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Stergioula A, Kokkali S, Pantelis E. Multimodality treatment of primary cardiac angiosarcoma: A systematic literature review. Cancer Treat Rev 2023; 120:102617. [PMID: 37603906 DOI: 10.1016/j.ctrv.2023.102617] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Primary cardiac angiosarcoma (PCA) is the most prevalent histological type of cardiac sarcoma but its rarity poses a challenge for standardizing treatment protocols. Moreover, published studies are limited by small patient numbers and lack of randomization, making it challenging to establish evidence-based treatment strategies. This systematic review aims to consolidate the heterogeneous published data and identify factors related to the treatment outcome of PCA patients. METHODS The PubMed and Scopus bibliographic databases were systematically searched for original articles reporting clinical, treatment and outcome data for PCA patients. Kaplan-Meier analysis was used to calculate the time to progression and survival. The Log-Rank test was used to compare progression-free and overall survival data. The Cox proportional hazards regression model was used for univariate and multivariate analysis of survival data. RESULTS A total of 127 studies containing data for 162 patients were analyzed. The median age of the patient cohort was 45 years, with males being 1.5 times more frequently affected than females. Tumors were primarily located on the right side of the heart, with a median size of 6 cm. Median progression-free and overall survival of 5 months and 12 months, respectively, were calculated. Age, sex, and resection margins did not have a significant impact on PCA survival, as determined by both univariate and multivariate analyses. The presence of metastases at diagnosis was associated with lower overall survival in univariate analysis, although this effect was not significant in multivariate analysis. Multimodality treatment that incorporated surgery and adjuvant chemo-radiotherapy was associated with a statistically significant survival benefit. Median overall survival increased from 6 months with surgery alone to 13 months and 27 months with adjuvant chemotherapy and chemo-radiotherapy, respectively. CONCLUSION Multimodality treatment including surgery and chemo-radiotherapy was found to offer the greatest survival benefit for PCA patients.
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Affiliation(s)
- Anastasia Stergioula
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Center of Radiotherapy, IASO General Hospital, Athens, Greece.
| | - Stefania Kokkali
- Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Maliszewska O, Roszkowska A, Lipiński M, Treder N, Olędzka I, Kowalski P, Bączek T, Bień E, Krawczyk MA, Plenis A. Profiling Docetaxel in Plasma and Urine Samples from a Pediatric Cancer Patient Using Ultrasound-Assisted Dispersive Liquid-Liquid Microextraction Combined with LC-MS/MS. Pharmaceutics 2023; 15:pharmaceutics15041255. [PMID: 37111740 PMCID: PMC10143245 DOI: 10.3390/pharmaceutics15041255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
In recent years, therapeutic drug monitoring (TDM) has been applied in docetaxel (DOC)-based anticancer therapy to precisely control various pharmacokinetic parameters, including the concentration of DOC in biofluids (e.g., plasma or urine), its clearance, and its area under the curve (AUC). The ability to determine these values and to monitor DOC levels in biological samples depends on the availability of precise and accurate analytical methods that both enable fast and sensitive analysis and can be implemented in routine clinical practice. This paper presents a new method for isolating DOC from plasma and urine samples based on the coupling of microextraction and advanced liquid chromatography with tandem mass spectrometry (LC-MS/MS). In the proposed method, biological samples are prepared via ultrasound-assisted dispersive liquid-liquid microextraction (UA-DLLME) using ethanol (EtOH) and chloroform (Chl) as the desorption and extraction solvents, respectively. The proposed protocol was fully validated according to the Food and Drug Administration (FDA) and the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) requirements. The developed method was then applied to monitor the DOC profile in plasma and urine samples collected from a pediatric patient suffering from cardiac angiosarcoma (AS) with metastasis to lungs and mediastinal lymph nodes, who was receiving treatment with DOC at a dose of 30 mg/m2 body surface area. Due to the rarity of this disease, TDM was carried out to determine the exact levels of DOC at particular time points to ascertain which levels were conducive to maximizing the treatment's effectiveness while minimizing the drug's toxicity. To this end, the concentration-time profiles of DOC in the plasma and urine samples were determined, and the levels of DOC at specific time intervals up to 3 days after administration were measured. The results showed that DOC was present at higher concentrations in the plasma than in the urine samples, which is due to the fact that this drug is primarily metabolized in the liver and then eliminated with the bile. The obtained data provided information about the pharmacokinetic profile of DOC in pediatric patients with cardiac AS, which enabled the dose to be adjusted to achieve the optimal therapeutic regimen. The findings of this work demonstrate that the optimized method can be applied for the routine monitoring of DOC levels in plasma and urine samples as a part of pharmacotherapy in oncological patients.
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Affiliation(s)
- Olga Maliszewska
- Department of Analytical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Anna Roszkowska
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Marcin Lipiński
- Department of Pharmaceutical Biochemistry, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Natalia Treder
- Department of Analytical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Ilona Olędzka
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Piotr Kowalski
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Małgorzata Anna Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Alina Plenis
- Department of Analytical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
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Khan SR, Nasir S, Tariq M, Rashid YA, Jabbar AA. Cardiac sarcoma: A rare case of primary cardiac sarcoma. Int J Surg Case Rep 2022; 102:107836. [PMID: 36525693 PMCID: PMC9772576 DOI: 10.1016/j.ijscr.2022.107836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary cardiac sarcoma is a rare malignancy with a poor prognosis because of diagnostic delay, therapeutic difficulties, and high metastatic potential. The therapeutic approach includes surgery, chemotherapy, and radiation therapy, alone or in combination. However, there is a lack of evidence to guide the treatment. CASE PRESENTATION We present a case of primary cardiac sarcoma. Our patient was presented in the department of emergency medicine (ED) in our institute with shortness of breath on exertion associated with orthopnea. Based on the history and cardiovascular examination, he underwent an echocardiogram, which revealed a sizeable echogenic density in the right ventricular outflow tract. He underwent surgical resection of the cardiac mass via median sternotomy and total cardiopulmonary bypass approach. The patient was eventually diagnosed with primary cardiac sarcoma, confirmed by tissue biopsy after surgical intervention. CLINICAL DISCUSSION Through this report, we highlight the rarity of primary cardiac sarcomas, the importance of multidisciplinary tumor board (MDT) discussion and provide evidence of surgical excision being the treatment of choice, followed by systemic chemotherapy in selected cases. CONCLUSION Cardiac sarcoma is a rare but highly malignant tumor with a poor prognosis. However, early diagnosis and surgical resection of a primary cardiac sarcoma can significantly increase the patient's survival and quality of life. Therefore, physicians should keep a high suspicion of a patient with clinical features suggestive of cardiac sarcoma, and echocardiography should be the diagnostic modality of choice in such patients.
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Affiliation(s)
- Saqib Raza Khan
- Department of Medical Oncology, Section of Oncology, Aga Khan University Hospital, Karachi, Pakistan,Corresponding author.
| | - Saad Nasir
- Department of Medical Oncology, Section of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Tariq
- Department of Medical Oncology, Section of Oncology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Yasmin Abdul Rashid
- Department of Medical Oncology, Section of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Adnan Abdul Jabbar
- Department of Medical Oncology, Section of Oncology, Dr. Ziauddin Hospital, Karachi, Pakistan
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Kobayashi A, Araki Y, Terada T, Terazawa S, Kawaguchi O. Surgical and multitreatment approach in a case of primary cardiac angiosarcoma: A case report. Int J Surg Case Rep 2022; 96:107349. [PMID: 35772263 PMCID: PMC9284058 DOI: 10.1016/j.ijscr.2022.107349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary cardiac angiosarcoma is extremely rare, and its prognosis remains poor, with a mean life expectancy of only a few months. Here, we report a case of primary cardiac angiosarcoma. CASE PRESENTATION A 49-year-old Japanese woman with a month-long history of dyspnea was admitted to our hospital for pericardial effusion. Chest computed tomography and cardiac magnetic resonance imaging showed a mass in the right atrium. The patient underwent surgical resection of the tumor, and the pathological diagnosis was angiosarcoma. The patient received radiotherapy after surgery. Six months following surgery, she underwent chemotherapy following the diagnosis of lung metastasis. The patient died 18 months after the initial diagnosis. CLINICAL DISCUSSION Cardiac angiosarcoma is rare and difficult to diagnose early because it is associated with few symptoms. Moreover, there are currently no established guidelines for the treatment of this disease because of its rarity and sparse descriptive literature Therefore, multidisciplinary therapies should be considered, including surgery, radiotherapy, and chemotherapy. CONCLUSION There is no standard treatment for cardiac angiosarcoma, but surgical resection, chemotherapy, radiation therapy, or a combination of these therapies may be useful.
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Affiliation(s)
- Akihiro Kobayashi
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan.
| | - Yoshimori Araki
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan
| | - Takafumi Terada
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Osamu Kawaguchi
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan
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Wang ZH, Lv XH, Pu JH, Yang MF, Chen LJ. Treatment of primary cardiac angiosarcoma in a 35 weeks pregnant woman. J Card Surg 2021; 36:3452-3455. [PMID: 34216385 DOI: 10.1111/jocs.15751] [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: 03/30/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac angiosarcoma is a rare but highly malignant cardiac tumor. It is characterized by poor prognosis, and current treatment approaches are not effective. CASE PRESENTATION A 37-year-old female with 35 weeks pregnancy experienced chest tightness and shortness of breath for 1 month. She was diagnosed with primary cardiac angiosarcoma. Delivery of fetus was performed early to treat the mother. The patient underwent resection of the tumor then she was treated with chemotherapy. However, the tumor recurred 11 months after surgery. CONCLUSION Angiosarcoma is a highly malignant tumor explaining recurrence of the tumor recurred after surgery. Cardiac angiosarcoma should be treated through a comprehensive treatment plan, comprising surgery, radiotherapy, and chemotherapy approaches.
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Affiliation(s)
- Zhao-Hui Wang
- Department of Cardiac Surgery, People's Hospital of Dongyang, Dongyang, Zhejiang, China
| | - Xiao-Hui Lv
- Department of Cardiac Surgery, People's Hospital of Dongyang, Dongyang, Zhejiang, China
| | - Jin-Hai Pu
- Department of Cardiac Surgery, People's Hospital of Dongyang, Dongyang, Zhejiang, China
| | - Ming-Feng Yang
- Department of Cardiac Surgery, People's Hospital of Dongyang, Dongyang, Zhejiang, China
| | - Li-Jun Chen
- Department of Cardiac Surgery, People's Hospital of Dongyang, Dongyang, Zhejiang, China
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Corradini S, von Bestenbostel R, Romano A, Curta A, Di Gioia D, Placidi L, Niyazi M, Boldrini L. MR-guided stereotactic body radiation therapy for primary cardiac sarcomas. Radiat Oncol 2021; 16:60. [PMID: 33771179 PMCID: PMC7995725 DOI: 10.1186/s13014-021-01791-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/17/2021] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Primary cardiac tumors are an extremely rare disease with limited prognosis. The treatment of choice is surgery. Other treatment options include chemotherapy and radiation therapy, which historically represented a palliative approach in patients who were not eligible for surgery. The development of hybrid MR-guided radiation therapy makes it possible to better visualize cardiac lesions and to apply high doses per fraction in sensible organs such as the heart. CASE PRESENTATION Patients affected by inoperable primary cardiac sarcomas and treated at two different institutions were considered for this analysis and retrospectively analyzed. All patients were treated using a 0.35 T hybrid MR Linac system (MRIdian, ViewRay Inc., Mountain View, CA). In the present study we investigated the feasibility, early outcome and toxicity of MR-guided RT in primary cardiac sarcomas. Four consecutive non-metastasized patients who were treated between 05-09/2020 were analyzed. The cardiac sarcomas were mostly located in the right atrium (50%) and one patient presented with 3 epicardial lesions. All patients received MRgRT as a salvage treatment for recurrent cardiac sarcoma after initial surgery, after a mean interval of 12 months (range 1-29 months). Regarding the treatment characteristics, the mean GTV size was 22.9 cc (range 2.5-56.9 cc) and patients were treated with a mean GTV dose of 38.9 Gy (range 30.1-41.1 Gy) in 5 fractions. Regarding feasibility, all treatments were completed as planned and all patients tolerated the treatment very well and showed only mild grade 1 or 2 symptoms like fatigue, dyspnea or mild chest pain at early follow-up. CONCLUSION To the best of our knowledge, in this retrospective analysis we present the first and largest series of patients presenting with primary cardiac sarcomas treated with online adaptive MRgRT. However, further studies are needed to evaluate the impact of this new methodology on the outcome of this very rare disease.
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Affiliation(s)
- Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Angela Romano
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
| | - Adrian Curta
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Dorit Di Gioia
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Lorenzo Placidi
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Luca Boldrini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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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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Primary Cardiac Angiosarcoma: Authors' Perspective Following Synthesis of Available Literature. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen CF, Lin MH, Chu KA, Liu WS, Hsiao SH, Lai RS. Effective cardiac radiotherapy relieved life-threatening heart failure caused by advanced small cell lung cancer with cardiac metastasis: a case report. J Thorac Dis 2018; 10:E250-E254. [PMID: 29850163 DOI: 10.21037/jtd.2018.03.104] [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: 11/06/2022]
Abstract
Cardiac radiotherapy is rarely used in clinical practice because of concern of adverse effects on the heart. We present a case of a 64-year-old man with advanced small cell lung cancer (SCLC) treated with chemo-radiotherapy who attained partial remission initially but had disease progression to bulky cardiac metastasis and significant pericardial effusion. Severe heart failure with hepatic failure was found. Chemotherapy and pericardiocentesis were contraindicated because of the associated high risk and bleeding tendency. Emergent palliative cardiac radiotherapy resulted in rapid improvements of dyspnea, liver function, and urine output. Pericardiocentesis was performed 5 days later and effusion cytology confirmed metastatic SCLC. To our knowledge, this is the first case of effective cardiac radiotherapy for SCLC with life-threatening cardiac metastasis. Palliative cardiac radiotherapy may be an effective alternative treatment for radiosensitive malignancy with cardiac metastasis in cases of multiple organ dysfunction and unsuitability for chemotherapy and pericardiocentesis.
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Affiliation(s)
- Chiu-Fan Chen
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung.,Department of Internal Medicine, Taipei Veterans General Hospital, Taitung Branch, Taitung
| | - Min-Hsi Lin
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Kuo-An Chu
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Wen-Shan Liu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Ruay-Sheng Lai
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
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Fields EC, Squires B, Lomas H. Treating the Critically Ill with Radiotherapy: Lessons Learned from a Young Woman with Cardiac Angiosarcoma. Front Oncol 2017; 7:29. [PMID: 28303236 PMCID: PMC5332370 DOI: 10.3389/fonc.2017.00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/17/2017] [Indexed: 01/09/2023] Open
Abstract
Background Treating patients who are critically ill with radiotherapy (RT) brings a unique set of challenges as it involves treating patients who require mechanical life support, unconventional positioning, and a multidisciplinary team approach to ensure safety. However, when the benefits of such treatment outweigh the risks, the challenges can be overcome, as demonstrated in this unique case of cardiac angiosarcoma. Case description This is a case of a 42-year-old female with a right sided cardiac angiosarcoma who quickly developed cardiac tamponade and respiratory failure related to compression of her right heart by the tumor. She was treated with high dose single fraction RT initially and had a clinical response allowing further conformal RT with concurrent chemotherapy. Discussion Managing critically ill patients requires creativity, improvisation, and careful consideration of existing evidence. Although limited, the data suggest that multi-modality therapy with a combination of surgery, RT, and chemotherapy provide the best outcomes.
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Affiliation(s)
- Emma C Fields
- Radiation Oncology, Virginia Commonwealth University , Richmond, VA , USA
| | - Bryan Squires
- Radiation Oncology, Wayne State University , Detroit, MI , USA
| | - Harry Lomas
- Radiation Oncology, Virginia Commonwealth University , Richmond, VA , USA
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Jiang L, Luo T, Leong K. Large right atrial angiosarcoma with superior vena cava obstruction and cardiovascular collapse. Hellenic J Cardiol 2016; 57:355-358. [DOI: 10.1016/j.hjc.2016.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/11/2015] [Indexed: 11/16/2022] Open
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Wilson TG, Jenkins P, Hoschtitzky A, McCabe M. An extremely rare case of a high-grade pleomorphic cardiac sarcoma and likely cerebral metastasis in a young patient. Ecancermedicalscience 2016; 10:664. [PMID: 27594909 PMCID: PMC4990053 DOI: 10.3332/ecancer.2016.664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Indexed: 11/26/2022] Open
Abstract
To date, there have been less than a 100 confirmed case reports of primary cardiac malignant fibrous histiocytomas, a rare form of sarcoma. In this report, we discuss the case of a 15-year-old girl who initially presented with a histiocytic cerebral sarcoma that was treated with aggressive resection and chemotherapy. Three years later, the same patient developed increasing shortness of breath and was found to have a high-grade pleomorphic undifferentiated cardiac sarcoma that likely represents the primary tumour from which the cerebral lesion metastasised. This represents an extremely unique case; in 2010, a research group in Germany claimed the very first description of a true cardiac sarcoma with brain metastasis [1]. However, even as far back as 1960, there were three case reports [2] and more extensive sarcoma studies recently have revealed further cases [3]. Nevertheless, there have probably been less than 10 cases in the literature up until this point.
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Affiliation(s)
- T G Wilson
- Central Manchester Foundation Trust, Oxford Rd, Manchester M13 9WL, UK
| | - P Jenkins
- Central Manchester Foundation Trust, Oxford Rd, Manchester M13 9WL, UK
| | - A Hoschtitzky
- Central Manchester Foundation Trust, Oxford Rd, Manchester M13 9WL, UK
| | - M McCabe
- Central Manchester Foundation Trust, Oxford Rd, Manchester M13 9WL, UK
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Schur S, Hamacher R, Brodowicz T. Pazopanib in Primary Cardiac Angiosarcoma of the Right Atrium: A Case Report. Case Rep Oncol 2016; 9:363-7. [PMID: 27462238 PMCID: PMC4939669 DOI: 10.1159/000447088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022] Open
Abstract
Primary heart tumors are an extremely rare oncological entity with primary cardiac sarcomas usually representing 20% of all primary cardiac tumorous lesions [Shanmugam: Eur J Cardiothorac Surg 2006;29: 925–932; Orlandi et al.: J Thorac Oncol 2010;5: 1483–1489]. Angiosarcoma is the most prevalent histology and despite a multidisciplinary approach tends to have a dismal prognosis [Shanmugam: Eur J Cardiothorac Surg 2006;29: 925–932; Fury et al.: Cancer J 2005;11: 241–247]. Based on the prevailing literature, we report a 48-year-old woman diagnosed with primary metastatic cardiac angiosarcoma who showed a severe hypersensitivity reaction to conventional chemotherapy with taxanes but an excellent response to treatment with the multitargeted receptor tyrosine kinase inhibitor pazopanib.
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Affiliation(s)
- Sophie Schur
- Comprehensive Cancer Center - Musculo Skeletal Tumors, GIST, Bone Sarcoma & Soft Tissue Sarcoma Program, Clinical Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, General Hospital Vienna, and Sarcoma Platform Austria, Vienna, Austria
| | - Rainer Hamacher
- Comprehensive Cancer Center - Musculo Skeletal Tumors, GIST, Bone Sarcoma & Soft Tissue Sarcoma Program, Clinical Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, General Hospital Vienna, and Sarcoma Platform Austria, Vienna, Austria
| | - Thomas Brodowicz
- Comprehensive Cancer Center - Musculo Skeletal Tumors, GIST, Bone Sarcoma & Soft Tissue Sarcoma Program, Clinical Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, General Hospital Vienna, and Sarcoma Platform Austria, Vienna, Austria
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Jang Y, Kim J, Shim JW, Kim EY, Moon J, An J, Jeon YB, Lee KC, Ahn HK. Primary cardiac angiosarcoma: a prolonged response to surgical resection followed by concurrent chemoradiotherapy with docetaxel. SPRINGERPLUS 2016; 5:648. [PMID: 27330914 PMCID: PMC4870531 DOI: 10.1186/s40064-016-2248-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/28/2016] [Indexed: 12/05/2022]
Abstract
Introduction Primary cardiac cancer is a very rare disease, among which primary cardiac angiosarcoma is one of the most frequent type and is characterized by extremely poor prognosis without established optimal treatment. Case description Here we report a case of primary cardiac angiosarcoma with hemorrhagic pericardial effusion who achieved a durable response with tumor excision followed by concurrent chemoradiotherapy with docetaxel. A sixty year old man was presented with dyspnea and was diagnosed with primary cardiac angiosarcoma with hemorrhagic pericardial effusion. After surgical excision of primary tumor with microscopic residual disease followed by concurrent chemoradiotherapy with docetaxel, the patient showed durable response of progression free survival of 12 months. Discussion and evaluation This case shows benefit of concurrent chemoradiotherapy with taxane. Further investigation of aggressive multimodal treatment strategy is warranted for primary cardiac angiosarcoma with pauci-metastasis even when achievement of complete resection seems unlikely.
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Affiliation(s)
- Youngwoo Jang
- Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760 Republic of Korea
| | - Joonhwan Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760 Republic of Korea
| | - Jung Woo Shim
- Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760 Republic of Korea
| | - Eun Young Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jungkeun Moon
- Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760 Republic of Korea
| | - Jungsuk An
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yang Bin Jeon
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Kyu Chan Lee
- Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760 Republic of Korea
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15
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Minichillo S, Pantaleo MA, Nannini M, Coccolo F, Gatto L, Biasco G, Brandi G. Efficacy of weekly docetaxel in locally advanced cardiac angiosarcoma. BMC Res Notes 2015. [PMID: 26223870 PMCID: PMC4519000 DOI: 10.1186/s13104-015-1296-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Primary cardiac angiosarcoma is extremely aggressive; however, it is often misdiagnosed because of its rarity. For locally advanced tumors, doxorubicin-based chemotherapy regimens are the standard of treatment, even if the gain in term of progression-free survival is limited and is no longer than 5 months. Case presentation We report the case of a Caucasian 23-year-old man with locally advanced cardiac angiosarcoma who underwent radical surgical resection after a prolonged response to weekly docetaxel and complementary radiotherapy. Conclusion Combined treatment with weekly docetaxel
and radiotherapy may be a valid alternative for the treatment of locally advanced cardiac angiosarcoma; the combination can lead to radical surgical resections, avoiding the cumulative cardiotoxicity of antracycline-based regimens.
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Affiliation(s)
- Santino Minichillo
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Maria Abbondanza Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy. .,"Giorgio Prodi" Cancer Research Center, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy. .,"Giorgio Prodi" Cancer Research Center, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Fabio Coccolo
- Cardiovascular Department of the University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Lidia Gatto
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Guido Biasco
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy. .,"Giorgio Prodi" Cancer Research Center, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Giovanni Brandi
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
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16
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Dhull VS, Sharma P, Mukherjee A, Jana M, Bal C, Kumar R. 18F-FDG PET-CT for Evaluation of Cardiac Angiosarcoma: A Case Report and Review of Literature. Mol Imaging Radionucl Ther 2015; 24:32-6. [PMID: 25800597 PMCID: PMC4372771 DOI: 10.4274/mirt.02486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/04/2013] [Indexed: 12/03/2022] Open
Abstract
Cardiac angiosarcomas are rare neoplasms. We here present the case of a 24 year old male with a cardiac mass which was characterised as malignant on 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT). In addition 18F-FDG PET-CT also demonstrated pericardial infiltration and bone metastases. The tumor was confirmed to be angiosarcoma on biopsy and palliative chemotherapy was started. Here we have highlighted the potential role of 18F-FDG PET-CT in patients with cardiac angiosarcoma and presented a brief review.
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Affiliation(s)
- Varun Singh Dhull
- All India Institute of Medical Sciences, Department of Nuclear Medicine, New Delhi, India. E-mail:
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17
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18
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Ostrowski S, Marcinkiewicz A, Kośmider A, Jaszewski R. Sarcomas of the heart as a difficult interdisciplinary problem. Arch Med Sci 2014; 10:135-48. [PMID: 24701226 PMCID: PMC3953983 DOI: 10.5114/aoms.2014.40741] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/10/2011] [Accepted: 03/20/2011] [Indexed: 12/17/2022] Open
Abstract
Cardiac tumors are assumed to be a rare entity. Metastases to the heart are more frequent than primary lesions. Sarcomas make up the majority of cardiac malignant neoplasms. Among them angiosarcoma is the most common and associated with the worst prognosis. Malignant fibrous histiocytoma comprises the minority of cardiac sarcomas and has uncertain etiology as well as pathogenesis. Transthoracic echocardiography remains the widely available screening examination for the initial diagnosis of a cardiac tumor. The clinical presentation is non-specific and the diagnosis is established usually at an advanced stage of the disease. Sarcomas spread preferentially through blood due to their immature vessels without endothelial lining. Surgery remains the method of choice for treatment. Radicalness of the excision is still the most valuable prognostic factor. Adjuvant therapy is unlikely to be effective. The management of cardiac sarcomas must be individualized due to their rarity and significant differences in the course of disease.
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Affiliation(s)
- Stanisław Ostrowski
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Anna Marcinkiewicz
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Anna Kośmider
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Ryszard Jaszewski
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
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19
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Rahbar K, Seifarth H, Schäfers M, Stegger L, Hoffmeier A, Spieker T, Tiemann K, Maintz D, Scheld HH, Schober O, Weckesser M. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med 2012; 53:856-63. [PMID: 22577239 DOI: 10.2967/jnumed.111.095364] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED In the diagnostic algorithm of cardiac tumors, the noninvasive determination of malignancy and metastatic spread is of major interest to stratify patients and to select and monitor therapies. In the diagnostic work-up, morphologic imaging modalities such as echocardiography or magnetic resonance tomography offer information on, for example, size, invasiveness, and vascularization. However, preoperative assessment of malignancy may be unsatisfactory. The aim of this study was to evaluate the diagnostic value of (18)F-FDG PET and the incremental diagnostic value of an optimized CT score in this clinical scenario. METHODS (18)F-FDG PET/CT scans (whole-body imaging with low-dose CT) of 24 consecutive patients with newly diagnosed cardiac tumors were analyzed (11 men, 13 women; mean age ± SD, 59 ± 13 y). The maximum standardized uptake values (SUV(max)) of the tumors were measured. Patients were divided into 2 groups: benign cardiac tumors (n = 7) and malignant cardiac tumors (n = 17) (cardiac primaries [n = 8] and metastases [n = 9]). SUV(max) was compared between the 2 groups. Results were compared with contrast-enhanced CT, using standardized criteria of malignancy. Histology served as ground truth. RESULTS Mean SUV(max) was 2.8 ± 0.6 in benign cardiac tumors and significantly higher both in malignant primary and in secondary cardiac tumors (8.0 ± 2.1 and 10.8 ± 4.9, P < 0.01). Malignancy was determined with a sensitivity of 100% and specificity of 86% (accuracy, 96%), after a cutoff with high sensitivity (SUV(max) of 3.5) was chosen to avoid false-negatives. Morphologic imaging reached a sensitivity of 82% and a specificity of 86% (accuracy, 83%). Both false-positive and false-negative decisions in morphology could be corrected in all but 1 case using a metabolic threshold with an SUV(max) of 3.5. In addition, extracardiac tumor manifestations were detected in 4 patients by whole-body (18)F-FDG PET/CT. CONCLUSION (18)F-FDG PET/CT can aid the noninvasive preoperative determination of malignancy and may be helpful in detecting metastases of malignant cardiac tumors.
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Affiliation(s)
- Kambiz Rahbar
- Department of Nuclear Medicine, University of Münster, Münster, Germany.
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20
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Look Hong NJ, Pandalai PK, Hornick JL, Shekar PS, Harmon DC, Chen YL, Butrynski JE, Baldini EH, Raut CP. Cardiac Angiosarcoma Management and Outcomes: 20-Year Single-institution Experience. Ann Surg Oncol 2012; 19:2707-15. [DOI: 10.1245/s10434-012-2334-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Indexed: 11/18/2022]
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21
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22
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Angiosarcoma Arising from Right Atrium: Remarkable Response to Concurrent Chemoradiotherapy with Carboplatin and Paclitaxel. J Thorac Oncol 2011; 6:970-1. [DOI: 10.1097/jto.0b013e318215a22b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Treatment of Cardiac Angiosarcoma with Radiation and Docetaxel: A Case Report with Partial Response and Prolonged Stable Disease. J Thorac Oncol 2011; 6:834-5. [DOI: 10.1097/jto.0b013e31820c2f18] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Uto T, Bando M, Yamauchi H, Nakayama M, Ohata M, Mato N, Nakaya T, Yamasawa H, Kawai T, Sugiyama Y. Primary cardiac angiosarcoma of the right auricle with difficult-to-treat bilateral pleural effusion. Intern Med 2011; 50:2371-4. [PMID: 22001468 DOI: 10.2169/internalmedicine.50.5751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old woman was admitted to our hospital with pleuritis and pericarditis. Cytological examination of pleural and pericardial effusion, and pleural biopsy specimens under thoracoscopy revealed no specific pathological findings. The pleural effusion was drained continuously; however, she died of circulatory insufficiency at day 45 from admission. At autopsy, a fragile hemorrhagic mass arising from the right auricle had invaded bilateral pleura and the pericardium directly without distant metastasis. Immunohistochemical staining showed that the tumor cells expressed endothelial markers such as CD31 and CD34 antibodies, and factor VIII-related protein. These findings supported the diagnosis of a poorly differentiated angiosarcoma.
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Affiliation(s)
- Tomohiro Uto
- Division of Pulmonary Medicine, Jichi Medical University, Japan.
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26
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Metastatic angiosarcoma arising from the right atrium: unusual presentation and excellent response to treatment in a young patient. J Thorac Oncol 2010; 5:1301-2. [PMID: 20661090 DOI: 10.1097/jto.0b013e3181dd1c78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Candeias CM, Luís I, Ribeiro J, Costa L, de Almeida LS, Gomes MM, Barreto L, Brito-Avô L, Ducla-Soares JL. Extended remission of metastatic epithelioid angiosarcoma of the heart with liposomal doxorubicin. BMJ Case Rep 2010; 2010:bcr08.2009.2157. [PMID: 22347886 DOI: 10.1136/bcr.08.2009.2157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Angiosarcoma is the most common primary malignant tumour of the heart. It is a rare and aggressive neoplasm that almost always has a short and fatal evolution. By the time it produces symptoms it has usually progressed to a mass causing haemodynamic compromise. Initial presentation with metastatic disease is unusual. We report the case of a 72-year-old man who presented with painful skin lesions on both hands. The skin biopsy was diagnosed as intravascular metastasis of epithelioid angiosarcoma. Body computed tomography scan disclosed a solid mass in the left atrium. The tumour was judged unresectable and the patient was treated with systemic chemotherapy, consisting of liposomal doxorubicin, which resulted in a complete clinical response. The patient remains free of disease after 48 months of follow-up. The excellent clinical evolution of our patient verifies that liposomal doxorubicin may be effective in the treatment of these tumours and significantly prolong patients' lifespan.
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A case of right atrial angiosarcoma: The utility of PET and CT fusion imaging in detecting a malignant cardiac tumor. J Cardiol Cases 2009; 1:e84-e87. [PMID: 30615737 DOI: 10.1016/j.jccase.2009.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 11/22/2022] Open
Abstract
A 49-year-old woman was admitted to the hospital because of cardiac tamponade. The hemorrhagic pericardial effusion was cytologically negative for malignant cells. Cardiac magnetic resonance imaging showed two masses in the anterior and lateral right atrium; however, positron emission tomography (PET) image using 18F-fluorodeoxyglucose revealed strong uptake in the anterior right atrium, without other tumors or metastasis. Intraoperatively, the lateral mass was confirmed as a thrombus, whereas the anterior mass was removed surgically and was diagnosed as an angiosarcoma with histopathological examination. However, she was re-admitted to the hospital 1 month after the operation because of cerebral hemorrhage, suspicious of distant metastasis. PET is useful for the detection of cardiac angiosarcoma.
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Cardiac angiosarcoma: a case report and review of the literature. Cardiovasc Pathol 2009; 19:e69-74. [PMID: 19150248 DOI: 10.1016/j.carpath.2008.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 09/17/2008] [Accepted: 10/12/2008] [Indexed: 12/20/2022] Open
Abstract
We present the case of a 36-year-old woman with widespread metastatic cardiac angiosarcoma to the lungs and the liver. She was treated with preoperative chemotherapy and underwent extensive surgical resection of the cardiac mass and is currently doing well. Analysis of the effectiveness of various treatment modalities from cases which have been reported has also been reviewed and discussed.
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