1
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El Mourabit Y, Saadouni Y, Tribak M, Jaafar RM, Sayah R, Laaroussi M. [Fatal outcome of complete resection of undifferentiated pleomorphic cardiac sarcoma : About a case]. Ann Cardiol Angeiol (Paris) 2024; 73:101769. [PMID: 39121517 DOI: 10.1016/j.ancard.2024.101769] [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: 04/02/2024] [Revised: 04/17/2024] [Accepted: 05/17/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Undifferentiated pleomorphic sarcoma (UPS) is a very rare malignant primary cardiac tumor with a poor prognosis. OBSERVATION A 34-year-old woman complained of dyspnea evolving in a febrile context with altered general condition: Transthoracic echocardiography (TTE) revealed a left intra-atrial mass measuring 51/26 mm in diameter. A thoracic computed tomography (CT) revealed a mass occupying the left atrium measuring 42/28/34 mm, associated with two pulmonary metastases. The cardiac mass was resected and the postoperative suites were fatal. Histological diagnosis was UPS. CONCLUSION We present an atypical case of invasive UPS, which was surgically resected and scheduled for radio-chemotherapy with a fatal outcome.
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Affiliation(s)
- Yassin El Mourabit
- Service de chirurgie cardiovasculaire A, Hôpital Ibn Sina, Université Med V, Rabat, Maroc.
| | - Youssef Saadouni
- Service de chirurgie cardiovasculaire A, Hôpital Ibn Sina, Université Med V, Rabat, Maroc
| | - Mohammed Tribak
- Service de chirurgie cardiovasculaire B, Hôpital Ibn Sina, Université Med V, Rabat, Maroc
| | | | - Rochdi Sayah
- Service de chirurgie cardiovasculaire A, Hôpital Ibn Sina, Université Med V, Rabat, Maroc
| | - Mohamed Laaroussi
- Service de chirurgie cardiovasculaire A, Hôpital Ibn Sina, Université Med V, Rabat, Maroc
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2
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Karigyo CJT, Pessoa BMS, Nicacio SP, Terwilliger E, Costa P, dos Santos PR, Ernani V, Seetharam M, Murakami AN, Batalini F. Cardiac Tumors: Review. Braz J Cardiovasc Surg 2024; 39:e20230405. [PMID: 39038269 PMCID: PMC11262154 DOI: 10.21470/1678-9741-2023-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 07/24/2024] Open
Abstract
Cardiac tumors are rare and encompass a variety of presentations. Clinica symptoms are usually nonspecific, but they can present as obstructive, embolic, or constitutional symptoms. Treatment options and prognosis vary highly depending on the subtype, tumor size, and location. Surgical resection is usually the first-line therapy, except for cardiac lymphomas, and provides favorable long-term prognosis in most benign tumors. Cardiac sarcomas, however, are usually diagnosed in advanced stages, and the treatment relies on a multimodal approach with chemotherapy and radiotherapy. Metastatic cardiac tumors are usually related to advanced disease and carry an overall poor prognosis.
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Affiliation(s)
- Carlos J. T. Karigyo
- Engineering Center for Circulatory Assistance, Instituto Dante
Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
- Postgraduate Program in Medicine/Technology and Intervention in
Cardiology, Universidade de São Paulo, São Paulo, São Paulo,
Brazil
| | | | | | - Emma Terwilliger
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota,
United States of America
| | - Philippos Costa
- Division of Hematology and Oncology, Yale University Yale Cancer
Center, New Haven, Connecticut, United States of America
| | - Pedro Reck dos Santos
- Division of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix,
Arizona, United States of America
| | - Vinicius Ernani
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | - Mahesh Seetharam
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | | | - Felipe Batalini
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
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3
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Nistor C, Stanciu Gavan C, Birceanu A, Betianu C, Carsote M, Cucu AP, Stanciu M, Popa FL, Ciuche A, Ciobica ML. Primary Cardiac Intimal Sarcoma: Multi-Layered Strategy and Core Role of MDM2 Amplification/Co-Amplification and MDM2 Immunostaining. Diagnostics (Basel) 2024; 14:919. [PMID: 38732333 PMCID: PMC11083306 DOI: 10.3390/diagnostics14090919] [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: 03/23/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Primary cardiac tumours are relatively uncommon (75% are benign). Across the other 25%, representing malignant neoplasia, sarcomas account for 75-95%, and primary cardiac intimal sarcoma (PCIS) is one of the rarest findings. We aimed to present a comprehensive review and practical considerations from a multidisciplinary perspective with regard to the most recent published data in the specific domain of PCIS. We covered the issues of awareness amid daily practice clinical presentation to ultra-qualified management in order to achieve an adequate diagnosis and prompt intervention, also emphasizing the core role of MDM2 immunostaining and MDM2 genetic analysis. An additional base for practical points was provided by a novel on-point clinical vignette with MDM2-positive status. According to our methods (PubMed database search of full-length, English publications from January 2021 to March 2023), we identified three studies and 23 single case reports represented by 22 adults (male-to-female ratio of 1.2; male population with an average age of 53.75 years, range: 35-81; woman mean age of 55.5 years, range: 34-70) and a 4-year-old child. The tumour-related clinical picture was recognized in a matter of one day to ten months on first admission. These non-specific data (with a very low index of suspicion) included heart failure at least NYHA class II, mitral regurgitation and pulmonary hypertension, acute myocardial infarction, ischemic stroke, obstructive shock, and paroxysmal atrial fibrillation. Awareness might come from other complaints such as (most common) dyspnoea, palpitation, chest pressure, cough, asthenia, sudden fatigue, weakness, malaise, anorexia, weight loss, headache, hyperhidrosis, night sweats, and epigastric pain. Two individuals were initially misdiagnosed as having endocarditis. A history of prior treated non-cardiac malignancy was registered in 3/23 subjects. Distant metastasis as the first step of detection (n = 2/23; specifically, brain and intestinal) or during follow-up (n = 6/23; namely, intestinal, brain and bone, in two cases for each, and adrenal) required additional imagery tools (26% of the patients had distant metastasis). Transoesophageal echocardiography, computed tomography (CT), magnetic resonance imagery, and even 18F-FDG positronic emission tomography-CT (which shows hypermetabolic lesions in PCIS) represent the basis of multimodal tools of investigation. Tumour size varied from 3 cm to ≥9 cm (average largest diameter of 5.5 cm). The most frequent sites were the left atrium followed by the right ventricle and the right atrium. Post-operatory histological confirmation was provided in 20/23 cases and, upon tumour biopsy, in 3/23 of them. The post-surgery maximum free-disease interval was 8 years, the fatal outcome was at the earliest two weeks since initial admission. MDM2 analysis was provided in 7/23 subjects in terms of MDM2-positive status (two out of three subjects) at immunohistochemistry and MDM2 amplification (four out of five subjects) at genetic analysis. Additionally, another three studies addressed PCISs, and two of them offered specific MDM2/MDM2 assays (n = 35 patients with PCISs); among the provided data, we mention that one cohort (n = 20) identified a rate of 55% with regard to MDM2 amplification in intimal sarcomas, and this correlated with a myxoid pattern; another cohort (n = 15) showed that MDM2-positive had a better prognostic than MDM2-negative immunostaining. To summarize, MDM2 amplification and co-amplification, for example, with MDM4, CDK4, HMGA3, CCND3, PDGFRA, TERT, KIT, CCND3, and HDAC9, might improve the diagnosis of PCIS in addition to MDM2 immunostaining since 10-20% of these tumours are MDM2-negative. Further studies are necessary to highlight MDM2 applicability as a prognostic factor and as an element to be taken into account amid multi-layered management in an otherwise very aggressive malignancy.
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Affiliation(s)
- Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.N.); (A.C.)
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
| | - Camelia Stanciu Gavan
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
| | - Adelina Birceanu
- Pathology and Immunohistochemistry Laboratory, Pathoteam Diagnostic, 051923 Bucharest, Romania;
| | - Cezar Betianu
- Department of Interventional Imaging, “Doctor Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania
| | - Anca-Pati Cucu
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Adrian Ciuche
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.N.); (A.C.)
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.S.G.); (A.-P.C.)
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
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Siegel S, Claus L, Kamphausen T, Feld K. Lethal complication of a rare cardiac tumor. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00703-5. [PMID: 37715931 DOI: 10.1007/s12024-023-00703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
Cardiac tumors, especially malignant ones, are rare and diagnosis is challenging since symptoms manifest late and are often non-specific. Achieving a histological diagnosis prior to resection is also difficult because biopsies often fail to yield conclusive results. Due to the low frequency, no standard treatment protocol exists and the prognosis is poor. We present a case of a cardiac sarcoma, which was found during an autopsy performed with regard to medical malpractice, because the patient died due to a medical intervention. To report cases like this is important to gain more knowledge about possible complications regarding rare diseases.
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Affiliation(s)
- S Siegel
- Institut für Rechtsmedizin des Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - L Claus
- Institut für Pathologie am St. Elisabeth-Krankenhaus Köln, Cologne, Germany
| | - T Kamphausen
- Institut für Rechtsmedizin der Uniklinik Köln, Cologne, Germany
| | - K Feld
- Institut für Rechts- und Verkehrsmedizin des Universitätsklinikum Heidelberg, Heidelberg, Germany
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5
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Santos RR, Abecasis J, Gomes DA, Paiva MS, Rocha B, Ribeiras R, Freitas P, Abecasis M, Trabulo M. An Incidental Finding of a Cardiac Sarcoma. Arq Bras Cardiol 2022; 119:349-352. [PMID: 35946698 PMCID: PMC9363064 DOI: 10.36660/abc.20210703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rita Reis Santos
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - João Abecasis
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal.,Hospital Lusíadas, Lisboa - Portugal.,Nova Medical School, Lisboa - Portugal
| | - Daniel A Gomes
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Mariana Sousa Paiva
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Bruno Rocha
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Regina Ribeiras
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Pedro Freitas
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Miguel Abecasis
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
| | - Marisa Trabulo
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide - Portugal
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6
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Stoica AI, Harpa MM, Banceu CM, Ghiragosian C, Opris CE, Al-Hussein H, Al-Hussein H, Flamind Oltean S, Mezei T, Mares RG, Suciu H. A Rare Case of Undifferentiated Pleomorphic Cardiac Sarcoma with Inflammatory Pattern. Medicina (B Aires) 2022; 58:medicina58081009. [PMID: 36013476 PMCID: PMC9413296 DOI: 10.3390/medicina58081009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiac undifferentiated pleomorphic sarcoma (UPS) associated with fever and inflammatory response is an extremely rare condition. Herein, we report a rare case of cardiac UPS with unusual clinical presentation and inflammatory response. A 67-year-old male complaining of progressive dyspnea and intermittent fever of unknown cause was referred to our hospital for surgical resection of a left atrial mass. Laboratory analysis showed leukocytosis (26 × 103/μL) and high C-reactive protein (CRP) levels (155.4 mg/L). Hemoculture tests and urine analysis were negative for infection. A contrast chest computed tomography revealed a mass measuring 5.5 × 4.5 cm, occupying the left atrium cavity. The patient underwent surgical excision of the mass, however, surgical margin of the resected tumor could not be evaluated, due to the multifragmented nature of the resection specimen. Postoperative CRP and leukocyte levels normalized, highlighting the relationship between the tumor and the inflammatory status. Early diagnosis is crucial for a proper management and favorable outcome, enabling patients to undergo chemotherapy and achieve complete surgical resection.
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Affiliation(s)
- Alexandra Iulia Stoica
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
| | - Marius Mihai Harpa
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
- Correspondence:
| | - Cosmin Marian Banceu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
| | - Claudiu Ghiragosian
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
| | - Carmen Elena Opris
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
| | - Hussam Al-Hussein
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
| | - Hamida Al-Hussein
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
| | - Sanziana Flamind Oltean
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
| | - Tibor Mezei
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
| | - Razvan Gheorghita Mares
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Mures, Romania
| | - Horatiu Suciu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Mures, Romania; (A.I.S.); (C.M.B.); (C.G.); (C.E.O.); (H.A.-H.); (H.A.-H.); (S.F.O.); (T.M.); (R.G.M.); (H.S.)
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7
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Koelsche C, Benhamida JK, Kommoss FKF, Stichel D, Jones DTW, Pfister SM, Heilig CE, Fröhling S, Stenzinger A, Buslei R, Mentzel T, Baumhoer D, Ladanyi M, Antonescu CR, Flucke U, Gorp JV, Bode-Lesniewska B, Deimling AV, Mechtersheimer G. Intimal sarcomas and undifferentiated cardiac sarcomas carry mutually exclusive MDM2, MDM4, and CDK6 amplifications and share a common DNA methylation signature. Mod Pathol 2021; 34:2122-2129. [PMID: 34312479 PMCID: PMC8592836 DOI: 10.1038/s41379-021-00874-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023]
Abstract
Undifferentiated mesenchymal tumors arising from the inner lining (intima) of large arteries are classified as intimal sarcomas (ISA) with MDM2 amplification as their molecular hallmark. Interestingly, undifferentiated pleomorphic sarcomas (UPS) of the heart have recently been suggested to represent the cardiac analog of ISA due to morphological overlap and high prevalence of MDM2 amplifications in both neoplasms. However, little is known about ISAs and cardiac UPS without MDM2 amplifications and molecular data supporting their common classification is sparse. Here, we report a series of 35 cases comprising 25 ISAs of the pulmonary artery, one ISA of the renal artery and 9 UPS of the left atrium. Tumors were analyzed utilizing the Illumina Infinium MethylationEPIC BeadChip array, enabling copy number profile generation and unsupervised DNA methylation analysis. DNA methylation patterns were investigated using t-distributed stochastic neighbor embedding (t-SNE) analysis. Histologically, all ISAs and UPS of the left atrium resembled extra-cardiac UPS. All cases exhibited highly complex karyotypes with overlapping patterns between ISA and UPS. 29/35 cases showed mutually exclusive amplifications in the cell-cycle associated oncogenes MDM2 (25/35), MDM4 (2/35), and CDK6 (2/35). We further observed recurrent co-amplifications in PDGFRA (21/35), CDK4 (15/35), TERT (11/35), HDAC9 (9/35), and CCND1 (4/35). Sporadic co-amplifications occurred in MYC, MYCN, and MET (each 1/35). The tumor suppressor CDKN2A/B was frequently deleted (10/35). Interestingly, DNA methylation profiling (t-SNE) revealed an overlap of ISA and cardiac UPS. This "ISA" methylation signature was distinct from potential histologic and molecular mimics. In conclusion, our data reveal MDM4 and CDK6 amplifications in ISAs and UPS of the left atrium, lacking MDM2 amplification. We further report novel co-amplifications of various oncogenes, which may have therapeutic implications. Finally, the genetic and epigenetic concordance of ISAs and UPS of the left atrium further supports a shared pathogenesis and common classification.
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Affiliation(s)
- Christian Koelsche
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jamal K. Benhamida
- grid.51462.340000 0001 2171 9952Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Felix K. F. Kommoss
- grid.5253.10000 0001 0328 4908Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Damian Stichel
- grid.5253.10000 0001 0328 4908Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T. W. Jones
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Paediatric Glioma Research Group, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M. Pfister
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph E. Heilig
- grid.7497.d0000 0004 0492 0584Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefan Fröhling
- grid.7497.d0000 0004 0492 0584Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Albrecht Stenzinger
- grid.5253.10000 0001 0328 4908Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Rolf Buslei
- grid.419802.60000 0001 0617 3250Institute of Pathology, Sozialstiftung Bamberg, Bamberg, Germany
| | | | - Daniel Baumhoer
- grid.6612.30000 0004 1937 0642Bone Tumor Reference Center at the Institute of Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Marc Ladanyi
- grid.51462.340000 0001 2171 9952Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Cristina R. Antonescu
- grid.51462.340000 0001 2171 9952Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Uta Flucke
- grid.10417.330000 0004 0444 9382Department of Pathology, Radboud University Hospital, Nijmegen, the Netherlands
| | - Joost van Gorp
- grid.415960.f0000 0004 0622 1269Department of Pathology, St Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands
| | - Beata Bode-Lesniewska
- grid.412004.30000 0004 0478 9977Department of Pathology, University Hospital, Zurich, Switzerland
| | - Andreas von Deimling
- grid.5253.10000 0001 0328 4908Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gunhild Mechtersheimer
- grid.5253.10000 0001 0328 4908Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
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8
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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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9
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Salvador-Coloma C, Saigí M, Díaz-Beveridge R, Penín RM, Pané-Foix M, Mayordomo E, Melián M, Schuler M, García Del Muro X, Font de Mora J. Identification Of Actionable Genetic Targets In Primary Cardiac Sarcomas. Onco Targets Ther 2019; 12:9265-9275. [PMID: 31807008 PMCID: PMC6847994 DOI: 10.2147/ott.s214319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/09/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary cardiac tumors are extremely rare; most are myxomas with a benign prognosis. However, primary sarcomas are highly aggressive and treatment options are limited. Radical surgery is often not feasible and conventional therapies provide only modest results. Due to the rare nature of primary cardiac tumors, there are no proper randomized studies to guide treatment. Their complexity requires alternative approaches in order to improve treatment efficacy. METHODS We isolated DNA from 5 primary cardiac sarcomas; the quality of DNA from 3 of them was sufficient to perform high-resolution single nucleotide polymorphism (SNP) array analysis. RESULTS In the present study, molecular karyotyping revealed numerous segmental chromosomal alterations and amplifications affecting actionable genes that may be involved in disease initiation and/or progression. These include chromosomal break flanking AKT2 in undifferentiated pleomorphic rhabdomyosarcoma, chromosomal break in promoter of TERT, and gain of CDK4 and amplification of MDM2 in inflammatory myofibroblastic tumor. We detected segmental break flanking MOS in high-grade myxofibrosarcoma. In addition, the high number of chromosomal aberrations in high-grade myxofibrosarcoma may cause multiple tumor-specific epitopes, supporting the study of immunotherapy treatment in this type of aggressive tumor. CONCLUSION Our results provide a genetic rationale that supports an alternative, personalized therapeutic management of primary cardiac sarcomas.
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Affiliation(s)
- Carmen Salvador-Coloma
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Laboratory of Cellular and Molecular Biology, Clinical and Translational Research in Cancer, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María Saigí
- Department of Medical Oncology, Institut Català Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Roberto Díaz-Beveridge
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosa María Penín
- Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - María Pané-Foix
- Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Empar Mayordomo
- Department of Pathology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marcos Melián
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mona Schuler
- Department of Cardiac Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Xavier García Del Muro
- Department of Medical Oncology, Institut Català Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaime Font de Mora
- Laboratory of Cellular and Molecular Biology, Clinical and Translational Research in Cancer, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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10
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Vaitiekiene A, Vaitiekus D, Urbonaite L, Jankauskas A, Portacenko J, Lapinskas T, Benetis R, Siudikas A, Veikutiene A, Poskiene L, Kavoliuniene A, Janciauskiene R, Jarusevicius L, Juozaityte E, Zaliunas R, Ereminiene E. Multidisciplinary approach to rare primary cardiac sarcoma: a case report and review. BMC Cancer 2019; 19:529. [PMID: 31151427 PMCID: PMC6544955 DOI: 10.1186/s12885-019-5705-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
Background Undifferentiated pleomorphic sarcoma is a very rare and aggressive type of primary cardiac tumors. Most cardiac sarcomas result in rapid growth and quick death. According to different sources the median survival is typically 6 to 12 months. We are presenting a case of primary cardiac sarcoma with 26 months disease free survival following cytoreductive surgery and chemotherapy. Case presentation A 48-year-old woman with progressing symptoms of dyspnea and palpitations for over 2 months was referred to a cardiologist. With the help of echocardiography and cardiovascular magnetic resonance cardiac sarcoma was suspected. Open biopsy and cytoreductive surgery were performed, complete resection of the tumor was not possible. Histology revealed undifferentiated pleomorphic sarcoma. Seven cycles of chemotherapy with Doxorubicine and Ifosfamide were completed. Cardiovascular magnetic resonance revealed a complete response – only signs of fibrosis without any signs of tumor were visible. Follow ups with echocardiography, cardiovascular magnetic resonance and chest, abdomen and pelvic computed tomography is performed every 3 months. Twenty-six months from initial diagnosis the patient is still free of recurrence of tumor with no compromises of the quality of life. Conclusion Standard chemotherapy together with cytoreductive surgery can have a complete response effect in undifferentiated pleomorphic sarcoma with unusual long-term survival.
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Affiliation(s)
- Audrone Vaitiekiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Domas Vaitiekus
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laura Urbonaite
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Antanas Jankauskas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justina Portacenko
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Adakrius Siudikas
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Audrone Veikutiene
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lina Poskiene
- Department of Pathology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ausra Kavoliuniene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rasa Janciauskiene
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimonas Jarusevicius
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elona Juozaityte
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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11
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Al-Sabeq B, Shen SS, Reardon M, Nabi F. Lightning striking twice: Redo mitral valve replacement due to recurrent cardiac sarcoma using partial autotransplantation technique. J Thorac Cardiovasc Surg 2019; 158:e1-e4. [PMID: 30857811 DOI: 10.1016/j.jtcvs.2019.01.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Basil Al-Sabeq
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
| | - Steven S Shen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Tex
| | - Michael Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex.
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
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