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Garcia JJB, Pascual JLV. Cancer-associated stroke from progressive acinic cell carcinoma. BMJ Case Rep 2024; 17:e260385. [PMID: 38789271 DOI: 10.1136/bcr-2024-260385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
Cancer-associated stroke is an evolving subgroup of embolic strokes of undetermined source. A man in his mid-20s with progressive follicular variant acinic cell carcinoma of the parotid was admitted because of new onset left-sided weakness. Neuroimaging confirmed a right middle cerebral artery infarction. After extensive diagnostics, stroke aetiology was deemed from cancer-induced hypercoagulability. Questions which arose regarding his management included (1) What was the best antithrombotic for secondary stroke prevention? (2) What was his risk for intracranial or tumorous bleeding once antithrombotics had been started? (3) How many days post-stroke could the antithrombotic be initiated? and (4) When could he be cleared for palliative chemotherapy and whole brain irradiation? The approach to address the abovementioned questions in the management of a rare cancer complicated by stroke is presented. Although treatments are guided by known pathomechanisms, additional studies are needed to further support current treatment strategies for this subgroup of patients.
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Affiliation(s)
- Jao Jarro Borromeo Garcia
- Department of Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Metro Manila, Philippines
| | - Jose Leonard Vr Pascual
- Department of Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Metro Manila, Philippines
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2
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Hussain SMA. Lung cancer embolization causing acute limb ischemia: a case report. J Med Case Rep 2023; 17:56. [PMID: 36797755 PMCID: PMC9936652 DOI: 10.1186/s13256-023-03769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Acute tumour embolism to the popliteal artery resulting in limb-threatening ischemia is a rare complication of neoplastic disease. Generally, tumors embolize to the pulmonary circulation via the venous system. In this case, the originating tumor was a lung cancer of a large size and advanced stage that had invaded the left atrium of the heart and disseminated in the systemic circulation. The tumor likely fragmented, resulting in showering to the right popliteal artery, superior mesenteric artery, and left renal artery, which is a unique presentation of tumor embolism. CASE REPORT We present a case of a 62-year-old Caucasian gentleman with a large left lower lobe squamous cell lung cancer that had invaded into the left atrium via the pulmonary veins. He presented with acute limb threatening ischemia. A computed tomographic angiogram revealed an occlusion of the left popliteal artery as well as embolization to the superior mesenteric artery and the right renal artery. He was started on intravenous heparin and underwent an emergency popliteal embolectomy and calf fasciotomies, which was limb saving. His fasciotomy wounds were closed after 1 week and he was discharged on anticoagulation. CONCLUSION This is a rare case of tumor embolism resulting in both an embolectomy and calf fasciotomies. In the light of such cases, we suggest that tumors invading the bloodstream should be considered high risk for embolization and hypothesize that prophylactic antithrombotic therapy may avoid major morbidity.
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3
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Bagai S, Malik V, Prasad P, Singh P, Sahu A, Khullar D. Poorly Differentiated Lung Cancer with Intracardiac Extension Causing Malignant Stroke in a Peritoneal Dialysis Patient: a Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:255. [PMCID: PMC9662106 DOI: 10.1007/s42399-022-01331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Sahil Bagai
- Department of Nephrology and Renal Transplant Medicine, Max Super Speciality Hospital, Saket, Delhi India
| | - Vipra Malik
- Department of Pathology, Core Diagnostics Pvt Ltd, Gurugram, India
| | - Pallavi Prasad
- Department of Nephrology and Renal Transplant Medicine, Max Super Speciality Hospital, Saket, Delhi India
| | - Priyanka Singh
- Department of Radion Oncology, Max Super Speciality Hospital, Saket, Delhi India
| | - Amit Sahu
- Department of Radiology, Max Super Speciality Hospital, Saket, Delhi India
| | - Dinesh Khullar
- Department of Nephrology and Renal Transplant Medicine, Max Super Speciality Hospital, Saket, Delhi India
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4
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Tumor embolism and acute arterial occlusion: A systematic review. Surg Open Sci 2022; 10:216-222. [DOI: 10.1016/j.sopen.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
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5
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Andryukhova ES, Tashireva LA, Isaeva AV, Vtorushin SV, Zavyalova MV, Perelmuter VM. The Rarity of Metastasis to the Spleen — a Phenomenon with an Unknown Mechanism. Bull Exp Biol Med 2022; 173:575-582. [DOI: 10.1007/s10517-022-05591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Indexed: 11/05/2022]
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6
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Tanaka C, Sakamaki F, Furuya H, Yamaguchi M, Kanabuchi K, Kuwaki K. Acute Limb Ischemia Caused by Embolus of Primary Lung Cancer Complicating Trousseau’s Syndrome. Ann Vasc Dis 2022; 15:64-67. [PMID: 35432655 PMCID: PMC8958403 DOI: 10.3400/avd.cr.21-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022] Open
Abstract
Limb ischemia caused by tumor embolus is rare. In this study, we report the case of a 77-year-old woman who suffered from acute ischemic limb. Computed tomography showed a tumor in the right bronchus invading the left atrium. The tumor fragments scattered resulting in the occlusion of the right iliac artery. The excluded embolus was revealed as a squamous cell carcinoma. Regarding the popliteal venous thrombus, Trousseau’s syndrome was complicated. The patient was discharged without any complications. We believe that advanced lung cancer is a differential diagnosis of acute ischemic limbs and that successful limb rescue contributed to a patient’s quality of life.
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Affiliation(s)
- Chiharu Tanaka
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital
| | - Fumio Sakamaki
- Department of Respiratory Medicine, Tokai University Hachioji Hospital
| | - Hidekazu Furuya
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital
| | - Masaomi Yamaguchi
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital
| | - Kazuo Kanabuchi
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital
| | - Kenji Kuwaki
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital
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7
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Harnarayan P, Islam S, Naraynsingh V. Arterial Embolism in Malignancy: The Role of Surgery. Ther Clin Risk Manag 2021; 17:635-640. [PMID: 34177265 PMCID: PMC8219304 DOI: 10.2147/tcrm.s308026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Peripheral arterial embolism from malignant disease is uncommon and a rare cause of limb ischemia. In the acute setting, patients can present with severe ischemia of either the upper or lower limb, and urgent surgical intervention is often required to avoid severe debilitation and limb loss. Patients Our case series comprised three patients who presented with upper and lower limb ischemia and were found to have concomitant malignancy. All three patients were female, with a median age of 54.3 years, and none of the patients was on active chemotherapy. One presented with stage IIb uterine carcinoma, one with stage IIIb ovarian carcinoma, and the other with stage IIIb cervical carcinoma. These patients were referred for vascular management, with two being acute and the other acute on chronic. Results Of the three patients, two presented with acute limb ischemia and underwent arterial thrombectomy, one of the upper and the other the lower limb. The third patient, with acute-on-chronic upper limb ischemia, was treated conservatively with intravenous heparin followed by oral anticoagulation. All three had limb salvage and survival outcome at 1 year post-treatment. Conclusion In this small series, surgical intervention in two patients and conservative management in the other patient led to limb salvage with a reasonably good quality of life. Even though the long-term survival for patients with malignant disease is generally poor, surgical intervention can achieve limb salvage with a reasonably good quality of life.
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Affiliation(s)
- Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shariful Islam
- Department of Surgery, San Fernando General & Teaching Hospitals, San Fernando, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, Medical Associates Hospital, St. Joseph, Trinidad and Tobago
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8
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Tsubouchi K, Ibusuki R, Makisumi K, Okamoto H, Iwasaki T, Okamatsu Y, Inoue K, Harada T. Tumor Embolism as a Cause of Renal Artery Occlusion and Acute Kidney Injury Diagnosed and Treated with Endovascular Intervention in a Patient with Mediastinal Undifferentiated Sarcoma. Intern Med 2021; 60:1907-1910. [PMID: 33456039 PMCID: PMC8263193 DOI: 10.2169/internalmedicine.6249-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 72-year-old man presented with back pain due to a mass in the left posterior mediastinum that had surrounded and partly infiltrated the descending aorta. Mediastinal undifferentiated sarcoma was diagnosed. After the diagnosis, sudden anuria was observed. Contrast-enhanced computed tomography revealed an enhancement defect at the origins of the bilateral renal arteries. He received catheter-directed thrombolysis and was weaned off dialysis. The aspirated artery thrombus contained tumor cells, proving our diagnosis of acute kidney injury secondary to bilateral renal artery tumor embolism. In cancer patients, endovascular intervention may be a useful diagnostic and therapeutic option in cases of acute kidney injury secondary caused by peripheral thromboembolic complications.
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Affiliation(s)
- Kazuya Tsubouchi
- Department of Respiratory Medicine, Japan Community Health Care Organization Kyushu Hospital, Japan
| | - Ritsu Ibusuki
- Department of Respiratory Medicine, Japan Community Health Care Organization Kyushu Hospital, Japan
| | - Kenji Makisumi
- Department of Radiology, Japan Community Health Care Organization Kyushu Hospital, Japan
| | - Hirofumi Okamoto
- Department of Nephrology, Japan Community Health Care Organization Kyushu Hospital, Japan
| | - Takeshi Iwasaki
- Department of Pathology, Japan Community Health Care Organization Kyushu Hospital, Japan
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yuki Okamatsu
- Department of Respiratory Medicine, Japan Community Health Care Organization Kyushu Hospital, Japan
| | - Katsuhiro Inoue
- Department of Respiratory Medicine, Japan Community Health Care Organization Kyushu Hospital, Japan
| | - Taishi Harada
- Department of Respiratory Medicine, Japan Community Health Care Organization Kyushu Hospital, Japan
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9
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Mordhorst A, Baxter K. Acute mesenteric ischemia leading to diagnosis of advanced spindle cell carcinoma of the lung. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:557-561. [PMID: 33134642 PMCID: PMC7588807 DOI: 10.1016/j.jvscit.2020.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Abstract
Acute ischemic events secondary to pulmonary malignancy are rare. Those who present with acute peripheral arterial occlusions from malignant sources will typically have advanced pulmonary malignancy or myxomatous tumors. A 79-year-old woman had presented to Vancouver General Hospital with acute mesenteric ischemia. The pathology reports after embolectomy indicated cell morphology consistent with spindle cell carcinoma of the lung. Imaging investigations revealed a right upper lobe mass not present on chest imaging studies performed 14 months previously. The findings from the present report serves to remind us that acute ischemic events in the setting of no known history of malignancy or cardiac disease should prompt investigations into possible malignant sources.
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Affiliation(s)
- Alexa Mordhorst
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith Baxter
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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10
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[Hemoglobin drop after thrombolytic therapy in a 57-year-old stroke patient with "erosive gastritis"]. Internist (Berl) 2020; 61:746-753. [PMID: 32533196 DOI: 10.1007/s00108-020-00818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 57-year-old woman underwent esophagogastroduodenoscopy due to a continuous drop in hemoglobin levels reaching 7.4 g/dl after treatment with intravenous thrombolytic therapy 1 week earlier because of an ischemic insult. Numerous erosive lesions were found in the gastric corpus. Histological staining of a specimen from the gastric lesions revealed a poorly differentiated adenocarcinoma. Immunohistochemical examination confirmed the diagnosis of gastric metastasis from lung cancer based on positive staining for thyroid transcriptional factor‑1 (TTF-1) and cytokeratin 7 (CK7) as well as via negative staining for caudal-type homeobox‑2 (CDX-2). Chest computed tomography demonstrated a mediastinal mass, measuring 3.2 cm and involving the cervical and supraclavicular lymph nodes. A lymph node was subsequently extirpated. Immunohistochemical examination confirmed the diagnosis of lymph node metastasis from lung cancer by positive staining for TTF‑1 and CK7. Symptomatic gastric metastasis from lung cancer is an extremely rare clinical entity. Transesophageal echocardiography detected a mass measuring 1.6 cm at the mitral valve with pericardial effusion. On the basis of the echocardiographic findings, a malignant origin was suggested after exclusion of infectious endocarditis. We assumed that the multiple organ infarctions (spleen, kidney, and brain) and gastric hematogenous metastasis must have been caused by disseminated arterial tumor embolism from the intracardiac metastasis. The patient was treated palliatively and died.
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11
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Atrial invasion and showering phenomenon in primary lung cancer: A case report. Respir Med Case Rep 2020; 30:101064. [PMID: 32382497 PMCID: PMC7199007 DOI: 10.1016/j.rmcr.2020.101064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/21/2020] [Indexed: 12/25/2022] Open
Abstract
Advanced lung cancer can have numerous extra-pulmonary complications. Due to the proximity to the heart, cardiac invasion and the subsequent seeding of the tumor into the vascular system present numerous challenges in physician team care coordination. Here we have a 55-year-old male who presented with stroke symptoms in the setting of undiagnosed advanced lung cancer complicated by direct tumor invasion into the left atria and mixed embolic showering phenomenon and thrombotic hypercoagulability. Review of both the embolic showering phenomenon and hypercoagulability will be discussed as both can result in embolic occlusion or metastatic seeding at distant sites. Fewer than ten cases of spontaneous tumor embolization resulting from lung cancer invasion of the pulmonary vein have been reported. Poor prognosis of advanced lung cancer requires delicate, yet pragmatic conversations between care teams and the patient. Lung cancer has potential sequelae that extend well beyond confines of pulmonary pleura. Caution is needed when differentiating between tumor extension and metastatic seeding for atrial masses in the setting of lung cancer. The showering phenomenon of tumor emboli should be considered when presented with stroke symptoms that cannot be attributed to a unilateral deficit or when multiple areas of the brain are affected.
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12
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Cleary C, Laskey D, Shapiro M, Paolillo S, Harrison S. Acute Lower Extremity Ischemia Following Thoracotomy Owing to Arterial Tumor Emboli. Ann Thorac Surg 2019; 108:e323-e324. [DOI: 10.1016/j.athoracsur.2019.03.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
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13
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Chandra R, Abugroun A, Goldberg A, Cooney E, Mehrotra S, Volgman A. Small Cell Lung Cancer Invading the Left Atrium With Subsequent Malignant Embolic Stroke: A Case Report and Review of Literature. Cardiol Res 2019; 10:188-192. [PMID: 31236182 PMCID: PMC6575106 DOI: 10.14740/cr752w] [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: 06/23/2018] [Accepted: 09/22/2018] [Indexed: 11/24/2022] Open
Abstract
Cardiac tumors are uncommon, and the vast majority of them are metastases from extracardiac sources. Metastatic spread to the heart causes symptoms by mechanical obstruction of circulation, direct myocardial invasion, or distal embolization. We herein report a case of a 58-year-old male who presented to the hospital with multilobar intracranial embolic infarcts who was found to have small cell lung cancer (SCLC) with invasion of the left atrium and pulmonary artery resulting in malignant embolic stroke. Cerebral tumor thromboembolism from SCLC is extremely rare. This case demonstrates the thromboembolic risk associated with metastatic endoluminal cardiac tumors.
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Affiliation(s)
| | | | | | | | - Swati Mehrotra
- Department of Pathology, Stritch School of Medicine of Loyola University, Maywood, IL 60153, USA
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Şeker M, Erol C. Left atrial extension of metastatic renal cell carcinoma via pulmonary vein: A case report. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.450495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Bao T, Xiao F, Liu D, Guo Y, Liang C. [Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:24-31. [PMID: 29357969 PMCID: PMC5972358 DOI: 10.3779/j.issn.1009-3419.2018.01.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy. METHODS From August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study. RESULTS Of the 11 patients (mean age of 57.9), 7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min (210 min-380 min), with an average of 436 mL (100 mL-1,600 mL) blood loss. One patient (9.1%) died within 90 days after surgery, and another 4 cases (36.4%) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia. Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as pT4N0M0 while 4 cases were staged as pT4N1M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7%, the median disease-free survival time was 31 months, the 3-year overall survival rate was 49.1% and the median overall survival time was 33 months. CONCLUSIONS For selected patients of non-small cell lung cancer complicated with left atrial tumor thrombus, choose a reasonable surgical approach to resect both the tumor and the thrombus, strengthen the perioperative management and apply neoadjuvant/adjuvant radiotherapy and/or chemotherapy, might obtain satisfying prognosis.
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Affiliation(s)
- Tong Bao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fei Xiao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yongqing Guo
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Lioudaki S, Kontopodis N, Palioudakis S, Koutsopoulos AV, Drositis I, Ioannou CV. Acute aortic occlusion due to tumor embolism in a patient with lung malignancy. SAGE Open Med Case Rep 2017; 5:2050313X17720627. [PMID: 28781880 PMCID: PMC5521335 DOI: 10.1177/2050313x17720627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Acute lower limb ischemia caused by tumor embolization is rare, despite the fact that cancer is a common cause of hypercoagulability predisposing to venous thrombosis. Arterial embolization is mostly associated with intracardiac tumors while lung malignancies are the second most common cause of tumor embolism. METHODS In this report, we present a male patient who developed acute bilateral lower limb ischemia in the immediate postoperative period after a thoracotomy for attempted left upper lobe resection for lung cancer. RESULTS The patient was treated with a subclavian-bifemoral bypass, since an initial attempted embolectomy was unsuccessful. Histopathological characteristics of thrombus obtained during embolectomy were consistent with the histopathology of the primary tumor. CONCLUSION Acute ischemia is an emergency that should be diagnosed and treated immediately. Interestingly, in this case, the presence of epidural anesthesia masked the initial symptoms and delayed diagnosis. Preoperative assessment with transesophageal echocardiography may reveal patients at high risk for tumor embolism.
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Affiliation(s)
- Stella Lioudaki
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Stefanos Palioudakis
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
| | | | - Ioannis Drositis
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
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17
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Ohshima K, Tsujii Y, Sakai K, Oku H, Morii E. Massive tumor embolism in the abdominal aorta from pulmonary squamous cell carcinoma: Case report and review of the literature. Pathol Int 2017; 67:467-471. [DOI: 10.1111/pin.12554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Kenji Ohshima
- Department of Pathology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Yuri Tsujii
- Department of Emergency Medicine; Saiseikai Senri Hospital; Osaka Japan
| | - Kazuya Sakai
- Department of Emergency Medicine; Saiseikai Senri Hospital; Osaka Japan
| | - Hiroshi Oku
- Department of Emergency Medicine; Saiseikai Senri Hospital; Osaka Japan
| | - Eiichi Morii
- Department of Pathology; Osaka University Graduate School of Medicine; Osaka Japan
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18
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Wang W, Li X, Song W, Zhang Y, Yue C, Shang L, Li J, Wen F, Liu J, Zha P. An Atypically Large, Free-Floating Thrombus Extending From the Lung to the Left Atrium via a Pulmonary Vein: A Case Report. Medicine (Baltimore) 2015; 94:e1853. [PMID: 26579798 PMCID: PMC4652807 DOI: 10.1097/md.0000000000001853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
An atypically large, free-floating thrombus extending from primary pulmonary malignancy into the left atrium (LA) is a rare phenomenon. Here, we report a 61-year-old man presenting with a large mass in the lower lobe of the left lung, extending to LA via the left inferior pulmonary vein.The thrombus remained clinically silent and was detected by computed tomography (CT) and transthoracic echocardiography. To prevent life-threatening complications including systemic embolism and sudden death, the patient underwent surgical excision of the mass under cardiopulmonary bypass. Pathology of the tumor and the embolus was confirmed as moderately differentiated squamous cell carcinoma. Furthermore, immunohistochemical studies demonstrated consistency of the tumor cells in this pathological category.The patient tolerated the surgery well and his condition began to improve gradually after the operation.
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Affiliation(s)
- Wei Wang
- From the Department of Thoracic Surgery (WW, XL, WS, CY, LS, JL, FW, JL, PZ) and Department of Ultrasound (YZ), PLA Navy General Hospital, Beijing, China
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19
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Inra ML, Allen MS. Lung Cancer With Tumor Emboli. Ann Thorac Surg 2015; 100:295-7. [PMID: 26140769 DOI: 10.1016/j.athoracsur.2014.08.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 07/29/2014] [Accepted: 08/08/2014] [Indexed: 11/27/2022]
Abstract
We report a case of squamous cell lung carcinoma that invaded the left atrium through the left pulmonary vein. This patient had two episodes of systemic embolism before diagnosis. The second episode was treated with embolectomy, and the pathology analysis showed squamous cell carcinoma. The tumor was surgically resected, using cardiopulmonary bypass to resect the intracardiac portion. We discuss causes of tumor emboli in lung cancer and surgical treatment.
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Affiliation(s)
- Matthew L Inra
- General Thoracic Surgery Department, Mayo Clinic, Rochester, Minnesota.
| | - Mark S Allen
- General Thoracic Surgery Department, Mayo Clinic, Rochester, Minnesota
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Xiao F, Bao T, Chen J, Liang C, Ye Z, Guo Y. Video-assisted thoracoscopic surgery in the treatment of non-small-cell lung cancer complicated with left atrial tumor thrombus. Thorac Cancer 2015; 7:154-8. [PMID: 26816551 PMCID: PMC4718128 DOI: 10.1111/1759-7714.12289] [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: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022] Open
Abstract
We report a case of pulmonary squamous cell carcinoma complicated with a tumor thrombus in the left atrium. The left atrial tumor thrombus, together with the left lower lobe, was removed via complete video‐assisted thoracoscopic surgery (VATS), with cardiopulmonary bypass standby. The patient recovered well from surgery, received four cycles of postoperative chemotherapy, and is now under follow‐up at the outpatient clinic. Although the optimal treatment is still controversial, simultaneous VATS and atriotomy under the premise of preoperative evaluation of the thrombus, including size and extent, might prevent systemic embolization and sudden death, alleviate the wound, promote postoperative rehabilitation, and improve prognosis in selected patients.
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Affiliation(s)
- Fei Xiao
- Department of Thoracic Surgery China-Japan Friendship Hospital Beijing China
| | - Tong Bao
- Department of Thoracic Surgery China-Japan Friendship Hospital Beijing China
| | - Jingyu Chen
- Department of Thoracic Surgery China-Japan Friendship Hospital Beijing China
| | - Chaoyang Liang
- Department of Thoracic Surgery China-Japan Friendship Hospital Beijing China
| | - Zhidong Ye
- Department of Cardiac Surgery China-Japan Friendship Hospital Beijing China
| | - Yongqing Guo
- Department of Thoracic Surgery China-Japan Friendship Hospital Beijing China
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