1
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Bashir H, Ahmed A, Mahalwar G, Lane J, Alquthami A. Tricuspid Papillary Fibroelastoma: A Rare Tumor in an Uncommon Location. Cureus 2024; 16:e61709. [PMID: 38975395 PMCID: PMC11227620 DOI: 10.7759/cureus.61709] [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: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Papillary fibroelastomas (PFEs) are rare benign cardiac tumors typically arising from the valvular endocardium, often affecting the aortic and mitral valves. They can range from asymptomatic to causing severe thromboembolic complications like stroke. This article presents a case of a tricuspid valve PFE in an 81-year-old patient with severe multi-vessel coronary artery disease. Transthoracic echocardiography revealed a mass on the tricuspid valve, confirmed by cardiac MRI. The patient underwent surgical excision, and histopathology confirmed the PFE diagnosis. The case highlights the importance of multimodal imaging in diagnosis and individualized treatment strategies for valvular heart tumors.
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Affiliation(s)
- Hanad Bashir
- Cardiovascular Medicine, The Christ Hospital, Cincinnati, USA
| | - Ahmed Ahmed
- Internal Medicine, Unity Hospital, Rochester, USA
| | | | - Jason Lane
- Pathology, Cleveland Clinic Akron General, Akron, USA
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2
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Prasad RM, Osman AF, Garces CC, Gumbita R, Elshafie A, Pandrangi P, Kehdi M. Rare Cardiac Papillary Fibroelastoma: Right Atrial, Non-Valvular, Large, Symptomatic With Pulmonary Embolism. Perm J 2021; 25. [PMID: 35348102 DOI: 10.7812/tpp/21.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Primary cardiac tumors are rarely seen in the general population and only a subset are classified as cardiac papillary fibroelastoma. CASE PRESENTATION A 59-year-old female that presented for unresponsiveness and cardiac arrest required 4 rounds of cardiopulmonary resuscitation and intubation. Laboratory investigations showed uncompensated respiratory acidosis, hyperkalemia, and elevated troponins. A chest computed tomography angiogram illustrated an acute right pulmonary embolism and a right atrial filling defect. Furthermore, an echocardiogram demonstrated a normal ejection fraction and a large, pedunculated, mobile, and non-valvular echodensity that was attached to the right atrium endocardium. Therefore, the patient was started on a heparin infusion and catheter-directed thrombolysis; however, the mass persisted. A surgical excision was performed, and a 40 mm was removed. The patient was diagnosed with a papillary fibroelastoma based on the clinical symptoms, imaging, and histological findings. CONCLUSION This patient's papillary fibroelastoma had multiple rare features including right atrial origin, large size, non-valvular location, and developed symptoms. Although this disease can be initially fatal, the patients typically have a favorable prognosis after a successful excision.
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Affiliation(s)
- Rohan M Prasad
- Department of Internal Medicine, Sparrow Hospital, Michigan State University, Lansing, MI
| | - Abdul-Fatawu Osman
- Department of Internal Medicine, Sparrow Hospital, Michigan State University, Lansing, MI
| | - Christopher C Garces
- Department of Internal Medicine, Sparrow Hospital, Michigan State University, Lansing, MI
| | - Robert Gumbita
- Department of Internal Medicine, Sparrow Hospital, Michigan State University, Lansing, MI
| | - Ahmed Elshafie
- Department of Internal Medicine, Sparrow Hospital, Michigan State University, Lansing, MI
| | - Pranay Pandrangi
- Department of Cardiology, Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, MI
| | - Michael Kehdi
- Department of Cardiology, Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, MI
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3
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Tadic S, Ilic A, Stefanovic M, Stojsic-Milosavljevic A, Popov T, Bjelobrk M, Milovancev A, Maksimovic N, Drid P. Case Report: Multimodality Imaging as a Lifeline for Fatal Localization of Valsalva Sinus Fibroelastoma. Front Cardiovasc Med 2021; 8:683534. [PMID: 34136550 PMCID: PMC8200485 DOI: 10.3389/fcvm.2021.683534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Papillary fibroelastomas are rare benign heart tumors, and is most likely to involve the cardiac valves. We will present an extremely rare localization of a large Valsalva sinus fibroelastoma, with occasional left coronary artery ostial obstruction presented as an acute coronary syndrome. The tumor was removed surgically and histologically confirmed as papillary fibroelastoma. This review points to the crucial importance of multidisciplinary team decision and multimodality imaging methods for diagnosing the fibroelastoma, determination of size, and localization, which avoided complications of fatal embolization during an invasive procedure. Case Summary: A healthy 55-year-old male with vigorous physical daily training and exercise was admitted to the acute coronary syndrome emergency department. Shortly after admission, expert transthoracic echocardiography was performed. Computed tomography of the chest observed a large irregular hypodense tumor-like lesion in the bulbar aorta that was occasionally prolapsing into the left main coronary artery ostium and which corresponded to fibroelastoma. A few hours after admission, an emergency cardiac surgery was performed with the excision of a Valsalva sinus tumor (size 2 × 2 cm) located between the right and left coronary cusp of the aortic valve. Conclusions: Focus cardiac ultrasound should be performed for any acute coronary syndrome because of the possible Valsalva sinus fibroelastoma etiology. Its localization next to the left main coronary artery ostium is rare, and dangerous. The timely diagnosis can be made by the multimodality imaging method, however, the final diagnosis will be made pathohistologically. Early cardiac surgery may be a necessitated recourse for these patients in order to prevent a fatal outcome.
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Affiliation(s)
- Snezana Tadic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Electrocardiography, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Ilic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Electrocardiography, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Maja Stefanovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Electrocardiography, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Anastazija Stojsic-Milosavljevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Electrocardiography, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Tanja Popov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Electrocardiography, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Marija Bjelobrk
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Electrocardiography, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Milovancev
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Electrocardiography, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Nebojsa Maksimovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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4
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Alozie A, Zimpfer A, Erbersdobler A, Neßelmann C, Öner A, Dohmen PM. Surgery for Valvular and Nonvalvular Papillary Fibroelastomas. Semin Thorac Cardiovasc Surg 2021; 34:560-568. [PMID: 34022368 DOI: 10.1053/j.semtcvs.2021.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Papillary fibroelastomas (PFE) are benign neoplasms, mostly located on valvular surfaces with high embolic potential. This study presents a 27-year single institutional experience on surgical treatment of PFE in an adult patient- cohort with long-term follow-up. This study was approved by the institutional review board. Date and number of IRB approval: 11/23/2017, Institutional Review Board approval number A2014-0149. The need for individual patient consent was waived. We retrospectively evaluated all patients who underwent cardiac surgery for suspected space-occupying lesions in the observation period between June 1991 and June 2018 at our hospital. Clinicopathological features, imaging characteristics, surgical procedures and disease outcome were analyzed. 120 patients were diagnosed with various primary/secondary cardiac tumors and histology confirmed 21 PFEs were found in 16 patients. There was no significant age difference between patients with valvular vs nonvalvular PFEs (P = 0.26). Valvular lesions were found in aortic valve (n = 6), mitral valve (n = 2) and tricuspid valve (n = 1). Nonvalvular PFEs were found in right atrium (n = 2), left ventricle (n = 2), left atrial appendage (n = 2) and aortic wall (n = 1). Valvular lesions were significantly smaller in size compared to non-valvular lesions (P = 0.0013). Left-side PFEs were associated with a high embolization episodes (10/13 patients, 77%) not related to the size. One patient died in-hospital. All other patients were discharged out of the hospital postoperative. Follow-up was performed regularly for a median of 2.8 years (range 0.1-11 years) postoperative. Nonvalvular PFE tended to be larger in size and at least when located on the left sided heart had equally high propensity to embolize compared to valvular PFE. We strongly advocate surgical excision in all left-sided PFE.
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Affiliation(s)
- Anthony Alozie
- Rostock Heart Center, Department of Cardiac Surgery, University of Rostock, Rostock, Germany.
| | - Annette Zimpfer
- Institute of Pathology, University Hospital Rostock, Rostock, Germany
| | | | - Catharina Neßelmann
- Rostock Heart Center, Department of Cardiology, University of Rostock, Rostock, Germany
| | - Alper Öner
- Rostock Heart Center, Department of Cardiology, University of Rostock, Rostock, Germany
| | - Pascal M Dohmen
- Rostock Heart Center, Department of Cardiac Surgery, University of Rostock, Rostock, Germany; Department of Cardiothoracic Surgery, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
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5
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Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C, Westwood M, Ghosh AK, Guha A. Cardiac Tumors: JACC CardioOncology State-of-the-Art Review. JACC: CARDIOONCOLOGY 2020; 2:293-311. [PMID: 34396236 PMCID: PMC8352246 DOI: 10.1016/j.jaccao.2020.05.009] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl’s excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses. Cardiac tumors are rare and should be considered as part of the differential diagnosis of any space-occupying mass noted on cardiovascular and/or thoracic imaging modalities. It may be possible to get close to a diagnosis without biopsy using a structured imaging approach. The prognosis and treatment of each tumor is different, although early diagnosis is usually associated with a better outcome.
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Affiliation(s)
- Sara Tyebally
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Daniel Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Abdallah Mughrabi
- Jordan University of Science and Technology, Al Ramtha, Irbid, Jordan
| | - Zeeshan Hussain
- Division of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Charlotte Manisty
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Mark Westwood
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
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6
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Mashicharan M, El-Dean Z, Zlocha V, Khoo J. Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events. Echo Res Pract 2019; 6:K13-K17. [PMID: 31413862 PMCID: PMC6689122 DOI: 10.1530/erp-19-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/18/2019] [Indexed: 11/24/2022] Open
Abstract
Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small highly mobile left atrial mass with frond-like projections attached by a stalk to the orifice of the LAA. The mass was surgically excised and confirmed to be a fibroelastoma on histological examination. This case report describes a rare but treatable source of multiple cerebrovascular events and highlights the utility of TOE in the assessment of cardiac embolic source.
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Affiliation(s)
- Mary Mashicharan
- Department of Cardiology, University Hospital Leicester, Leicester, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, University Hospital Leicester, Leicester, UK
| | - Viktor Zlocha
- Department of Cardiac Surgery, University Hospital Leicester, Leicester, UK
| | - Jeffrey Khoo
- Department of Cardiology, University Hospital Leicester, Leicester, UK
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7
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Tsugu T, Nagatomo Y, Endo J, Kawakami T, Murata M, Yamazaki M, Shimizu H, Fukuda K, Mitamura H, Lancellotti P. Multiple papillary fibroelastomas attached to left ventricular side and aortic side of the aortic valve: A report of new case and literature review. Echocardiography 2019; 36:1194-1199. [PMID: 31116464 DOI: 10.1111/echo.14350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022] Open
Abstract
The aortic valve (AV) is the most commonly affected site in multiple papillary fibroelastomas, but the frequency of embolism caused by the attachment side of the AV has not been elucidated. According to the review of the previous literature, 16 cases have been found attached to the AV. Of these, 6 of these have been found to be attached on the aortic side and 4 on the left ventricular side, 1 was bilateral, and 5 cases were unknown. Of the cases found on the aortic side, embolism occurred in 3 of them, and of the left ventricular side cases, embolism occurred in 2 of them. The frequency of embolism is equivalent even if papillary fibroelastoma attached to either side of the AV.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Cardiology, Federation of National Public Service Personnel Mutual Aid Association Tachikawa Hospital, Tachikawa, Japan.,Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liege, Belgium.,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Jin Endo
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kawakami
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Mitsushige Murata
- Center for Preventive Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Masataka Yamazaki
- Department of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hideo Mitamura
- Department of Cardiology, Federation of National Public Service Personnel Mutual Aid Association Tachikawa Hospital, Tachikawa, Japan
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liege, Belgium
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8
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Cianciulli TF, Saccheri MC, Cozzarín A, Lax JA, Simonetti ME. Papillary Fibroelastoma of the Left Ventricle in a Radiation-treated Cancer Patient. Heart Views 2019; 19:137-140. [PMID: 31057706 PMCID: PMC6487294 DOI: 10.4103/heartviews.heartviews_21_18] [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] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 69-year-old female patient with a history of endometrial carcinoma in 1996, who underwent a total hysterectomy and bilateral adnexectomy. The patient also received chemotherapy and mediastinal radiotherapy followed by cancer remission. Ten years later she presented with heart failure and her Doppler-echocardiogram showed severe mitral regurgitation with pulmonary hypertension and a papillary fibroelastoma in the left ventricle. In 2011, she underwent a mitral valve replacement with a biological prosthesis and the pathology exam revealed valve damage consistent with radiotherapy- induced changes and confirmed the presence of a papillary fibroelastoma. This unusual mechanism of papillary fibroelastoma should be disseminated among cardiology physicians and in patients who have survived for long periods after radiotherapy. It is important to remember that cardiac complications may indeed occur, and the treating physician is responsible for detecting them.
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Affiliation(s)
| | - María Cristina Saccheri
- Department of Cardiology and Oncology, Hospital "Dr. Cosme Argerich," Buenos Aires, Argentina
| | - Alberto Cozzarín
- Department of Cardiology and Oncology, Hospital "Dr. Cosme Argerich," Buenos Aires, Argentina
| | - Jorge Alberto Lax
- Department of Cardiology and Oncology, Hospital "Dr. Cosme Argerich," Buenos Aires, Argentina
| | - Mario Enrique Simonetti
- Department of Cardiology and Oncology, Hospital "Dr. Cosme Argerich," Buenos Aires, Argentina
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9
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Cianciulli TF, Kazelián LR, Cichello MF, Zappi A, Diaz DST, Saccheri MC, Gagliardi JA. Atypical localization of a papillary fibroelastoma in the ligament of Marshall. J Echocardiogr 2018; 18:73-74. [PMID: 30565049 DOI: 10.1007/s12574-018-0413-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/18/2018] [Accepted: 12/07/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Tomás Francisco Cianciulli
- Department of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Lucia Raquel Kazelián
- Department of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Florencia Cichello
- Department of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina
| | - Andrea Zappi
- Department of Pathology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich, Pi y Margall 750 (C1155AHB), Ciudad Autónoma de Buenos Aires, Argentina
| | - Daiana Solange Testa Diaz
- Department of Pathology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich, Pi y Margall 750 (C1155AHB), Ciudad Autónoma de Buenos Aires, Argentina
| | - María Cristina Saccheri
- Department of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Alberto Gagliardi
- Department of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina
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10
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Lau C, Leonard JR, Schwann AN, Soletti G, Abouarab AA, Munjal M, Gaudino M, Girardi LN. A 20-Year Experience With Resection of Primary Cardiac Tumors and Metastatic Tumors of the Heart. Ann Thorac Surg 2018; 107:1126-1131. [PMID: 30471276 DOI: 10.1016/j.athoracsur.2018.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/19/2018] [Accepted: 10/08/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac tumors are uncommon, occurring in less than 1% of the population, and are comprised of numerous tumor types. Management of certain tumors types such as sarcoma have evolved and improved in the recent era. We evaluate the outcomes of patients who underwent resection of benign or malignant cardiac tumors with a focused review of cardiac sarcomas. METHODS Institutional data were reviewed from 1997 to 2017, and 180 patients who underwent tumor resection were identified. Outcomes and survival were examined based on tumor type. RESULTS Two-thirds of patients (119 of 180) had benign tumors. Of 61 malignant tumors, 23 were sarcomas, 24 were cavoatrial tumors, and 8 were T4 lung tumors. In the sarcoma group, operative mortality was 2 of 23 (9.1%). Neoadjuvant therapy was administered to 8 of 23 patients (34.8%) with R0 resection achieved in 5 of 8 patients (62.5%). R0 resection was successful in 7 of 15 patients (46.7%) without neoadjuvant therapy. Mean survival with neoadjuvant therapy was 2.76 ± 3.85 years versus 1.28 ± 1.31 years without neoadjuvant therapy (p = 0.428). Mean survival with R0 resection was 2.79 ± 4.23 years compared with 1.64 ± 1.63 years without (p = 0.407). In the T4 lung tumor group, operative mortality was zero and R0 resection was achieved in 6 of 8 (75%). The cavoatrial tumors were mostly renal cell carcinoma resected with a mortality of 4.5%. CONCLUSIONS Cardiac tumors are comprised of diverse tumor types. Indications for, and benefits of, resecting benign tumors and many malignant tumor types are clear, and operative outcomes are generally good. Cardiac sarcomas benefit from neoadjuvant therapy, which improves the rate of complete resection, thus improving survival.
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Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Alexandra N Schwann
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Ahmed A Abouarab
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Monica Munjal
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
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11
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Mansueto G, Capasso E, Buccelli C, Niola M. Pulmonary Eosinophilic Inflammatory Infiltration Post-Intensive Care in a Nearly Drowned Young Man with Papillary Fibroelastoma: A Rare Complication Discovered by Forensic Autopsy. Front Med (Lausanne) 2018; 4:253. [PMID: 29379783 PMCID: PMC5775214 DOI: 10.3389/fmed.2017.00253] [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: 08/23/2017] [Accepted: 12/21/2017] [Indexed: 12/28/2022] Open
Abstract
Papillary fibroelastoma is a rare benign lesion of heart (1). It is the second most common primary cardiac neoplasm, accounting for 4.4-8% of all tumors of the heart (2). We described a forensic autopsy of a nearly drowned young man with cardiac papillary fibroelastoma who died because of a pulmonary inflammatory infiltration rich in granulocytes after intensive care. This occurrence is rare but possible and should be kept in mind because a lung inflammatory infiltrate rich in eosinophilic granulocytes can be present in different pathological conditions and differential diagnoses are often difficult to do.
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Affiliation(s)
- Gelsomina Mansueto
- Department of Advanced Biomedical Sciences-Pathology Section, University of Naples Federico II, Napoli, Italy
| | - Emanuele Capasso
- Legal Medicine Section, University of Naples Federico II, Napoli, Italy
| | - Claudio Buccelli
- Legal Medicine Section, University of Naples Federico II, Napoli, Italy
| | - Massimo Niola
- Legal Medicine Section, University of Naples Federico II, Napoli, Italy
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12
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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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13
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Ruisanchez C, Alonso A, Carballo B, Gil A, Lerena P, Sarralde JA, Ruano FJ. Incidental tricuspid valve fibroelastoma associated with patent foramen ovale in a young female: Straightforward diagnosis but controversial management. Echocardiography 2017; 34:1399-1400. [PMID: 28401594 DOI: 10.1111/echo.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Papillary fibroelastoma is an uncommon primary cardiac tumor, predominantly associated with left-sided valvular endocardium. Affectation of tricuspid valve leaflets is rare, and management in asymptomatic patients remains controversial. We present a 30-year-old female referred for evaluation prior to bariatric surgery. A routine echocardiogram revealed a mobile cardiac mass attached to the tricuspid valve. A patent foramen ovale was also present. Tumor was surgically removed. Histology confirmed the definite diagnosis of a papillary fibroelastoma. In our case, the presence of a patent foramen ovale associated with the right-sided fibroelastoma was decisive in the decision for surgery.
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Affiliation(s)
- Cristina Ruisanchez
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Angela Alonso
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Beatriz Carballo
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Aritz Gil
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Piedad Lerena
- Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jose Aurelio Sarralde
- Cardiovascular Surgery Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
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14
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Erdogan M, Guney MC, Ayhan H, Kasapkara HA, Uğuz E, Durmaz T, Keleş T, Bozkurt E. An unusual presentation of papillary fibroelastoma originating from right ventricular outflow tract. Echocardiography 2017; 34:476-477. [PMID: 28247577 DOI: 10.1111/echo.13465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Papillary fibroelastomas (PFEs) are primary cardiac tumors with a benign and avascular nature. Majority of the PFEs are originated from the valvular endocardium, while the most common site is aortic valve. In this case, we present a patient with multiple PFEs originating from the right ventricular outflow tract who was admitted to our clinic with exertional dyspnea. As far as we know, this is the first case of this unusual presentation of multiple PFEs and also had a history of breast cancer and permanent pacemaker reported in the literature.
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Affiliation(s)
- Mehmet Erdogan
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Murat Can Guney
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Hüseyin Ayhan
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Hacı Ahmet Kasapkara
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Emrah Uğuz
- Department of Cardiovascular Surgery, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Tahir Durmaz
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Telat Keleş
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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