| | - Kota Ouchi
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Japan
| | - Haruka Sato
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Taijyu Satoh
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | | | - Nobuhiro Yaoita
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hideka Hayashi
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kotaro Nochioka
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hiroyuki Takahama
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Satoshi Yasuda
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
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2
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Mohammadi A, Mohammadi M, Pazoki M, Ayoubpour MR, Babaheidarian P, Zeraatian Nejad Davani S, Ghaderi R. Clinical presentation, diagnostic evaluation, and management of undifferentiated/unclassified cardiac sarcoma: A case report and literature review. Radiol Case Rep 2024; 19:1200-1207. [PMID: 38259715 PMCID: PMC10801150 DOI: 10.1016/j.radcr.2023.11.065] [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: 10/22/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024] Open
Abstract
This case report details a challenging instance of undifferentiated/unclassified cardiac sarcoma in a 28-year-old female, presenting with diverse symptoms like muscle weakness, shortness of breath, and hemoptysis. Diagnostic hurdles led to an initial misdiagnosis of granulomatosis with polyangiitis before discovering a sizable left atrial mass, ultimately diagnosed as high-grade undifferentiated/unclassified sarcoma. Despite initial surgical intervention, the patient's condition worsened, underscoring the complexities in managing such cases involving cardiac sarcomas. This case emphasizes the diagnostic complexities associated with primary cardiac sarcomas, particularly the challenges in achieving accurate diagnoses and formulating effective treatment strategies.
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Affiliation(s)
- Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahboubeh Pazoki
- Department of Cardiology, School of Medicine, Hazrat-e Rasool General Hospital Iran University of medical sciences, Tehran, Iran
| | - Mohammad reza Ayoubpour
- Department of Radiology, School of Medicine, Hazrat-e Rasool General Hospital Iran University of medical sciences, Tehran, Iran
| | - Pegah Babaheidarian
- Department of Pathology, School of Medicine, Hazrat-e Rasool General Hospital Iran University of medical sciences, Tehran, Iran
| | - Sam Zeraatian Nejad Davani
- Department of Cardiovascular Surgery, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Ghaderi
- Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
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3
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Atkins MD, Ravi V, Reardon MJ. The 7 Pillars of Primary Cardiac Sarcoma Treatment. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:3-7. [PMID: 38439184 DOI: 10.1177/15569845241231794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Marvin D Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, TX, USA
| | - Vinod Ravi
- Department of Sarcoma Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, TX, USA
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4
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Khan SR, Nasir S, Tariq M, Rashid YA, Jabbar AA. Cardiac sarcoma: A rare case of primary cardiac sarcoma. Int J Surg Case Rep 2022; 102:107836. [PMID: 36525693 PMCID: PMC9772576 DOI: 10.1016/j.ijscr.2022.107836] [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: 09/17/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary cardiac sarcoma is a rare malignancy with a poor prognosis because of diagnostic delay, therapeutic difficulties, and high metastatic potential. The therapeutic approach includes surgery, chemotherapy, and radiation therapy, alone or in combination. However, there is a lack of evidence to guide the treatment. CASE PRESENTATION We present a case of primary cardiac sarcoma. Our patient was presented in the department of emergency medicine (ED) in our institute with shortness of breath on exertion associated with orthopnea. Based on the history and cardiovascular examination, he underwent an echocardiogram, which revealed a sizeable echogenic density in the right ventricular outflow tract. He underwent surgical resection of the cardiac mass via median sternotomy and total cardiopulmonary bypass approach. The patient was eventually diagnosed with primary cardiac sarcoma, confirmed by tissue biopsy after surgical intervention. CLINICAL DISCUSSION Through this report, we highlight the rarity of primary cardiac sarcomas, the importance of multidisciplinary tumor board (MDT) discussion and provide evidence of surgical excision being the treatment of choice, followed by systemic chemotherapy in selected cases. CONCLUSION Cardiac sarcoma is a rare but highly malignant tumor with a poor prognosis. However, early diagnosis and surgical resection of a primary cardiac sarcoma can significantly increase the patient's survival and quality of life. Therefore, physicians should keep a high suspicion of a patient with clinical features suggestive of cardiac sarcoma, and echocardiography should be the diagnostic modality of choice in such patients.
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Affiliation(s)
- Saqib Raza Khan
- Department of Medical Oncology, Section of Oncology, Aga Khan University Hospital, Karachi, Pakistan,Corresponding author.
| | - Saad Nasir
- Department of Medical Oncology, Section of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Tariq
- Department of Medical Oncology, Section of Oncology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Yasmin Abdul Rashid
- Department of Medical Oncology, Section of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Adnan Abdul Jabbar
- Department of Medical Oncology, Section of Oncology, Dr. Ziauddin Hospital, Karachi, Pakistan
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5
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Hasan SM, Witten J, Collier P, Tong MZ, Pettersson GB, Smedira NG, Toth A, Shepard D, Blackstone EH, Roselli EE. Outcomes after resection of primary cardiac sarcoma. JTCVS OPEN 2021; 8:384-390. [PMID: 36004100 PMCID: PMC9390277 DOI: 10.1016/j.xjon.2021.08.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/30/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Saad M. Hasan
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - James Witten
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Z. Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gosta B. Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas G. Smedira
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Toth
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dale Shepard
- Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Hematology and Oncology, Oncology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E. Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Address for reprints: Eric E. Roselli, MD, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195-5108.
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6
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Kwon Y, Park SJ, Kim HJ, Kim JB. Complete Resection of Cardiac Angiosarcoma Invading Right Heart and Right Coronary Artery. Ann Thorac Surg 2020; 110:e501-e503. [PMID: 32454015 DOI: 10.1016/j.athoracsur.2020.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022]
Abstract
Complete surgical resection is the most critical factor to achieve better long-term outcomes in treating primary cardiac sarcomas; however, it is oftentimes hampered when there is extensive tumor involvement into important cardiac apparatus. Here, we report a case of successful complete resection of a cardiac sarcoma infiltrating the right atrioventricle, tricuspid valve, and right coronary artery.
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Affiliation(s)
- Yelee Kwon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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7
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Monteagudo-Vela M, Riesgo-Gil F, Smail H, García-Saez D, Hassan B, Simon A. Cardiac tumors invading the right ventricle; Aggressive Surgical Management with backup mechanical circulatory support if necessary. Surg Oncol 2020; 34:190-194. [PMID: 32891328 DOI: 10.1016/j.suronc.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/09/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary cardiac tumors are exceedingly rare. Amongst the malignant types, sarcomas are the most frequently encountered. Treatment includes attempted aggressive surgical resection as the only curative option. We report our experience. METHODS During the last five years, six patients presented at our institution with complex cardiac tumors with different underlying diagnoses and were at different stages of their disease. RESULTS 6 patients with median age of 30-years-old underwent surgery in our centre. 3 patients had undergone debulking prior to surgery at our institution. In all patients, the tumor involved the right ventricle. One patient had biventricular involvement, the septum was involved in 4 patients, 2 patients had extracardiac growth, one invading both great vessels, one involving the pericardium and the hilar structures on the right side. Complete resection was achieved in 4 cases, 3 with successful resection-reconstruction, one with cardiectomy and implantation of a total artificial heart. 5 patients are currently alive, 4 free of recurrence. CONCLUSIONS Complete radical surgery is the only curative treatment for patients suffering from cardiac tumors. The availability of mechanical circulatory support allows for a more radical surgical approach even including total cardiectomy, possibly resulting in a significant increase in R0 resections.
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Affiliation(s)
- María Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Fernando Riesgo-Gil
- Department of Heart Failure, Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Hassiba Smail
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Diana García-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Bass Hassan
- Department of Medical Oncology, Oxford University Hospital NHS Foundation Trust, UK
| | - André Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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8
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Yin K, Luo R, Wei Y, Wang F, Zhang Y, Karlson KJ, Zhang Z, Reardon MJ, Dobrilovic N. Survival outcomes in patients with primary cardiac sarcoma in the United States. J Thorac Cardiovasc Surg 2020; 162:107-115.e2. [PMID: 32111430 DOI: 10.1016/j.jtcvs.2019.12.109] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aim to evaluate the survival outcomes of primary cardiac sarcoma in a US nationwide cancer database. METHODS The Surveillance, Epidemiology, and End Results database was queried to identify patients with primary cardiac sarcoma from 1973 to 2015. Kaplan-Meier analysis and log-rank tests were performed to compare overall survival for subpopulations, stratified on year at diagnosis (dichotomized into 2 periods: 1973-2005 and 2006-2015), pathological types, whether patients were treated with surgery or not, and surgery and chemotherapy combinations. Multivariable Cox regression was performed to estimate the adjusted hazard ratios and 95% confidence intervals of potentially clinically important factors. RESULTS A total of 442 patients (mean age, 47.2 ± 18.7 years; male 52.0%) were identified. Most patients were white (78.1%) and diagnosed at age 20 to 60 years (70.2%). Angiosarcoma (43.2%) was the most common histologic type. Overall, the median survival was 7 months, and the 1-, 3-, and 5-year survivals were 40.7%, 15.6%, and 9.8%, respectively. Patients who were diagnosed within the recent decade (2006-2015) did not achieve a better overall survival (P = .13). Surgery (adjusted hazard ratio, 0.49; 95% confidence interval, 0.37-0.64; P < .001) and chemotherapy (adjusted hazard ratio, 0.70; 95% confidence interval, 0.54-0.92; P = .009) were independently associated with improved overall survival. Increasing age (adjusted hazard ratio of 5-year increment, 1.07; 95% confidence interval, 1.04-1.11; P < .001) was independently associated with worse survival. CONCLUSIONS At the population level, primary cardiac sarcoma has a poor prognosis. Both surgery and chemotherapy are associated with improved survival, whereas increasing age at diagnosis was associated with worse survival.
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Affiliation(s)
- Kanhua Yin
- Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yaguang Wei
- Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Fenglei Wang
- Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Karl J Karlson
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Zhiqi Zhang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
| | - Nikola Dobrilovic
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
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9
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Hartvigson PE, Velamoor GR, Loggers ET, Kim E. Cardiac Angiosarcoma from a Saphenous Vein Coronary Artery Bypass Graft. Cureus 2019; 11:e5503. [PMID: 31667037 PMCID: PMC6816531 DOI: 10.7759/cureus.5503] [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] [Indexed: 11/24/2022] Open
Abstract
Primary cardiac sarcomas (PCS) are rare and the prognosis is generally poor. Angiosarcomas are the most common cardiac sarcoma histology. The best management of PCS is poorly defined. Chronic lymphedema, foreign bodies, including Dacron grafts, and arteriovenous fistulas have been associated with angiosarcoma, and angiosarcomas arising from saphenous vein femoropopliteal bypass grafts have been reported. We present the first known case of a cardiac angiosarcoma originating from an autologous saphenous vein graft used in a coronary artery bypass. The patient’s course and the literature on primary cardiac angiosarcomas are reviewed.
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Affiliation(s)
- Pehr E Hartvigson
- Radiation Oncology, University of Washington Medical Center, Seattle, USA
| | | | | | - Edward Kim
- Radiation Oncology, University of Washington, Seattle, USA
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10
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Boyacıoğlu K, Ak A, Dönmez AA, Çayhan B, Aksüt M, Tunçer MA. Outcomes After Surgical Resection of Primary Non-Myxoma Cardiac Tumors. Braz J Cardiovasc Surg 2019; 33:162-168. [PMID: 29898146 PMCID: PMC5985843 DOI: 10.21470/1678-9741-2017-0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023] Open
Abstract
Objective Primary cardiac tumors are rare lesions with different histological type. We
reviewed our 17 years of experience in the surgical treatment and clinical
results of primary non-myxoma cardiac tumors. Methods Between July 2000 and February 2017, 21 patients with primary cardiac tumor
were surgically treated in our institution. The tumors were categorized as
benign non-myxomas and malignants. Data including the demographic
characteristics, details of the tumor histology and grading, cardiac medical
and surgical history, surgical procedure of the patients were obtained from
the hospital database. Results Eleven patients were diagnosed with benign non-myxoma tumor
(male/female:7/4), ranging in age from 10 days to 74 years (mean age
30.9±26.5 years). Papillary fibroelastoma was the most frequent type
(63.6%). There were two early deaths in benign group (all were rhabdomyoma),
and mortality rate was 18%. The mean follow-up period was 69.3±58.7
months (range, 3 to 178 months). All survivals in benign group were free of
tumor-related symptoms and tumor relapses. Ten patients were diagnosed with
malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from
14 years to 73 years (mean age 44.7±18.9 years). Total resection
could be done in only three (30%) patients. The mean follow-up period was
18.7±24.8 months (range, 0-78 months). Six patients died in the first
10 months. Conclusion Complete resection of the cardiac tumors, whenever possible, is the main goal
of surgery. Surgical resection of benign cardiac tumors is safe, usually
curative and provides excellent long-term prognosis. On the contrary,
malignant cardiac tumors still remain highly lethal.
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Affiliation(s)
- Kamil Boyacıoğlu
- Cardiovascular Surgery Department, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Adnan Ak
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Arzu Antal Dönmez
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Burçin Çayhan
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Mehmet Aksüt
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Mehmet Altuğ Tunçer
- Kartal Koşuyolu Research and Training Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
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11
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Sadanand A, Ladell M, Fischer K. Case 1: Syncope in a 16-year-old Girl. Pediatr Rev 2019; 40:37-39. [PMID: 30600277 DOI: 10.1542/pir.2018-0028] [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: 11/24/2022]
Affiliation(s)
| | | | - Kayleigh Fischer
- Department of Pediatrics, Division of Pediatric Emergency Medicine, St Louis Children's Hospital/Washington University in St Louis, St Louis, MO
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12
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Chen TWW, Loong HH, Srikanthan A, Zer A, Barua R, Butany J, Cusimano RJ, Liang YC, Chang CH, Iakobishvili Z, Razak ARA, Lewin J. Primary cardiac sarcomas: A multi-national retrospective review. Cancer Med 2018; 8:104-110. [PMID: 30575309 PMCID: PMC6346258 DOI: 10.1002/cam4.1897] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Primary cardiac sarcoma (PCS) is a rare but often fatal disease. The current study aimed to analyze the impact of baseline demographics, local and systemic therapies in a contemporary cohort. METHODS Clinical records of PCS across six institutions in three continents were reviewed. Kaplan-Meier method was used to estimate survival. Cox proportional hazard model was used to determine variables impacting progression-free survival (PFS) or overall survival (OS). RESULTS Sixty-one patients with PCS (1996-2016) were identified. The median age at diagnosis was 46 (range 18-79); 36% (n = 22) presented with metastatic disease. The most common histology was angiosarcoma (n = 24, 39%). A total of 46 patients received surgery (75%) but only 5 (8%) patients achieved R0 resection. Multi-modality treatment to the primary tumor was given to 28 patients (46%; localized disease 23/39 (59%); metastatic disease 5/22 (23%)). The median OS for the entire cohort was 17.5 months (95% CI 9.5-20.6), with seven (11%) patients surviving longer than 36 months. On multi-variate analysis, age <65 (P = 0.01) was the only significant favorable prognostic factor. For first-line palliative chemotherapy, the median PFS was 4.4 months (95% CI 2.9-7.7 months). The best response for first-line chemotherapy was 32% (CR = 1, PR = 9). No significant improvement in OS was identified in patients presenting throughout the 20-year period of this review. CONCLUSION Younger age at diagnosis was associated with improved outcome although the prognosis of PCS remains poor. Given the lack of improvement in survival, further dedicated research is required.
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Affiliation(s)
- Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,National Taiwan University Cancer Center, Taipei, Taiwan
| | - Herbert H Loong
- Department of Clinical Oncology, State Key Laboratory of Oncology in South China, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Alona Zer
- Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Reeta Barua
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jagdish Butany
- Division of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Cusimano
- Division of Cardiovascular Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yun-Chieh Liang
- Clinical Trial Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Albiruni R Abdul Razak
- Sarcoma Department, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jeremy Lewin
- Sarcoma Department, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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13
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Niclauss L, Montemurro M, Kirsch M, Prêtre R. Sarcoma of the heart: survival after surgery†. Interact Cardiovasc Thorac Surg 2018; 27:198-201. [DOI: 10.1093/icvts/ivy045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/09/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Lars Niclauss
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Michael Montemurro
- Department of Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - René Prêtre
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Randhawa JS, Budd GT, Randhawa M, Ahluwalia M, Jia X, Daw H, Spiro T, Haddad A. Primary Cardiac Sarcoma: 25-Year Cleveland Clinic Experience. Am J Clin Oncol 2017; 39:593-599. [PMID: 25036471 DOI: 10.1097/coc.0000000000000106] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac sarcomas are rare and have a poor prognosis. The median overall survival remains dismal and has been reported ranging from 6 months to a few years. Primary cardiac sarcoma is the most common malignant tumor comprising approximately 95% of all malignant tumors of the heart. METHODS We conducted a retrospective chart review in a single institution of patients diagnosed between March 1988 and April 2013. A total of 42 patients were identified. The following variables were studied: age at diagnosis, year of diagnosis, sex, stage, site of tumor involvement, tumor histology, grade, treatment modality, type of chemotherapy, and survival outcome. The overall median follow-up time was 49.5 months. RESULTS The most common histologic type was angiosarcoma. Overall estimated median survival (EMS) was 25 months. Tumors involving the left side of the heart and pericardium demonstrated better survival. Patients who received multimodality treatment (any combination of surgery, radiation therapy, and chemotherapy) had an EMS of 36.5 months compared with 14.1 months for patients treated with surgery, radiation therapy, or chemotherapy only (P=0.05). CONCLUSIONS Cardiac sarcoma is a lethal tumor with an EMS of 25 months. The tumor histology could be a possible predictor of better survival. Although selection bias may have been present, multimodality therapy (surgery, radiation therapy, and chemotherapy) was associated with improved survival.
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Hassan M, Khattak M, Abdullah HMA, Nasib B. Primary cardiac leiomyosarcoma presenting as haemoptysis in a 22-year-old patient: an unusual presentation of a rare condition. BMJ Case Rep 2017; 2017:bcr-2017-219416. [PMID: 28705841 DOI: 10.1136/bcr-2017-219416] [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] [Indexed: 12/27/2022] Open
Abstract
Primary cardiac sarcomas are rare malignant tumours and among them, leiomyosarcoma is extremely rare. They are especially rare in a young age group. We present a case of a 22-year-old male patient with primary leiomyosarcoma of the left atrium involving the pulmonary veins who presented with haemoptysis and shortness of breath. He underwent surgical excision of the tumour along with mitral valve replacement followed by adjuvant chemotherapy. No recurrence was reported on his second 6 monthly follow-ups.
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Affiliation(s)
- Masroor Hassan
- Department of Histo-Pathology, Rehman Medical Institute, Peshawar, Pakistan
| | - Maria Khattak
- Department of Histo-Pathology, Rehman Medical Institute, Peshawar, Pakistan
| | | | - Bushra Nasib
- Department of Histo-Pathology, Rehman Medical Institute, Peshawar, Pakistan
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16
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Abu Saleh WK, Ramlawi B, Shapira OM, Al Jabbari O, Ravi V, Benjamin R, Durand JB, Leja MJ, Blackmon SH, Bruckner BA, Reardon MJ. Improved Outcomes With the Evolution of a Neoadjuvant Chemotherapy Approach to Right Heart Sarcoma. Ann Thorac Surg 2017; 104:90-96. [PMID: 28189277 DOI: 10.1016/j.athoracsur.2016.10.054] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/20/2016] [Accepted: 10/24/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Right-side heart sarcomas tend to be bulky, infiltrative, and difficult to treat. We have previously examined our outcomes with right heart sarcomas. Surgical resection with R0 margins showed better survival than positive margins but in only one third of cases could R0 status be achieved. The hypothesis for this study was that preoperative neoadjuvant chemotherapy would shrink the tumor margins and allow an increase in R0 resection, and hence, better survival. METHODS Review of our cardiac tumor database from 1990 to 2015 yielded 133 primary cardiac sarcoma cases. Of these, we identified 44 patients with primary right-side heart sarcomas. Prospective database and retrospective data collection and clinical outcomes were evaluated for all 44 patients. Primary outcomes included 30-day mortality and morbidity and long-term survival. We used univariate and multivariate analyses to identify independent predictors of overall survival. RESULTS There were 27 male and 17 female patients with a mean age of 41 ± 12.7 years (range, 15 to 67). Seventy-three percent of the patients (32 of 44) received neoadjuvant chemotherapy. The most common tumor histology was angiosarcoma in 30 of 44 (68%). Thirty-day mortality was 4.5%, and statistically similar between the two groups. The median survival of patients who had R0 resection was 53.5 months compared with 9.5 months for R1. Neoadjuvant chemotherapy led to a doubling of survival (20 versus 9.5 months). CONCLUSIONS Neoadjuvant chemotherapy followed by radical surgery is a safe and effective strategy in patients with primary right-side heart sarcoma. This multimodality treatment enhances resectability (R0 resection) that translates into improved patient survival.
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Affiliation(s)
- Walid K Abu Saleh
- Department of Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Heart and Vascular Center, Valley Health System, Winchester, Virginia
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Odeaa Al Jabbari
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Benjamin
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Bernard Durand
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Monika J Leja
- Department of Internal Medicine and Cardiology, University of Michigan, Northville, Michigan
| | | | - Brian A Bruckner
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
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Minimally invasive diagnosis of a pericardial mass by CT-guided fine-needle aspiration. Cardiovasc Pathol 2016; 25:275-279. [PMID: 27131516 DOI: 10.1016/j.carpath.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/15/2016] [Accepted: 03/28/2016] [Indexed: 11/20/2022] Open
Abstract
The preferred management of a cardiac mass remains controversial, but it often includes open-chest surgical excision to obtain an adequate tissue sample for histological workup. We herein report a less invasive approach in which an accurate and timely cytological diagnosis of pericardial angiosarcoma was reached by studying a CT-guided fine-needle aspiration cell block. The cell block showed proliferation of atypical cells with occasional mitotic figures, vasoformative features, and immunoreactivity to WT1, vimentin, CD31, CD34, ERG, and Ki67. Recourse to fine-needle aspiration and cell block study is a valuable diagnostic approach to be considered when a cardiac mass is percutaneously accessible.
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18
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Neo-Left Atrium Construction on the Beating Heart After Extirpation of a Huge Mediastinal Tumor Invading Heart and Lung. Ann Thorac Surg 2015; 100:2350-2. [PMID: 26652532 DOI: 10.1016/j.athoracsur.2015.02.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/14/2015] [Accepted: 02/02/2015] [Indexed: 11/21/2022]
Abstract
We report on construction of a neo-left atrium (LA) with 2 bovine pericardial patches after in toto removal of a huge mediastinal tumor invading the heart and lung. The procedure was performed on the beating heart using normothermic cardiopulmonary bypass (CPB) without cardioplegic arrest. Treatment consisted of tumor removal necessitating left pneumonectomy, excision of the LA, resection of the mitral annulus, excision of the tumor from the left ventricle, and construction of a new LA using 2 bovine pericardial patches and a new mitral bioprosthesis. Histologic examination revealed myofibrosarcoma. The patient died 22 months after the operation.
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Turbendian H, Seastedt KP, Shavladze N, Port J, Altorki N, Stiles B, Girardi L. Extended resection of sarcomas involving the mediastinum: a 15-year experience. Eur J Cardiothorac Surg 2015; 49:829-34. [DOI: 10.1093/ejcts/ezv222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/18/2015] [Indexed: 11/14/2022] Open
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Pacini D, Careddu L, Pantaleo A, Parolari A, Leone O, Daprati A, Gargiulo GD, Di Bartolomeo R. Primary malignant tumors of the heart: Outcomes of the surgical treatment. Asian Cardiovasc Thorac Ann 2015; 23:645-51. [DOI: 10.1177/0218492315573674] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Malignant cardiac tumors are rare and have an extremely poor prognosis even when complete resection is attempted. The aim of this study was to review the experience of primary malignant cardiac tumors in 2 Italian academic hospitals. Methods The hospital records were searched to identify patients with primary malignant cardiac tumors who underwent surgery between January 1979 and December 2012. Secondary cardiac tumors, whether metastatic or invasive, were excluded as were primary sarcomas of the great arteries. Fourteen patients selected from our institution’s surgical series were identified. Eleven (78.6%) were men and 3 (21.4%) were women, and the mean age at surgery was 47.4 years. Results The most common histological type was angiosarcoma (28.6%). The mean survival was 28.8 ± 28 months and it was better in men than in women (30.5 ± 8.7 vs. 21.1 ± 3.2 months). Patients with a radical resection at the first surgery had a longer survival compared to patients with a partial resection (39.9 ± 23.2 vs. 24 ± 4 months). Conclusions The treatment outcome for patients affected by primary malignant heart tumors remains poor. Aggressive surgery alone does not provide good results in terms of survival rate. A new multidisciplinary approach is mandatory to improve long-term survival.
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Affiliation(s)
- Davide Pacini
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lucio Careddu
- Pediatric Cardiac Surgery and GUCH Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Pantaleo
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Ornella Leone
- Department of Pathology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Daprati
- Cardiac Surgery Department, Monzino Hospital, Milano, Italy
| | - Gaetano Domenico Gargiulo
- Pediatric Cardiac Surgery and GUCH Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Roberto Di Bartolomeo
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Hoey ETD, Shahid M, Ganeshan A, Baijal S, Simpson H, Watkin RW. MRI assessment of cardiac tumours: part 2, spectrum of appearances of histologically malignant lesions and tumour mimics. Quant Imaging Med Surg 2014; 4:489-97. [PMID: 25525582 DOI: 10.3978/j.issn.2223-4292.2014.11.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 12/19/2022]
Abstract
Cardiac magnetic resonance imaging (MRI) is the reference standard technique for assessment and characterization of a suspected cardiac tumour. It provides an unrestricted field of view, high temporal resolution and non-invasive tissue characterization based on multi-parametric assessment of the chemical micro-environment. Sarcomas account for around 95% of all primary malignant cardiac tumours with lymphoma, and primary pericardial mesothelioma making up most of the remainder of cases. By contrast cardiac metastases are much more common. In this article we review the MRI features of the spectrum of histologically malignant cardiac and pericardial tumours as well as some potential tumour mimics.
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Affiliation(s)
- Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Muhammad Shahid
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Shobhit Baijal
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Helen Simpson
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Richard W Watkin
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
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Hoey ETD, Shahid M, Ganeshan A, Baijal S, Simpson H, Watkin RW. MRI assessment of cardiac tumours: part 1, multiparametric imaging protocols and spectrum of appearances of histologically benign lesions. Quant Imaging Med Surg 2014; 4:478-88. [PMID: 25525581 DOI: 10.3978/j.issn.2223-4292.2014.11.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 01/06/2023]
Abstract
Cardiac magnetic resonance imaging (MRI) is the reference standard technique for assessment and characterization of a suspected cardiac tumour. It provides an unrestricted field of view, high temporal resolution and non-invasive tissue characterization based on multi-parametric assessment of the chemical micro-environment. MRI exploits differences in hydrogen proton density in conjunction with T1 and T2 relaxation properties of different tissues to help differentiation normal from abnormal and benign from malignant lesions. In this article we review specific cardiac MRI techniques, tumour protocol design and the appearance of the spectrum of histologically benign tumours.
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Affiliation(s)
- Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Muhammad Shahid
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Shobhit Baijal
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Helen Simpson
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Richard W Watkin
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
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