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Talbot S, Bandaru V, Nguyen T, Arif D, Sethi P. Rapid Development of Primary Right Atrial Angiosarcoma. Cureus 2024; 16:e64273. [PMID: 39131000 PMCID: PMC11315593 DOI: 10.7759/cureus.64273] [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: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Cardiac angiosarcomas are rare and generally followed by a high level of metastasis with poor median survival outcomes. Echocardiograms, CT scans, and MRIs are the standard methods for finding sites of cardiac tumors; however, immunohistochemical confirmation is necessary for a definitive diagnosis of angiosarcoma. A 58-year-old male presented to the emergency room with one week of dyspnea on moderate exertion accompanied by chest pain and alleviated with rest. A workup done to evaluate mass found a single 5 x 3.5 x 4.8 cm mass heavily vascularized by the right coronary artery and left circumflex involving the free wall of the right atrium with no extension to the tricuspid valve. Surgical resection was performed, and immunohistochemistry was consistent with a primary cardiac angiosarcoma. An exudative fluid analysis on pericardial and pleural fluid analysis may warrant screening for malignancy more frequently in concurrence with a patient's history and presentation. Although the time from onset of symptoms to diagnosis of cardiac angiosarcoma is not well established, further investigation of such correlation may offer insight into survival post-treatment.
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Affiliation(s)
- Sophie Talbot
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Vishal Bandaru
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Tung Nguyen
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Dauod Arif
- Pathology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Pooja Sethi
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
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2
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Yamashita D, Fujimoto N, Okado R, Ikami A, Yamamoto A, Tono Y, Watanabe K, Hayashi A, Ota S, Mizutani M, Kitamura T, Dohi K. Cardiac angiosarcoma with pulmonary and adrenal metastases diagnosed by FDG-PET/CT-guided adrenal biopsy. J Cardiol Cases 2024; 29:248-250. [PMID: 38826768 PMCID: PMC11143738 DOI: 10.1016/j.jccase.2024.02.003] [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: 10/04/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 06/04/2024] Open
Abstract
Primary cardiac angiosarcoma is a high-grade aggressive tumor with a poor prognosis and low incidence. We describe a case of cardiac angiosarcoma, with pulmonary and adrenal metastases, diagnosed via fluorodeoxyglucose-positron emission tomography/computed tomography-guided adrenal biopsy. Learning objective Cardiac angiosarcoma should be considered in a patient with a cardiac mass with no tumor cells in the pericardial fluid. Fluorodeoxyglucose-positron emission tomography/computed tomography could be useful in determining the biopsy site.
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Affiliation(s)
- Daiki Yamashita
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryo Okado
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
| | - Akiyoshi Ikami
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
| | - Ayato Yamamoto
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
| | - Yasutaka Tono
- Department of Medical Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | | | - Akinobu Hayashi
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Satoshi Ota
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
| | - Minoru Mizutani
- Department of Hematology, Suzuka General Hospital, Suzuka, Japan
| | - Tetsuya Kitamura
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
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3
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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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4
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Nasir A, Patel YB. Diffuse Large B-cell Lymphoma Presenting as a Cardiac Mass. Cureus 2024; 16:e59755. [PMID: 38840985 PMCID: PMC11152600 DOI: 10.7759/cureus.59755] [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: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
Cardiac involvement as the initial presentation of lymphoma is a rare occurrence. The most common type of cardiac lymphoma is diffuse large B-cell lymphoma (DLBCL), which often affects the right atrium. Cardiac lymphoma can either be mediastinal DLBCL invading the heart or primary cardiac lymphoma. We describe the case of an 84-year-old female who presented with an eight-week history of dyspnea. Computed tomography angiography (CTA) of the chest showed a right-sided pleural effusion with collapse of the right middle and lower lobes as well as a large mass-like density within the anterior pericardium, compressing the right atrium and right ventricle and encasing the right coronary artery. A transthoracic echocardiogram (TTE) showed a multilocular hypoechoic mass in the right atrium with invasion into the wall of the right atrium. The patient underwent diagnostic and therapeutic thoracentesis. Pleural fluid cytology revealed diffuse large B-cell lymphoma, with positive stains for CD20, PAX5, CD10, BCL6, and Mum-1. Fluorescence in situ hybridization (FISH) revealed an abnormality of BCL2/18q (16%). A staging positron emission tomography (PET) scan showed a large mediastinal mass involving the right pericardium, focal uptake in the left thyroid lobe, left skull base, and musculature around the proximal left femur. Chemotherapy was initiated with R-mini-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). PET scans after three cycles of chemotherapy showed a complete metabolic response with the resolution of previously noted hypermetabolic lesions. The patient completed all six cycles of chemotherapy without issues. The differential diagnosis of a right atrial cardiac mass should include lymphoma. TTE is usually the initial imaging test, and a tissue biopsy is required for a definitive diagnosis. DLBCL is highly aggressive and carries a poor prognosis if untreated. Early diagnosis and treatment with standard chemotherapy are crucial for favorable outcomes.
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Affiliation(s)
- Abdullah Nasir
- Internal Medicine, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
| | - Yash B Patel
- Internal Medicine, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
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Avranas K, Eisenbach C, Flechtenmacher C, Korosoglou G. Diagnostic Pathway From Incidental Mass to Metastatic Melanoma: Role of Multimodal Imaging and Medical Therapy. JACC Case Rep 2024; 29:102146. [PMID: 38223263 PMCID: PMC10784600 DOI: 10.1016/j.jaccas.2023.102146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 01/16/2024]
Abstract
We present a case of detection of a right atrial mass during surveillance echocardiography, mimicking myxoma. Cardiac magnetic resonance and computed tomography revealed infiltration into the pericardium, suggesting malignancy. Abdominal computed tomography showed multiple liver masses that were histologically positive for metastatic amelanotic melanoma. Under immunotherapy adequate remission was achieved.
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Affiliation(s)
| | - Christoph Eisenbach
- Gesundheitszentren Rhein-Neckar Hospital Weinheim, Department of Gastroenterology and Diabetology, Weinheim, Germany
| | | | - Grigorios Korosoglou
- GRN Hospital Weinheim, Department of Cardiology, Vascular Medicine and Pneumology, Weinheim, Germany
- Weinheim Cardiac Imaging Center, Hector Foundation, Weinheim, Germany
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Yamashita H, Higashida T, Huchioka A, Asakawa Y, Nambu A, Ohyatsu S, Kohyama T, Takahashi M, Hayashi T, Tago M. Cardiac angiosarcoma with metastatic to lung, brain, and bone. Radiol Case Rep 2024; 19:473-478. [PMID: 38046925 PMCID: PMC10692493 DOI: 10.1016/j.radcr.2023.10.056] [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: 05/10/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Abstract
Cardiac angiosarcoma is a malignant tumor derived from vascular endothelium with a dismal prognosis. The imaging findings of cardiac angiosarcoma are nonspecific and endomyocardial and pericardial biopsies have insufficient accuracy. For these reasons, the diagnosis is sometimes difficult. Primary and metastatic tumors tend to bleed easily, causing hemoptysis and neurological symptoms. Brain metastases are not often known to be fatal when they cause hemorrhage. We report a 27-year-old man diagnosed with right atrium angiosarcoma, with metastases in the lung, brain, and bone. The patient had only respiratory symptoms at the first visit and did not show any symptoms derived from brain metastases yet died after 27 days due to hemorrhage from brain metastases. If brain metastasis from angiosarcoma is suspected based on imaging findings, urgent radiotherapy should be considered before histological examination for a definitive diagnosis.
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Affiliation(s)
- Hiroshi Yamashita
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Tomohiko Higashida
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Aya Huchioka
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Yasuma Asakawa
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Atsushi Nambu
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Sho Ohyatsu
- Department of Internal Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Tadashi Kohyama
- Department of Internal Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Mikiko Takahashi
- Department of Pathology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Takaki Hayashi
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Masao Tago
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
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Xie J, Yuan L, Qin Y, Liu J. Clinical presentation, diagnosis, and management of primary cardiac tumor: A case report. Asian J Surg 2023; 46:5320-5322. [PMID: 37596232 DOI: 10.1016/j.asjsur.2023.07.099] [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: 06/29/2023] [Accepted: 07/16/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Primary cardiac tumors are rare but have the potential to cause significant morbidity if not treated in an appropriate and timely manner. To date, however, there have been no studies examining the survival characteristics of patients who did not undergo surgical resection. CASE REPORT We are presenting a case of a 61-year-old male admitted to our department due to "heart tumor''. He had 5+years previous history of type 2 diabetes was, and he took Metformin orally for a long time. Under extracorporeal circulation and general anesthesia, the heart lesion was removed under thoracoscopy. The tumor was about 5 cm ∗ 4 cm pale yellow color and sent for biopsy. Pathology report showed tumor like hyperplasia of fat and striated muscle tissues, some fat cells had atypical hyperplasia. CONCLUSIONS For patients with malignant tumor, most of them had local invasion or had distant metastasis when the diagnosis was clear, and only conservative management could be done. Moreover, the prognosis of malignant tumor is poor, and the pathological morphology is diverse. The causes of death are due to widespread tumor metastasis, refractory heart failure, and various arrhythmias.
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Affiliation(s)
- Jianhua Xie
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Liang Yuan
- Department of Pathology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Yuxue Qin
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Jianxiong Liu
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
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Kurmann R, El-Am E, Ahmad A, Abbasi MA, Mazur P, Akiki E, Anand V, Herrmann J, Casanegra AI, Young P, Crestanello J, Bois MC, Maleszewski JJ, Klarich K. Cardiac Masses Discovered by Echocardiogram; What to Do Next? STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100154. [PMID: 37520139 PMCID: PMC10382990 DOI: 10.1016/j.shj.2022.100154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 02/12/2023]
Abstract
Cardiac tumors are rare conditions, typically diagnosed on autopsy, but with the advancement of imaging techniques they are now encountered more frequently in clinical practice. Echocardiography is often the initial method of investigation for cardiac masses and provides a quick and valuable springboard for their characterization. While some cardiac masses can be readily identified by echocardiography alone, several require incorporation of multiple data points to reach diagnostic certainty. Herein, we will provide an overview of the main clinical, diagnostic, and therapeutic characteristics of cardiac masses within the framework of their location.
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Affiliation(s)
- Reto Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elias Akiki
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ana I. Casanegra
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip Young
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie C. Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J. Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Yang Z, Niu Y, Ma H, Gong W, Yu L, Liu L, Zheng M. Contrast-enhanced echocardiographic diagnosis of benign and malignant cardiac tumors and its correlation with pathology. Front Cardiovasc Med 2023; 10:1182334. [PMID: 37363101 PMCID: PMC10285073 DOI: 10.3389/fcvm.2023.1182334] [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: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background This study aimed to explore the diagnostic value of contrast-enhanced echocardiography (CEE) in benign and malignant cardiac tumors and detect the correlation of CEE parameters and immunohistochemistry (IHC) markers. Methods The data of 44 patients with cardiac tumors confirmed by pathology were reviewed. Lesions were examined before surgery using transthoracic echocardiography (TTE) and CEE with time-intensity curve analysis. The expression of CD31, VEGF and Ki67 was measured by IHC staining. Microvessel density (MVD) was quantified via IHC for CD31. The clinical variables, TTE, CEE and IHC parameters were compared between benign and malignant cardiac tumors. Receiver operating characteristic curve were used to analyze the value of factors in predicting malignant cardiac tumors. The correlation between CEE and IHC parameters was analyzed. Results Among 44 cardiac tumors, 34 were benign and 10 were malignant. There were significant differences in the TTE parameters (pericardial effusion, tumor boundary, diameter, basal width), CEE parameters (tumor peak intensity (TPI), peak intensity ratio of tumor to myocardium (TPI/MPI), area under time-intensity curve (AUTIC)) and IHC parameters (Ki67, MVD, CD31, VEGF) between the benign and malignant tumor groups (all P < 0.05). Receiver operating characteristic curve analysis showed that the CEE and IHC parameters had diagnostic value in malignant cardiac tumors. There was a correlation between TPI/MPI and Ki67 (r = 0.62), AUTIC and Ki67 (r = 0.50), and AUTIC and CD31 (r = 0.56). Conclusion TTE and CEE parameters were different between benign and malignant cardiac tumors. CEE is helpful to differentiate the properties of cardiac tumors. There is a correlation between CEE parameters and IHC markers. AUTIC and TPI/MPI can reflect the proliferation and invasion of tumors.
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Affiliation(s)
- Zihao Yang
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yicui Niu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Hui Ma
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Wenqing Gong
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Lu Yu
- Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Minjuan Zheng
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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10
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Guo Y, Liu Q, Wu H. Primary cardiac tumor: a case report of right atrial angiosarcoma and review of the literature. Front Oncol 2023; 13:1164153. [PMID: 37305576 PMCID: PMC10250602 DOI: 10.3389/fonc.2023.1164153] [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: 02/12/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Primary cardiac angiosarcoma is a relatively rare tumor with early metastasis and poor prognosis. Radical resection of the primary tumor remains the primary approach for the optimal survival of patients with early-stage cardiac angiosarcoma without evidence of metastasis. This case involves a 76-year-old man with symptoms of chest tightness, fatigue, pericardial effusion, and arrhythmias who achieved good results after surgery to treat the angiosarcoma in the right atrium. In addition, literature analysis showed that surgery remains an effective way of treating primary early angiosarcoma.
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Affiliation(s)
- Yujian Guo
- Department of Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi, China
| | - Qianzhen Liu
- Department of Pathology, The First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Haibo Wu
- Department of Cardiothoracic Surgery, Changzhi People’s Hospital, Changzhi, Shanxi, China
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11
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Hu HM, Li YD, Wei CW, Liu Y, Lv XZ, Yang YH. Pulmonary artery sarcoma: an unexpected settler in the right ventricular outflow tract. J Cardiothorac Surg 2023; 18:178. [PMID: 37170135 PMCID: PMC10176877 DOI: 10.1186/s13019-023-02274-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
Pulmonary artery sarcoma (PAS) is a sporadic malignant tumor that mainly originates from the pulmonary arteries. However, PAS may also involve the right ventricular outflow tract (RVOT) and lead to obstruction, syncope, or sudden death. Early diagnosis and complete surgical resection are essential to prolong survival and improve the quality of life of patients with PAS. Herein, we report a case of a young female patient admitted for pulmonary malignancy and acute pulmonary embolism. The patient had a mass in the RVOT, which was detected by transthoracic echocardiography. Computed tomography and magnetic resonance imaging revealed the invasion depth and extent of the lesions. Surgical resection improved hemodynamics, while pathological and immunohistochemical tests confirmed the diagnosis of a pulmonary artery sarcoma. Local recurrence was detected in the adjacent tissues about two months after the surgery. Given the potential risk of reoperation, the patient was suggested to undergo conservative treatment.
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Affiliation(s)
- Hui-Min Hu
- Department of Ultrasound, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yi-Dan Li
- Department of Ultrasound, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Chang-Wei Wei
- Department of Anesthesia, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yan Liu
- Department of Cardiac Surgery, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiu-Zhang Lv
- Department of Ultrasound, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
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12
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Chambergo-Michilot D, De la Cruz-Ku G, Sterner RM, Brañez-Condorena A, Guerra-Canchari P, Stulak J. Clinical characteristics, management, and outcomes of patients with primary cardiac angiosarcoma: A systematic review. J Cardiovasc Thorac Res 2023; 15:1-8. [PMID: 37342661 PMCID: PMC10278191 DOI: 10.34172/jcvtr.2023.30531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/10/2023] [Indexed: 06/23/2023] Open
Abstract
Primary cardiac angiosarcomas (PCA) are highly aggressive malignant heart tumors. Previous reports have shown a poor prognosis regardless of management, and no consensus or guidelines exist. It is necessary to clarify this information since patients with PCA have a short survival. Therefore, we aimed to systematically review clinical manifestations, management, and outcomes. We systematically searched in PubMed, Scopus, Web of Science, and EMBASE. We intended to include cross-sectional studies, case-control studies, cohort studies, and case series that reported clinical characteristics, management, and outcomes of patients with PCA. As a methodological approach, we used the Joanna Briggs Institute Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale for cohorts. We included six studies (five case series, one cohort). The mean/median age ranged from 39 to 48.9 years. Male sex was predominant. The most frequent manifestations were dyspnea (range: 50%-80%), pericardial effusion (29% & 56%), and chest pain (10%-39%). The mean tumor size ranged from 5.8 to 7.2 cm, with the majority of these localized in the right atrium (70-100%). The most common locations of metastasis were the lung (20%-55.6%), liver (10%-22.2%), and bone (10%-20%). Resection (22.9%-94%), and chemotherapy as neoadjuvant or adjuvant (30%-100%) were the most commonly used methods of treatment. Mortality ranged from 64.7% to 100%. PCA often presents late in its course and usually results in poor prognosis. We strongly recommend performing multi-institutional prospective cohorts to better study disease course and treatments to develop consensus, algorithms, and guidelines for this type of sarcoma.
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Affiliation(s)
- Diego Chambergo-Michilot
- Universidad Científica del Sur, Lima, Perú
- Department of Cardiology Research, Torres de Salud National Research Center, Lima, Perú
| | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Perú
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Surgery of the University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Ana Brañez-Condorena
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Perú
- Asociación de Investigación Estudiantil en Ciencias de la Salud, Lima, Perú
| | - Pedro Guerra-Canchari
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Perú
- Sociedad Científica de San Fernando, Lima, Perú
| | - John Stulak
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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13
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Tian K, Liu Y, Zhu H, Wang T, Chen T, Pei X, Song F. A case report of primary cardiac angiosarcoma with DNMT3A gene mutation. Front Oncol 2022; 12:1018741. [PMID: 36387074 PMCID: PMC9647023 DOI: 10.3389/fonc.2022.1018741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/14/2022] [Indexed: 08/23/2023] Open
Abstract
Cardiac angiosarcoma is a rare disease with a high mortality rate despite its low incidence. Surgery is currently the mainstay treatment strategy for patients with this condition. Herein, we describe a case of primary cardiac angiosarcoma, including symptoms, examination findings, treatment strategy and prognosis. In 2020, the patient was admitted to our hospital, and Next-Generation Sequencing (NGS) revealed a mutation in the DNMT3A gene. Generally, DNMT3A mutations are most commonly seen in atherosclerosis and myeloid leukemia. To our knowledge, this is the first reported case of primary cardiac angiosarcoma with DNMT3A gene mutation.
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Affiliation(s)
| | | | | | | | | | | | - Feixue Song
- Department of Medical Oncology, Second Hospital of Lanzhou University, Lanzhou, China
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14
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Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
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Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
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15
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Doganozu E, Hasircı SH, Ozdemir H, Coskun M, Sezgin A, Muderrisoglu IH, Sade LE. A case of primer angiosarcoma ın a young woman: lessons from multi-modality ımaging. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2093-2098. [PMID: 37726613 DOI: 10.1007/s10554-022-02635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Ersin Doganozu
- Department of Cardiology, 29 Mayis State Hospital, Aydınlar mh. Dikmen Cd. No:312Çankaya, 06105, Ankara, Turkey.
| | - Senem Has Hasircı
- Department of Cardiology, Faculty of Medicine, Başkent University, Ankara Hospital, Fevzi Çakmak Cd. 10. Sk. No:45, Bahçelievler, Ankara, Turkey
| | - Handan Ozdemir
- Department of Pathology, Faculty of Medicine, Başkent University, Ankara Hospital, Fevzi Çakmak Cd. 10. Sk. No:45, Bahçelievler, Ankara, Turkey
| | - Mehmet Coskun
- Faculty of Medicine, Department of Radiology, Başkent University, Ankara Hospital, Fevzi Çakmak Cd. 10. Sk. No:45, Bahçelievler, Ankara, Turkey
| | - Atilla Sezgin
- Faculty of Medicine, Department of Cardiovascular Surgery, Başkent University, Ankara Hospital, Fevzi Çakmak Cd. 10. Sk. No:45, Bahçelievler, Ankara, Turkey
| | - I Haldun Muderrisoglu
- Department of Cardiology, Faculty of Medicine, Başkent University, Ankara Hospital, Fevzi Çakmak Cd. 10. Sk. No:45, Bahçelievler, Ankara, Turkey
| | - Leyla Elif Sade
- University of Pittsburgh - Heart & Vascular Institute UPMC, 200 Lothrop St Ste, Pıttsburgh, PA, E354.2 15213, USA
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16
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Yeh JK, Tsai YS, Chen YP, Roan JN, Chang HY. Right atrium angiosarcoma with feeding vessels from right coronary artery: a case report. Eur Heart J Case Rep 2022; 6:ytac025. [PMID: 35174309 PMCID: PMC8846175 DOI: 10.1093/ehjcr/ytac025] [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: 05/26/2021] [Revised: 07/20/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Primary cardiac angiosarcoma is a rare primary cardiac malignancy. Biopsy of such vascular-rich tumours may result in serious complications. CASE SUMMARY This is a case of a 43-year-old woman who presented with syncope. According to clinical history, she initially had massive pericardial effusion, with an uncertain aetiology. Multimodality imaging at our hospital revealed a cauliflower-like tumour in the right atrium. Coronary angiography results confirmed multiple feeding vessels from the right coronary artery to the tumour. Thoracoscopic biopsy resulted in a massive bleeding requiring haemostasis via thoracotomy. Histopathological examination of the specimen showed an angiosarcoma with atypical cells and spindle cells in a myxomatous background. Treatment with systemic targeted therapy and chemotherapy was initiated, and the patient is still under active treatment. DISCUSSION Cardiac angiosarcomas most commonly arise from the right atrium and may be hard to detect with transthoracic echocardiography. Biopsy of primary cardiac angiosarcomas requires careful planning because they are highly vascularized. Currently, no guidelines regarding the treatment of such tumours exist, and a multidisciplinary treatment is needed.
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Affiliation(s)
- Jian-Kuan Yeh
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Shan Tsai
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Ping Chen
- Division of Hematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsien-Yuan Chang
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan, Taiwan
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17
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Gonçalves I, Nunes C, Vieira C, Freitas D, Pinto L. Primary Cardiac Angiosarcoma: A Rare and Fatal Diagnosis. Cureus 2021; 13:e20816. [PMID: 35111478 PMCID: PMC8794415 DOI: 10.7759/cureus.20816] [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] [Accepted: 12/29/2021] [Indexed: 11/08/2022] Open
Abstract
Primary cardiac angiosarcoma is a rare malignant neoplasm and occurs most frequently in middle-aged males. It has an aggressive nature, with highly variable clinical features, which results in delayed diagnosis and high mortality. We report a 19-year-old man presented to the ED with a three-month history of hemoptysis and one-week history of anterior chest pain. Additionally, an aortic diastolic murmur grade II/VI was found on physical examination. Thoracic CT scan revealed bilateral dispersed hypodense pulmonary nodes with peripheral halo, alveolar densification, and pericardial effusion. The transthoracic echocardiogram confirmed sizeable pericardial effusion and bicuspid aortic valve, without other significant findings. A pericardiocentesis removed 1300 mL of hemorrhagic fluid, consistent with an exudate without malignant cells. Both cardiac magnetic resonance and transesophageal echocardiogram revealed a large mass on the right atrium’s anterior wall. Mass biopsy was performed, revealing malignant cardiac angiosarcoma. The biopsy of the lung lesions was compatible with lung metastasis of primary cardiac angiosarcoma. The patient was submitted to palliative chemotherapy but died 12 months after the diagnosis.
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18
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Campo Dall'Orto AOM, Sabatoski VV, Morato TN, Resende UM, Barzilai VS, Atik FA. Recurrent Cardiac Sarcoma Resection With Modified Partial Autotransplantation. JACC Case Rep 2021; 3:1694-1699. [PMID: 34766021 PMCID: PMC8571791 DOI: 10.1016/j.jaccas.2021.08.005] [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: 07/19/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022]
Abstract
Primary cardiac sarcomas are very aggressive, being a challenge to cardio-oncology specialty. Surgical planning and innovative techniques have enhanced the possibility of resection. We have described a case of recurrent primary left atrium angiosarcoma, successfully resected with a modified partial autotransplantation technique, planned using a 3-dimensional model created from computed tomography. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Aline O M Campo Dall'Orto
- Department of Post-graduation in Medical Sciences, University of Brasilia Medical School, Brasilia, DF, Brazil
| | - Viviane V Sabatoski
- Department of Cardiovascular Medicine, Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil
| | - Tiago N Morato
- Department of Cardiovascular Medicine, Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil
| | - Uirá M Resende
- Department of Cardiovascular Medicine, Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil
| | - Vitor S Barzilai
- Department of Cardiovascular Medicine, Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil
| | - Fernando A Atik
- Department of Post-graduation in Medical Sciences, University of Brasilia Medical School, Brasilia, DF, Brazil.,Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil
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19
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Melo MDTD, Paiva MG, Santos MVC, Rochitte CE, Moreira VDM, Saleh MH, Brandão SCS, Gallafrio CC, Goldwasser D, Gripp EDA, Piveta RB, Silva TO, Santo THCE, Ferreira WP, Salemi VMC, Cauduro SA, Barberato SH, Lopes HMC, Pena JLB, Rached HRS, Miglioranza MH, Pinheiro AC, Vrandecic BALM, Cruz CBBV, Nomura CH, Cerbino FME, Costa IBSDS, Coelho Filho OR, Carneiro ACDC, Burgos UMMC, Fernandes JL, Uellendahl M, Calado EB, Senra T, Assunção BL, Freire CMV, Martins CN, Sawamura KSS, Brito MM, Jardim MFS, Bernardes RJM, Diógenes TC, Vieira LDO, Mesquita CT, Lopes RW, Segundo Neto EMV, Rigo L, Marin VLS, Santos MJ, Grossman GB, Quagliato PC, Alcantara MLD, Teodoro JAR, Albricker ACL, Barros FS, Amaral SID, Porto CLL, Barros MVL, Santos SND, Cantisano AL, Petisco ACGP, Barbosa JEM, Veloso OCG, Spina S, Pignatelli R, Hajjar LA, Kalil Filho R, Lopes MACQ, Vieira MLC, Almeida ALC. Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology - 2021. Arq Bras Cardiol 2021; 117:845-909. [PMID: 34709307 PMCID: PMC8528353 DOI: 10.36660/abc.20200266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Mohamed Hassan Saleh
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Daniel Goldwasser
- Hospital Federal de Ipanema, Rio de Janeiro, RJ - Brasil
- Hospital Copa D'Or, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
| | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
| | | | - Tonnison Oliveira Silva
- Hospital Cardio Pulmonar - Centro de Estudos em Cardiologia, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | | - Vera Maria Cury Salemi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Silvio Henrique Barberato
- CardioEco Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico, Curitiba, PR - Brasil
| | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil
- Hospital Mãe de Deus, Porto Alegre, RS - Brasil
| | | | | | | | - César Higa Nomura
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Fernanda Mello Erthal Cerbino
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brasil
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Juliano Lara Fernandes
- Radiologia Clínica de Campinas, Campinas, SP - Brasil
- Instituto de Ensino e Pesquisa José Michel Kalaf, Campinas, SP - Brasil
| | - Marly Uellendahl
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Tiago Senra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Bruna Leal Assunção
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- ECOCENTER, Belo Horizonte, MG - Brasil
| | | | - Karen Saori Shiraishi Sawamura
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
- Instituto da Criança da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Márcio Miranda Brito
- Universidade Federal do Tocantins - Campus de Araguaina, Araguaina, TO - Brasil
- Hospital Municipal de Araguaina, Araguaina, TO - Brasil
| | | | | | | | | | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
- Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | - Letícia Rigo
- Hospital Beneficência Portuguesa, São Paulo, SP - Brasil
| | | | | | - Gabriel Blacher Grossman
- Clínica Cardionuclear, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Americas Serviços Médicos, Rio de Janeiro, RJ - Brasil
- Rede D'Or, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Simone Nascimento Dos Santos
- Hospital Brasília - Ecocardiografia, Brasília, DF - Brasil
- Eccos Diagnóstico Cardiovascular Avançado, Brasília, DF - Brasil
| | | | | | | | | | | | - Ricardo Pignatelli
- Texas Children's Hospital, Houston, Texas - EUA
- Baylor College of Medicine, Houston, Texas - EUA
| | - Ludhmilla Abrahão Hajjar
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Roberto Kalil Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa, PB - Brasil
- Hospital Metropolitano Dom José Maria Pires, João Pessoa, PB - Brasil
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de Santana - Cardiologia, Feira de Santana, BA - Brasil
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia, São Paulo, SP - Brasil
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20
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Kiwaki T, Ishihara A, Toyama T, Kusaka H, Kataoka H. Primary cardiac angiosarcoma directly invading the right lung: An autopsy report. Clin Case Rep 2021; 9:e04582. [PMID: 34457279 PMCID: PMC8380118 DOI: 10.1002/ccr3.4582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/22/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
We presented a difficult-to-diagnose case of cardiac angiosarcoma. The patient presented pericardial effusion, but cytology of the effusion was negative. Because cytological detection of angiosarcoma cells is difficult, a possibility of malignancy should not be excluded with negative cytological examination. Biopsy of cardiac mass is the best way for diagnosis.
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Affiliation(s)
- Takumi Kiwaki
- Section of Oncopathology and Regenerative BiologyDepartment of PathologyFaculty of MedicineUniversity of MiyazakiMiyazakiJapan
| | - Akira Ishihara
- Department of PathologyMiyazaki Prefectural Nobeoka HospitalNobeokaJapan
- Department of PathologyJunwakai Memorial HospitalMiyazakiJapan
| | - Takanori Toyama
- Department of Internal MedicineMiyazaki Prefectural Nobeoka HospitalNobeokaJapan
| | - Hiroaki Kusaka
- Department of Cardiovascular MedicineMiyazaki Prefectural Nobeoka HospitalNobeokaJapan
| | - Hiroaki Kataoka
- Section of Oncopathology and Regenerative BiologyDepartment of PathologyFaculty of MedicineUniversity of MiyazakiMiyazakiJapan
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21
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Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
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22
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Senthil Kumaran S, Asif AA, Hussain H, Chatterjee T. Pericardial Angiosarcoma: A Diagnostic Challenge. Cureus 2021; 13:e15350. [PMID: 34235027 PMCID: PMC8244580 DOI: 10.7759/cureus.15350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiac angiosarcomas are the most common malignant primary cardiac tumors accounting for 31% of all primary cardiac tumors. However, primary pericardial angiosarcomas are extremely rare and are associated with high mortality. A 41-year-old male with a past medical history of end-stage renal disease (ESRD) on hemodialysis, follicular thyroid carcinoma, hypertension, and asthma presented with recurrent pericardial effusions. Previously, different imaging modalities had shown small hemodynamically stable pericardial effusions with pericardial thickening. His pericardial effusion was attributed to his ESRD until this presentation. However, during the current admission, chest X-ray showed cardiomegaly with lobulated left heart border. Computed tomography (CT) and transthoracic echocardiogram showed an increased posterior complex pericardial effusion when compared to previous imaging. A pericardial window was created and the space was evacuated. Pericardial fluid cytology reported rare atypical cells, which were indeterminate for malignancy. Histopathology from the pericardial biopsy revealed fibrous tissue with cellular proliferation, consistent with an angiosarcoma. A positron emission tomography revealed findings of angiosarcoma (hypermetabolic pericardial soft tissue nodularity and complex pericardial fluid) limited only to the pericardium. Unfortunately, the angiosarcoma was deemed unresectable, and the patient underwent one cycle of chemotherapy with paclitaxel. The patient’s hospital course was further complicated by myelosuppression from chemotherapy and disseminated intravascular coagulation. Therefore, no further chemotherapy was pursued. A repeat echocardiogram showed constriction of both ventricles with loculated pericardial effusion. The patient eventually transitioned to comfort care and passed away. Through this case report, we would like to highlight that multiple confounders can be present when considering the etiology of persistent pericardial effusions. We suggest contemplating alternate diagnosis, such as malignancy, and initiate aggressive work-up especially in young individuals with recurrent, unexplained pericarditis.
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Affiliation(s)
- Sriviji Senthil Kumaran
- Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, USA.,Internal Medicine, OSF Saint Francis Medical Center, Peoria, USA
| | - Abuzar A Asif
- Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
| | - Habiba Hussain
- Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
| | - Tulika Chatterjee
- Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
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23
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Zheng Y, Che G, Wang Y. Metastatic intrapulmonary hemorrhagic foci secondary to cardiac angiosarcoma: a case report. BMC Surg 2021; 21:125. [PMID: 33750359 PMCID: PMC7941702 DOI: 10.1186/s12893-021-01132-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/02/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cardiac angiosarcoma is a very rare malignant neoplasm, typically showing terrible prognosis. Therefore, early diagnosis is essential for efficacious intervention. Here we report a cardiac angiosarcoma with unique imaging findings because of pulmonary metastases. CASE PRESENTATION A 55-year-old man presented to our Respiratory Department because of mild morning hemoptysis for five weeks with occasional palpitations, having undergone futile antibiotic therapy for two weeks at his local hospital before admission. Symptoms of hemoptysis were alleviated with venous hemostatic drugs. 18F-FDG PET/CT was performed, showing a right atrial mass with multiple parenchymal nodules in lungs surrounded by ground-glass opacity, and indicated an intracardiac malignant tumor associated with pulmonary metastases, consistent with cardiothoracic CT and ultrasound. No evidence of infection or neoplasm was found using a fiberoptic bronchoscope. After multidisciplinary consultation and discussion, provisional diagnosis was established such that metastatic intrapulmonary hemorrhagic foci were secondary to intracardiac malignancy. A percutaneous biopsy from the left lung was carried out and but showed mild chronic inflammation of the lung. Therefore, urgent wedge resections for biopsy were performed from the right lung and the histopathology revealed angiosarcoma. The patient died of cardiorespiratory failure before anticancer therapy. CONCLUSIONS Variety of clinical manifestations of cardiac angiosarcoma frequently makes its diagnosis difficult, the imaging features and epidemiology of cardiac malignancy are very significant to clinical diagnosis.
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Affiliation(s)
- Yu Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, West China Hospital 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, West China Hospital 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, West China Hospital 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China.
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24
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Dulal Karki S, Westhoff M, Maschek H, Augustyniak J, Gupta V, Welter S. A rare diagnostic challenge in a female patient with a rapid recurrent pleural effusion: Autopsy revealed cardiac angiosarcoma with bilateral pleural and pulmonary metastases. A case report. Int J Surg Case Rep 2021; 78:278-283. [PMID: 33373923 PMCID: PMC7776125 DOI: 10.1016/j.ijscr.2020.12.034] [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: 11/15/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION We present a very rare case with diffuse cardiac angiosarcoma. Because all symptoms are often non-specific, this diagnosis is difficult to establish. To our knowledge this is the first clinical description of this rare disease. PRESENTATION OF CASE A 47-year-old female presented with bilateral pulmonary infiltrates and non-specific symptoms as fever, chest pain and dyspnoea on exertion. She was treated with antibiotics for suspected lung infection but deteriorated developing rapid recurrent pleural effusion. Her transthoracic- and transoesophageal-echocardiography as well as the thoracentesis and endobronchial ultrasound findings were normal. A minimally invasive pulmonary wedge resection, partial pleurectomy and pericardial fenestration was performed. The pathologic interpretation of these specimen was very difficult and a correct diagnosis could be made only by the second reference pathologist. While awaiting reference histology report she was administered high-flow oxygen therapy for hypoxia, antibiotics, catecholamines and corticosteroids. The patient deteriorated very rapidly and died in the ICU. DISCUSSION As in earlier studies, misdiagnosis delayed the actual diagnosis, especially because there was no clinical suspicion for angiosarcoma. Pathologic evaluation may be difficult because different growth patterns may be present in the same tumour and pleural or lung specimen may show only very tiny tumour formations within a fibrosing tissue changes. CONCLUSION This case report highlights the difficulties to establish a diagnosis of diffuse angiosarcoma in time. An early diagnosis, to initiate oncologic treatment, require a high level of clinical suspicion and a histological proof from pericardial or myocardial biopsy.
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Affiliation(s)
| | | | | | | | - Varun Gupta
- Department of Thoracic Surgery, Lungenklinik Hemer, Hemer, Germany
| | - Stefan Welter
- Department of Thoracic Surgery, Lungenklinik Hemer, Hemer, Germany.
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Darbari A, Kumar B, Jose A, Kumar A. Unexplained recurrent pericardial effusion in a young adult male: Think beyond tuberculosis. Res Cardiovasc Med 2021. [DOI: 10.4103/rcm.rcm_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Purpose of Review Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors. Recent Findings Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. Summary A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.
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Nicoara A, Skubas N, Ad N, Finley A, Hahn RT, Mahmood F, Mankad S, Nyman CB, Pagani F, Porter TR, Rehfeldt K, Stone M, Taylor B, Vegas A, Zimmerman KG, Zoghbi WA, Swaminathan M. Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2020; 33:692-734. [PMID: 32503709 DOI: 10.1016/j.echo.2020.03.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount. Equally important is the need for complete understanding of the technical steps of the surgical procedures being performed and the complications that may occur, in order to direct the postprocedure evaluation toward aspects directly related to the surgical procedure and to provide pertinent echocardiographic information. The rationale for this document is to outline a systematic approach describing how to apply the existing guidelines to questions on cardiac structure and function specific to the intraoperative environment in open, minimally invasive, or hybrid cardiac surgery procedures.
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Affiliation(s)
| | | | - Niv Ad
- White Oak Medical Center and University of Maryland, Silver Spring, Maryland
| | - Alan Finley
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Bradley Taylor
- University of Maryland Medical Center, Baltimore, Maryland
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Mendes GS, Abecasis J, Ferreira A, Ribeiras R, Abecasis M, Gouveia R, Andrade MJ, Mendes M, Ramos S, Saraiva C, Neves JP. Cardiac tumors: three decades of experience from a tertiary center: are we changing diagnostic work-up with new imaging tools? Cardiovasc Pathol 2020; 49:107242. [PMID: 32629212 DOI: 10.1016/j.carpath.2020.107242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/05/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Primary cardiac tumours are relatively rare. Cardiac myxomas are the most prevalent and in a significant proportion of cases they are accidentally discovered in asymptomatic patients. Noninvasive definitive diagnosis remains challenging despite improvements provided by newer imaging tools. Our aim was to describe the long-term experience of a tertiary cardiac center managing cardiac tumours. METHODS We analyzed 154 consecutive patients admitted to a single-tertiary center with the diagnosis of a cardiac mass or tumor between 1990 and 2018. Data files including clinical presentation, noninvasive investigations, presumptive diagnosis and histopathology were collected. The follow-up was obtained from clinical records or telephone contact. RESULTS In 154 patients with a median age at diagnosis of 61 (51-71) years, 62% were females. Anatomopathology studywas obtained in 144 cases, from which 81% were benign tumours (106 myxomas; 11 papillary fibroelastomas). In comparison with malignant lesions, patients with benign tumours were older (62 versus 48 years) and more often women (65% versus 27%, P = .021). Incidental diagnosis of a benign tumor occurred in 36% of the cases. Transthoracic echocardiography was the initial technique for diagnostic suspicion in the great majority of patients. Both cardiac computed tomography and magnetic resonance were rarely performed before excision. Imaging based (mostly echocardiography) pre-operative presumptive diagnosis was discordant with histopathologic findings in 21% of the benign and in 55% of malignant lesions (previously considered as benign). Uncommon histologic findings were found in 18% of myxomas. During the follow-up period of 11 ± 12 years there were 12 recurrences. CONCLUSION Among surgically excised cardiac tumours benign cardiac tumors are far more common than both primary and secondary malignancies. In this series of patients, there was a significant proportion of asymptomatic lesions. Preoperative misdiagnosis could be related to the scarce use of adjunctive noninvasive imaging tools beyond echocardiography. Preoperative noninvasive investigation should be expanded to improve diagnostic presumption and better plan the best therapeutic approach.
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Affiliation(s)
- Gustavo Sá Mendes
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal.
| | - João Abecasis
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal; Nova Medical School, Lisboa, Portugal
| | - António Ferreira
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal
| | - Miguel Abecasis
- Cardiothoracic Surgery Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal
| | - Rosa Gouveia
- Pathology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Forensic Pathology, InstitutoNacional de Medicina Legal e CiênciasForenses, Coimbra, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal
| | - Miguel Mendes
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal
| | - Sância Ramos
- Pathology Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal
| | - Carla Saraiva
- Radiology Department, Centro Hospitalar de LisboaOcidental, Lisboa, Portugal
| | - José Pedro Neves
- Cardiothoracic Surgery Department, Hospital de Santa Cruz - Centro Hospitalar de LisboaOcidental, Carnaxide, Portugal
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Linfeng Q, Xingjie X, Henry D, Zhedong W, Hongfei X, Haige Z. Cardiac angiosarcoma: A case report and review of current treatment. Medicine (Baltimore) 2019; 98:e18193. [PMID: 31804339 PMCID: PMC6919397 DOI: 10.1097/md.0000000000018193] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Primary cardiac angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. As there are currently no guidelines or effective therapeutic strategies, management of this condition depends on previous experiences of the clinician treating and the consideration of reported cases. PATIENT CONCERNS A 65-year-old male presented to our department with a 4-day history of chest tightness, dyspnea, lower extremity weakness and occasional dizziness, and a transthoracic echo (TTE) revealed a right atrium occupying mass. DIAGNOSES TTE showed right atrium occupation, and the post-operative histopathology showed the tumor to be a primary cardiac angiosarcoma. INTERVENTIONS Right atrium tumor resection and right atrium reconstruction with a bovine pericardium were performed. OUTCOMES The patient recovered from surgery and discharged but died 10 months after surgery because of complete resection was impossible and adjuvant therapy was not performed. LESSONS Resection of primary cardiac angiosarcomas should be integrated with a combination of chemotherapy, radiotherapy, and targeted therapy based on tumor cell gene mutation and altered expression.
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Isaev GO, Mironova OY, Yudakova ME, Shakhnovish RM, Fomin VV. [Metastatic lesion of the right atrium with renal cell carcinoma]. TERAPEVT ARKH 2019; 91:124-128. [PMID: 32598823 DOI: 10.26442/00403660.2019.09.000218] [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: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Tumors in the heart are rare and difficult to diagnose pathologies. There are primary and secondary tumors, the letter tumors include metastases of other tumors. In this work is presented clinical case of metastatic lesion of the right atrium with renal cell carcinoma. Modern methods of diagnostics of patients with intracardiac formations are discussed.
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Affiliation(s)
- G O Isaev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O Y Mironova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M E Yudakova
- Hospital of the Central Bank of the Russian Federation
| | | | - V V Fomin
- Sechenov First Moscow State Medical University (Sechenov University)
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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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Ahumada-Zakzuk SJ, Ruiz-Pla FA. Uso de ecocardiografía en la evaluación de masas cardíacas. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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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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Nirmalanantham P, Elliott RM, Fitzsimons B, Gupta A, Patterson A, Elgudin Y, Sekulic M. Primary cardiac epithelioid angiosarcoma with frond-like features: a rare and ominous radiological mimicker of benign cardiac tumors. Cardiovasc Pathol 2019; 41:18-20. [PMID: 31005792 DOI: 10.1016/j.carpath.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022] Open
Abstract
Most primary cardiac tumors are benign neoplasms, which generally can be differentiated from malignant neoplasms via certain radiological features. We present briefly a case of a 26-year-old man undergoing resection of a right atrial mass that based on preceding radiologic findings represent a myxoma. After pathologic examination, the lesion was determined to be an epithelioid angiosarcoma with unique frond-like architecture and multiple pedicular attachments to the atrial wall.
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Affiliation(s)
- Priyatharsini Nirmalanantham
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robin M Elliott
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Fitzsimons
- Department of Anesthesiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amit Gupta
- Department of Radiology, Division of Cardiothoracic Imaging, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew Patterson
- Department of Radiology, Division of Cardiothoracic Imaging, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yakov Elgudin
- Department of Surgery, Cardiac Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Miroslav Sekulic
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Jiang L, Xu X, Davies H, Shi K. The effect of ifosfamide, epirubicin, and recombinant human endostatin therapy on a cardiac angiosarcoma: A case report. Medicine (Baltimore) 2019; 98:e15290. [PMID: 31027090 PMCID: PMC6831325 DOI: 10.1097/md.0000000000015290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cardiac angiosarcoma is a rare malignant tumor, for which only surgery has been proven to be effective to date. Currently there are no reports as to whether a postoperative regimen of ifosfamide, epirubicin, and recombinant human endostatin is effective. PATIENT CONCERN The patient presented to us with chest pain and dyspnea. DIAGNOSIS Enhanced computerized tomography (CT) and positron emission tomography-computerized tomography (PET-CT) suggested pericarditis and an atrial perforation, but malignancy was suspected, so the patient underwent an operation to resect the tumor and repair. Pathology of the tumor reseccted at operation showed the tumor to be an angiosarcoma. INTERVENTION After the surgery, the patient was stared on a paclitaxel chemotherapy regimen (135 mg/m once every 3 weeks). However, 2 cycles later, pulmonary and hepatic metastases were found. Chemotherapy was then changed to ifosfamide, epirubicin (ifosfamide 2000 mg/m days 1-3, epirubicin 70 mg/m days 1-2) and recombinant human endostatin (7.5 mg/m days 1-14) in 3 weekly cycles. OUTCOME Three cycles later, follow-up showed that chemotherapy had delayed progression of the pulmonary metastases, but that the hepatic node was still growing. The patient has now survived 8 months post surgery and is still on follow-up. LESSONS This case shows us that operation on late stage cardiac angiosarcomas can alleviate a patient's symptoms; postoperative paclitaxel monotherapy was insufficient and ifosfamide and epirubicin plus recombinant human endostatin has a limited effect on late stage cardiac angiosarcoma. Studies with a larger sample size are needed for verification of these findings.
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Affiliation(s)
- Lijun Jiang
- The First Affiliated Hospital of Zhejiang University
| | - Xingjie Xu
- Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Henry Davies
- Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Kexin Shi
- Zhejiang University, Hangzhou, Zhejiang Province, China
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Cunha-Silva M, Mazo DFDC, Gomes ILC, Imbrizi MR, Sevá-Pereira T, Vaz NF, Lourenço MS, Eloy da Costa LB, Escanhoela CAF, Almeida JRDS. Multiple hepatic metastases of cardiac angiosarcoma. AUTOPSY AND CASE REPORTS 2019; 8:e2018048. [PMID: 30775323 PMCID: PMC6360823 DOI: 10.4322/acr.2018.048] [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: 07/13/2018] [Accepted: 09/02/2018] [Indexed: 11/23/2022] Open
Abstract
The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson's capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome.
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Affiliation(s)
- Marlone Cunha-Silva
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Daniel Ferraz de Campos Mazo
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Igor Logetto Caetité Gomes
- University of Campinas (Unicamp), School of Medical Sciences, Department of Internal Medicine. Campinas, SP, Brazil
| | - Marcello Rabello Imbrizi
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Tiago Sevá-Pereira
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Nayana Fonseca Vaz
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Mariana Sandoval Lourenço
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | | | | | - Jazon Romilson de Souza Almeida
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
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Galván DC, Ayyappan AP, Bryan BA. Regression of primary cardiac angiosarcoma and metastatic nodules following propranolol as a single agent treatment. Oncoscience 2018; 5:264-268. [PMID: 30460329 PMCID: PMC6231448 DOI: 10.18632/oncoscience.472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022] Open
Abstract
Angiosarcoma is the most common malignant cardiac tumor. Cardiac angiosarcoma is a highly lethal neoplasm that is largely resistant to conventional anti-cancer therapy. Mean survival of patients with cardiac angiosarcoma is only 4 months, and almost all patients will succumb to the disease within 1 year. The beta blocker propranolol is an emerging therapy against angiosarcoma. When combined with conventional therapies, propranolol increases progression free and overall survival in patients with this tumor type. It is currently unknown if propranolol is capable of showing anti-cancer efficacy as a single agent therapy. We report a case of a 61 year old woman diagnosed with primary cardiac angiosarcoma and liver and lung metastases. This patient chose to decline conventional therapy, and instead was prescribed the beta blocker propranolol as a single agent treatment. After 12 months, the mediastinal mass substantially debulked and decreased in size, and the metastatic nodules stabilized or resolved with no evidence of hyper-metabolic activity on PET-CT. This is the first reported data showing long term efficacy of the beta blocker propranolol as a single agent therapy against angiosarcoma.
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Affiliation(s)
- Dana C Galván
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Anoop P Ayyappan
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Brad A Bryan
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
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Abstract
BACKGROUND Primary cardiac angiosarcoma (CAS) is a rare tumor with a dismal prognosis. Many patients present with noncardiac symptoms related to metastatic disease that could delay the diagnosis and deteriorate the outcome. CASE REPORT A 36-year-old male presented with hemoptysis. Initial imaging and biopsies were inconclusive, but a repeat transthoracic echocardiogram to evaluate the patient's pericardial effusion showed a mass inferior to the right atrium and invading the wall. Biopsy results from 3 different sites confirmed the diagnosis of CAS. However, the patient's course was complicated with respiratory failure that ultimately led to his death. Autopsy demonstrated CAS involving the full thickness of the right atrium and pericardial tissue, with a diffuse metastatic process involving the lung, brain, and stomach. CONCLUSION The case highlights the importance of having an increased level of suspicion for cardiac malignancy among young patients presenting with noncardiac symptoms.
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Yanagawa B, Mazine A, Chan EY, Barker CM, Gritti M, Reul RM, Ravi V, Ibarra S, Shapira OM, Cusimano RJ, Reardon MJ. Surgery for Tumors of the Heart. Semin Thorac Cardiovasc Surg 2018; 30:385-397. [PMID: 30205144 DOI: 10.1053/j.semtcvs.2018.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
Most surgeons will encounter only a handful of primary cardiac tumors outside of myxomas. Approximately 3 quarters of primary cardiac tumors are benign and 1 quarter is malignant. In most cases, cardiac tumors are silent but when symptoms do occur, they are primarily determined by tumor size and anatomical location, not by histopathology. The diagnosis and preoperative imaging relies heavily on multimodal imaging including echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Surgical resection is the most common treatment for most simple primary cardiac tumors and for some complex benign tumors. Surgical resection of primary cardiac tumors frequently involves the need for complex cardiac reconstruction, particularly when malignant. Secondary tumors to the heart are 30 times more frequent than primary cardiac tumors, and their incidence is increasing, largely as a result of advances in cancer diagnosis and therapy. Surgical resection is feasible in only a small fraction of highly-selected patients with secondary tumors to the heart. For complex benign tumors-such as paraganglioma or large fibromas-and all primary and secondary malignant tumors, a multidisciplinary cardiac tumor team review in experienced centers of excellence is recommended.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Edward Y Chan
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Colin M Barker
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael Gritti
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ross M Reul
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Vinod Ravi
- Department of Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Sergio Ibarra
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, Jerusalem, Israel
| | - Robert J Cusimano
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
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Sharifkazemi M, Rezaian G, Abtahi F. Right Atrial Myxoma and Chronic Transudative Ascites: A Rare and Challenging Clinical Presentation. CASE 2018; 2:120-122. [PMID: 30128407 PMCID: PMC6098165 DOI: 10.1016/j.case.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RA myxomas are quite rare and difficult to diagnose. RA myxomas can obstruct the tricuspid valve. RA myxomas should be considered a possible cause of chronic transudative ascites. Echocardiography is the standard diagnostic evaluation of choice.
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Affiliation(s)
| | - Gholamreza Rezaian
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Firouzeh Abtahi
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Maleszewski JJ, Bois MC, Bois JP, Young PM, Stulak JM, Klarich KW. Neoplasia and the Heart. J Am Coll Cardiol 2018; 72:202-227. [DOI: 10.1016/j.jacc.2018.05.026] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022]
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Abstract
PURPOSE OF REVIEW Primary cardiac tumors are a rare disease, which may have severe clinical consequences. Malignant tumors may be misdiagnosed as mixomas, with improper treatment. The aim of this review is to report how to make a differential diagnosis using old and modern tools, the latest trends in tumor classification and treatment, and their possible impact on prognosis. RECENT FINDINGS Papillary fibroelastomas seem to be more frequent than previously reported, and surgery is also suggested in asymptomatic patients. A genetic background has been identified for some myxomas and angiosarcomas. Malignant tumors are now classified as soft-tissue sarcomas of other organs. Immunohistochemistry and molecular diagnosis aid in recognizing several subtypes of sarcomas, leading to the possibility of targeted chemotherapy. The reports of single-center and multicenter experiences, collecting a large number of treated patients, analyzed the impact on prognosis of different approaches. The best results for survival and event-free survival are obtained with the multimodality approach. SUMMARY Before referring a patient with cardiac tumor to the cardiac surgeon, a presumptive diagnosis of benignity or malignancy should be obtained. Malignant tumors should be referred to a cardiac tumor team with special expertise, in order to plan the best therapeutic approach.
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43
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A Patient Presenting with Cardiac Tamponade and the Challenges of Finding Its Cause: A Cardiac Angiosarcoma. Case Rep Cardiol 2018; 2018:2084390. [PMID: 29682355 PMCID: PMC5851018 DOI: 10.1155/2018/2084390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Primary malignancies of the heart are so rare that most of the available data come from case reports or large single-center-based studies, with the overall incidence of 0.02% in the United States. Diagnosis in case of an isolated pericardial effusion as presentation is challenging, and determining that an angiosarcoma is even more challenging. Here, we presented a rare case of pericardial angiosarcoma which presented to us with tamponade. The patient eventually was diagnosed through pericardiectomy. A multimodality approach was attempted to treat the cancer. The clinical details of such a unique disease entity inspired us to present it as a case report.
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Abstract
PURPOSE OF REVIEW Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience. RECENT FINDINGS The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients. Cardiac MRI (CMR) appears to be helpful in determining whether cardiac tumors are benign or malignant by identifying presence of infiltration, uptake of contrast in first pass perfusion and gadolinium enhancement. Patients with evidence of cardiac metastases by CMR show similar survival to stage IV cancer without cardiac metastases. In our institution, we use a standardized approach for the evaluation of cardiac masses, which includes multimodality imaging in the appropriate clinical context. The autotransplantation surgical technique has shown some promise in improving survival in patients with primary cardiac sarcomas. In our institution, we do not routinely recommend anticoagulation for "tumor-thrombus" in renal cell carcinoma due to risk of bleeding from primary tumor. Cardiac masses are often found incidentally, but sometimes can present with cardiovascular symptoms due to obstruction and valvular dysfunction, which may prompt imaging. It is important to determine whether the mass is a normal variant, imaging artifact, vegetation, thrombus, or tumor. Transthoracic echocardiography is ideally suited to be the initial imaging modality because of the portability, wide availability, lack of radiation, and relatively low cost. The gold standard cardiac imaging technique to distinguish tumor from thrombus is contrast enhanced CMR with prolonged inversion time. Advantages of CMR when compared to echocardiography regarding characterization of cardiac tumors are as follows: larger field of view, better spatial resolution, better tissue characterization, lack of attenuation, and ability to image at any prescribed plane. Primary and secondary cardiac tumors have particular characteristics in echocardiography and CMR. Imaging of cardiac tumors plays an important role in establishing a diagnosis and in planning management.
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Mkalaluh S, Szczechowicz M, Torabi S, Schmack B, Sabashnikov A, Dib B, Karck M, Weymann A. Surgical Treatment of Cardiac Tumors: Insights from an 18-Year Single-Center Analysis. Med Sci Monit 2017; 23:6201-6209. [PMID: 29289957 PMCID: PMC5757895 DOI: 10.12659/msm.905451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to investigate the clinical presentation, operative data, and early and late outcomes of a large patient cohort undergoing surgical treatment for cardiac tumors in our institution. Material/Methods A total of 181 patients underwent surgery because of suspected cardiac tumor in our institution between 1998 and 2016. In 162 cases, the diagnosis was confirmed postoperatively and these patients were included in this study. Preoperative baseline characteristics, operative data, and postoperative early and long-term outcomes were analyzed. Results Mean age at presentation was 56.6±17.6 years, and 95 (58.6%) patients were female. There were 126 (77.8%) patients with benign cardiac tumors, while the remaining patients had malignant tumors (primary and metastasized). The mean follow-up time was 5.2±4.7 years. The most frequent histologically verified tumor type was myxoma (63%, n=102). In terms of malignant tumors, various types of sarcomas presented most primary malignant cardiac tumors (7.4%, n=12). The mean ICU length of stay was 1.7±2.2 days and overall in-hospital mortality was 3.1% (n=5). Frequent postoperative complications included mediastinal bleeding (5.8%, n=9), wound infection (1.3%, n=2), acute renal failure (5.6%, n=9), and major cerebrovascular events (n=7, 4.6%). The overall cumulative survival after cardiac tumor resection was 94% at 30 days, 85% at 1 year, 72% at 5 years, and 59% at 15 years. Conclusions Surgical treatment of cardiac tumors is a safe and highly effective strategy associated with good early and long-term outcomes.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
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Nomoto N, Tani T, Konda T, Kim K, Kitai T, Ota M, Kaji S, Imai Y, Okada Y, Furukawa Y. Primary and metastatic cardiac tumors: echocardiographic diagnosis, treatment and prognosis in a 15-years single center study. J Cardiothorac Surg 2017; 12:103. [PMID: 29183343 PMCID: PMC5704631 DOI: 10.1186/s13019-017-0672-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The frequency of primary cardiac tumors is rare at about 0.3% by autopsy. Our objective was to investigate the characteristics and locations of cardiac tumors and to provide a prognostic analysis in our hospital. METHODS We collected data on 95 patients with echocardiographic diagnosis or detection of cardiac tumors in a prospective analysis from 1999 to 2014. The median follow-up period was 43 months (0.5-183 months). RESULTS The subjects included 56 men and 39 women with a mean age of 65 years. Clinical diagnosis revealed primary tumors in 61 patients (64%) and secondary metastatic tumors in 34 patients (36%). In the 61 patients, 41 patients (67%) underwent surgery and tissue samples were obtained. Of these 41 patients, benign tumors were found in 30 cases (73%). One patient (2%) was diagnosed with thrombus. Among the benign tumors, myxoma (67%) was the most common type followed by papillary fibroelastoma (23%). The most common site was the left atrium (35%) followed by the right atrium (25%). Primary malignant tumors were diagnosed in 10 cases (24%), including 6 angiosarcomas, 3 lymphomas, and 1 leiomyosarcoma. The diagnostic accuracy of echocardiography was 80%. The patients with benign tumors were all alive at the end of the follow-up period. In contrast, 7 patients with malignant tumors died (70%) (p < 0.0001). CONCLUSIONS Our data is in line with previous literature. Our study also suggests the necessity of extending our knowledge of the characteristics of cardiac tumors for diagnosis.
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Affiliation(s)
- Natsumi Nomoto
- Department of Clinical Technology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Tomoko Tani
- Basic Medical Science, Kobe City College of Nursing, 3-4 Gakuennishi-machi, Nishi-ku, Kobe, 651-2103, Japan.
| | - Toshiko Konda
- Department of Clinical Technology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Mitsuhiko Ota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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47
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Abstract
BACKGROUND Primary cardiac angiosarcoma is rare, but it is the most aggressive type of cardiac malignant tumor. When disease is confirmed it is often late in its stage resulting in a poor prognosis. CASE PRESENTATION We reported a 52-year-old woman who complained of dyspnea for 2 months and dry cough for 10 days. Computed tomography (CT), F-fluorodeoxyglucose (F-FDG), positron emission tomography-computed tomography (PET-CT), and transthoracic echocardiography showed a space-occupying lesion 7 cm × 5 cm × 5 cm in the right atrium. Malignant cells can be seen in pericardial fluid by pericardiocentesis in local hospital, but not be diagnosed definitely. We conducted CT-guided biopsy of the tumor and observed the necrotic tissues. An exploratory thoracotomy was performed and histological examination confirmed angiosarcoma. Unable to be surgical excision due to infiltrating widely, the patients received chemotherapy with docetaxel for 2 cycles and the disease was progressive. Antiangiogenesis-targeted therapy was combined with chemotherapy for 3 months. Unfortunately, the tumor was still in progress. She died of respiratory failure, survived for 10 months. CONCLUSION It is difficult to diagnose the primary cardiac angiosarcoma in early stage. Chemotherapy and target therapy are very limited in this case. Surgery remains the preferred treatment for patients with primary cardiac angiosarcoma. More efforts should be carried out on the effective diagnosis and multimodality treatment for this malignant disease.
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Affiliation(s)
| | - Lu Li
- Department of Thoracic Surgery
| | | | | | - Jihua Wu
- Department of Pathology, the 306th Hospital of PLA, Beijing, China
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48
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Abstract
Pericardial tumors are rare lesions that include a range of neoplastic conditions that may arise within the pericardium or metastasize to involve it secondarily. Understanding the spectrum of lesions that are included in the differential diagnosis of a pericardial mass-lesion is critical to making timely, accurate diagnoses and getting the appropriate therapy should one be necessary. This review summarizes the radiologic and pathologic findings of the most commonly encountered of these entities.
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Affiliation(s)
- Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Clinical Genomics, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Division of Cardiac Radiology, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Wang C, Shi M, Yang C, Ma T, Jiang J, Liu Y, Xi W, Zhu Z, Zhang J. Comprehensive treatment of unresectable cardiac angiosarcoma: A case report and review of literature. Mol Clin Oncol 2017; 7:859-863. [PMID: 29181180 DOI: 10.3892/mco.2017.1390] [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: 02/16/2017] [Accepted: 06/28/2017] [Indexed: 01/13/2023] Open
Abstract
Cardiac angiosarcoma is a rare but lethal tumor that is difficult to diagnose and treat, due to its rapid local relapse and high incidence of systemic metastasis. The prognosis of cardiac angiosarcoma is dismal, with a mean life expectancy of only a few months. We herein report a case of unresectable angiosarcoma arising from the right atrium. The patient received first-line chemotherapy with weekly paclitaxel, and second-line therapy with vinorelbine and bevacizumab upon disease progression. The progression-free survival was 6 months and the overall survival was 7 months. The patient eventually succumbed to respiratory failure. A study of the present case and a review of the relevant literature suggest that treatment decisions for unresectable locally advanced or metastatic cardiac angiosarcoma are difficult, as the published literature on this disease mainly consists of case reports without sufficient data. Therefore, further clinical trials specific to the treatment of unresectable cardiac angiosarcoma are warranted.
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Affiliation(s)
- Chao Wang
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Min Shi
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Chen Yang
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Tao Ma
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jinling Jiang
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Ying Liu
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Wenqi Xi
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Zhenggang Zhu
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China.,Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jun Zhang
- Department of Oncology, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
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50
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Abstract
Cardiac tumours are a rare, but often devastating, clinical diagnosis. They encompass a broad set of lesions that include both neoplastic and non-neoplastic conditions. Cardiac tumours are often diagnosed incidentally during work-up for other conditions, or during ultrasound, CT, or MRI scans for unusual or nonspecific symptoms. In the past decade, important changes have been made in the nomenclature and the recommendations for diagnosis of cardiac tumours, as highlighted by the WHO's 2015 revision of the classification of cardiac tumours. Moreover, important advances in molecular genetics and therapeutics offer new approaches for the diagnosis and treatment of affected patients. In this Review, we provide an overview of the clinical, pathological, and imaging characteristics of all types of cardiac masses, including both benign and malignant primary cardiac neoplasms.
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