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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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Zuler M, Offenbacher J, Deri Y, Berzon B. Concomitant intravascular and extravascular obstructive shock: a case report of cardiac angiosarcoma presenting with pericardial tamponade. Clin Exp Emerg Med 2022; 9:150-154. [PMID: 35843617 PMCID: PMC9288883 DOI: 10.15441/ceem.20.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/18/2020] [Indexed: 11/26/2022] Open
Abstract
Atraumatic pericardial tamponade and intracardiac masses are both recognized etiologies of acute obstructive shock. Pericardial tamponade, is a cardiovascular emergency commonly considered by emergency physicians and, as a result, evaluation for this process has been incorporated into standardized point of care ultrasound algorithms for assessing hypotension. Obstructive shock secondary to intracardiac tumors is an atypical clinical presentation, and although it is evaluated by the same ultrasound imaging modality, it is generally not considered or evaluated for in the emergency department setting. The concomitant presentation of these two pathologic processes is an extremely rare oncologic emergency. Existing literature on the subject is found in a small number of case reports with nearly no prior descriptions in emergency medicine references. In the right clinical context this unique presentation should be considered and evaluated for in the emergency department via point of care ultrasound modality to help guide in the management of the resulting obstructive shock.
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van Wyk G, Weich H, Joubert Z, de Jager LJ, McCree K, John TJ. Extensive pulmonary metastases in young boy with primary cardiac angiosarcoma: a case report. Eur Heart J Case Rep 2021; 5:ytaa473. [PMID: 33644646 PMCID: PMC7898572 DOI: 10.1093/ehjcr/ytaa473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Malignant primary cardiac neoplasms are rare and primary cardiac angiosarcoma is the most common and aggressive subtype. It most commonly presents in middle-aged males and due to its non-specific clinical presentation, the diagnosis is often delayed until advanced disease is already present. Clinical presentation is determined by manifestations of local infiltration or metastatic disease and making an early diagnosis is extremely challenging. CASE SUMMARY A 15-year-old previously healthy boy was admitted to the emergency department with a history of pathological weight loss and functional decline. The patient was found to have a left-sided pneumothorax as well as bilateral diffusely spread pulmonary nodules on plain chest radiograph. Computed tomography chest confirmed widespread pulmonary metastases and a right atrial filling defect. Echocardiography revealed a right atrial tumour and transvenous endomyocardial biopsy of the tumour was done under fluoroscopic and echocardiographic guidance. A diagnosis of primary cardiac angiosarcoma was made. The patient demised shortly after presentation. DISCUSSION Primary cardiac angiosarcoma is rare and even more so in patients as young as the case described. The diagnostic process poses several challenges to the clinician, of which the obtaining of a histological sample is one. This case report demonstrates aspects both unique and typical of this rare disease. It also describes an effective option for obtaining tissue for a histological diagnosis in patients whose clinical condition may not allow biopsy under general anaesthesia.
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Affiliation(s)
- Gerhard van Wyk
- Department of Internal Medicine, Karl Bremer Hospital, Mike Pienaar Boulevard, Cape Town 7530, South Africa
| | - Hellmuth Weich
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Academic Hospital, Francie van Zijl Avenue, Cape Town 7505, South Africa
| | - Zirkia Joubert
- Department of Internal Medicine, Karl Bremer Hospital, Mike Pienaar Boulevard, Cape Town 7530, South Africa
| | - Louis Johann de Jager
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Francie van Zijl Avenue, Cape Town 7505, South Africa
| | - Kevin McCree
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Francie van Zijl Avenue, Cape Town 7505, South Africa
| | - Thadathilankal-Jess John
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Academic Hospital, Francie van Zijl Avenue, Cape Town 7505, South Africa
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Abstract
BACKGROUND Primary cardiac angiosarcoma is rare, but it is the most aggressive type of cardiac malignant tumor. When disease is confirmed it is often late in its stage resulting in a poor prognosis. CASE PRESENTATION We reported a 52-year-old woman who complained of dyspnea for 2 months and dry cough for 10 days. Computed tomography (CT), F-fluorodeoxyglucose (F-FDG), positron emission tomography-computed tomography (PET-CT), and transthoracic echocardiography showed a space-occupying lesion 7 cm × 5 cm × 5 cm in the right atrium. Malignant cells can be seen in pericardial fluid by pericardiocentesis in local hospital, but not be diagnosed definitely. We conducted CT-guided biopsy of the tumor and observed the necrotic tissues. An exploratory thoracotomy was performed and histological examination confirmed angiosarcoma. Unable to be surgical excision due to infiltrating widely, the patients received chemotherapy with docetaxel for 2 cycles and the disease was progressive. Antiangiogenesis-targeted therapy was combined with chemotherapy for 3 months. Unfortunately, the tumor was still in progress. She died of respiratory failure, survived for 10 months. CONCLUSION It is difficult to diagnose the primary cardiac angiosarcoma in early stage. Chemotherapy and target therapy are very limited in this case. Surgery remains the preferred treatment for patients with primary cardiac angiosarcoma. More efforts should be carried out on the effective diagnosis and multimodality treatment for this malignant disease.
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Affiliation(s)
| | - Lu Li
- Department of Thoracic Surgery
| | | | | | - Jihua Wu
- Department of Pathology, the 306th Hospital of PLA, Beijing, China
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Sanli M, Tuncozgur B, Sevinc A, Daglar B, Bakir K, Elbeyli L. Surgical Treatment of a Giant Primary Cardiac Angiosarcoma. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 51:237-9. [DOI: 10.14712/18059694.2017.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Primary cardiac angiosarcoma is a rare tumor, and surgical resection is often required to relieve its symptoms. A 54-year-old male with a large primary cardiac angiosarcoma is described in this case report. The tumor was located in the right atrium and right ventricle. The bulk was resected with the right coronary artery (RCA), and partial right atrium and partial right ventricle resections were performed during cardiopulmonary bypass. The resected tumor measured 15 x 10 x 8 cm, and the histopathological diagnosis was well differentiated primary cardiac angiosarcoma. In the postoperative period, the patient was followed up for 22 months, and radiotherapy and chemotherapy were performed for metastases. The optimal therapy for cardiac angiosarcoma is still controversial, but combined treatment including surgical resection should be considered.
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Kupsky DF, Newman DB, Kumar G, Maleszewski JJ, Edwards WD, Klarich KW. Echocardiographic Features of Cardiac Angiosarcomas: The Mayo Clinic Experience (1976-2013). Echocardiography 2015; 33:186-92. [PMID: 26460068 DOI: 10.1111/echo.13060] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Cardiac angiosarcoma is the most common primary malignant cardiac tumor. The dismal prognosis and nonspecific symptomatology underscore the need for an accurate and cost-effective approach to the identification and characterization of this rare tumor. METHODS Mayo Clinic tissue registry archives were queried for all histologically confirmed cases of cardiac angiosarcoma (1976-2013) with available imaging data. Echocardiograms were retrospectively reviewed. RESULTS Thirty-three cases of cardiac angiosarcoma were identified; of these, 17 had echocardiograms available (mean age, 46 years; six men). Transthoracic echocardiography (TTE) as the initial diagnostic test had 75% sensitivity for visualizing primary cardiac angiosarcoma (9/12 patients). Tumor extension into the pericardium was common and pericardial effusion was present in 15 patients (88%); however, pericardial fluid cytology was negative for malignancy in all tested patients (n = 15). Left ventricular ejection fraction (LVEF) was preserved in 16 patients (94%) (average LVEF, 62%). Right ventricular function was mildly reduced in two patients (12%) at initial presentation. Tricuspid valve obstruction was present in three patients (18%; mean diastolic gradient, 6.3 mmHg [range, 3-11 mmHg]). CONCLUSION The sensitivity of TTE as the first diagnostic imaging modality compared favorably with computed tomography. Pericardial effusion was common, but pericardial fluid cytology was negative in all patients who underwent pericardiocentesis. The absence of a stalk was a universal finding that may help distinguish angiosarcoma from benign, primarily pedunculated tumors such as myxoma and papillary fibroelastoma.
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Affiliation(s)
- Daniel F Kupsky
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Darrell B Newman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Gautam Kumar
- Division of Cardiology, Emory University School of Medicine/Atlanta VA Medical Center, Atlanta, Georgia
| | - Joseph J Maleszewski
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Kyle W Klarich
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Tembani-Munyandu NC, Makunike-Mutasa R, Katsidzira L, Chinogureyi A. An unusual cause of a large fibrinous pericardial effusion. Cardiovasc J Afr 2015; 26:e7-e10. [PMID: 26592992 PMCID: PMC4763481 DOI: 10.5830/cvja-2014-075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/01/2014] [Indexed: 11/06/2022] Open
Abstract
The commonest cause of a large fibrinous pericardial effusion in sub-Saharan Africa is tuberculosis. There are, however, limited resources available for making a definitive diagnosis of tuberculous pericarditis. The diagnosis is largely based on clinical criteria. There is a risk of misdiagnosing less-common causes of large fibrinous pericardial effusions. We present a patient who had a pericardial angiosarcoma that was initially thought to be a tuberculous pericardial effusion, and discuss the challenges in making a definitive diagnosis of tuberculosis.
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Affiliation(s)
| | - Rudo Makunike-Mutasa
- Department of Histopathology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Leolin Katsidzira
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Andrew Chinogureyi
- Department of Radiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Buresly KM, Shukkur AM, Uthaman B. Unusual survival time of primary cardiac sarcoma of the right ventricle. Heart Views 2011; 12:35-8. [PMID: 21731808 PMCID: PMC3123515 DOI: 10.4103/1995-705x.81552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary cardiac sarcomas are rare tumors with unfavorable prognosis. We report a 69-year-old male with a right ventricular mass diagnosed as primary malignant cardiac sarcoma with unexpected long survival of 16.5 months.
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Outcomes after right-side heart sarcoma resection. Ann Thorac Surg 2011; 91:770-6. [PMID: 21352995 DOI: 10.1016/j.athoracsur.2010.09.079] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/28/2010] [Accepted: 09/30/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND In patients with primary cardiac sarcoma, the tumor's location is more important than cell type in determining patient presentation, therapy options, and outcomes. The purpose of the current study was to investigate the outcomes after right-side heart sarcoma resection. METHODS Clinicopathologic data from patients who underwent right-side heart sarcoma resection at our institution and patients identified in a literature search were examined. Morbidity and the 30-day mortality rate and survival were determined. We used univariate and multivariate analyses to identify independent predictors of overall survival. RESULTS We identified 57 patients who underwent right-side heart sarcoma resection. Right-side heart failure was the most common complication (4 patients, 19%), and the 30-day mortality was 14% (3 patients). The overall 5-year survival rate was 17%, and the median overall survival duration was 9 months. Multivariate analyses revealed that surgical margin status was the only independent predictor of survival. Patients with negative surgical margins had a longer median overall survival duration (27 months versus 4 months) and a significantly higher overall 5-year survival rate (36% versus 0%; p = 0.0003) than patients with positive surgical margins. CONCLUSIONS The patients with right-side heart sarcoma resection had worse survival after resection than that reported for our patients who underwent resection for left-side heart sarcoma or pulmonary artery sarcoma. Because positive surgical margin status is an independent predictor of reduced survival, induction chemotherapy should considered to enhance resectability in right-side heart sarcoma patients, thus maximizing the possibility of obtaining negative surgical margins.
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Abstract
Prognosis of angiosarcoma, the most common primary malignant cardiac tumor, is very poor. An early detection and treatment may extend survival beyond one year. Newer imaging modalities, including magnetic resonance imaging (MRI), play an important role in the evaluation of cardiac masses. The case of a man admitted to the emergency room for a cardiac tamponade is reported. Thoracic computed tomography and MRI diagnosed a pericardial tumor, for which surgical biopsy revealed an angiosarcoma. Chemotherapy was started, and the patient survived for 28 months. Etiologies of hemorrhagic tamponades are discussed, as well as treatment of cardiac angiosarcoma.
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11
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Primary Cardiac Angiosarcoma: Morphologically Deceptive Benign Appearance and Potential Pitfalls in Diagnosis. Heart Lung Circ 2010; 19:473-5. [DOI: 10.1016/j.hlc.2010.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 01/07/2010] [Accepted: 02/28/2010] [Indexed: 11/19/2022]
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12
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Primary cardiac angiosarcoma: a fatal disease. Case Rep Med 2009; 2009:591512. [PMID: 19724650 PMCID: PMC2731464 DOI: 10.1155/2009/591512] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 07/08/2009] [Indexed: 11/17/2022] Open
Abstract
A 42-year-old man with a cardiac tamponade underwent an urgent pericardiotomy that showed tumoral tissue, covering the surface of the right atrium. The tumor was then partially excised, and the histological examination revealed the presence of a moderately-differentiated angiosarcoma. The patient was then referred to the oncology unit and scheduled for a chemotherapy schedule including Epirubicin (60 mg/m(2), on days 1 and 2) plus Ifosfamide (2000 mg/m(2), on days 1 to 3) and Uromitexan (2000 mg/m(2) at hours 0, 4, 8 after IFO). All drugs were administered every three weeks. After two cycles, a restaging work-up revealed a partial remission. The treatment was continued for another two cycles. A new evaluation by cardiac MRI evidenced a local and distant (lung) progression of disease. The patient died after three months. This paper confirms that cardiac angiosarcoma is a fatal disease, and the prognosis is usually 6-11 months from time of diagnosis.
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Abstract
Pericardial effusion may originate from a wide variety of underlying pathology. Primary cardiac malignancy should always be considered as a rare underlying cause. Angiosarcoma is the most common cardiac malignancy, which often arises as a mass in the right atrium. We describe a young patient with collapse due to pericardial effusion caused by a primary cardiac angiosarcoma. The case is an example of the difficulties and dilemmas which may be encountered in assessing the diagnosis of cardiac angiosarcoma.
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Umeda Y, Matsuno Y, Imaizumi M, Mori Y, Iwata H, Takiya H. Right atrial myxoma with tumor vascularity originated from the left and right coronary arteries. Int J Cardiol 2009; 131:e137-9. [PMID: 17961762 DOI: 10.1016/j.ijcard.2007.07.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 07/02/2007] [Indexed: 11/27/2022]
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El-Osta HE, Yammine YS, Chehab BM, Fields AS, Moore DF, Mattar BI. Unexplained Hemopericardium as a Presenting Feature of Primary Cardiac Angiosarcoma: A Case Report and a Review of the Diagnostic Dilemma. J Thorac Oncol 2008; 3:800-2. [DOI: 10.1097/jto.0b013e31817c9282] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim YG, Kim WJ, Park GM, Song JM, Kang DH, Song JK. Echocardiographic Diagnosis of Right Atrial Perforation due to Primary Cardiac Angiosarcoma Using Hand-Agitated Saline Contrast. J Cardiovasc Ultrasound 2008. [DOI: 10.4250/jcu.2008.16.3.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yong-Giun Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Jang Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyung-Min Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Nurkalem Z, Gorgulu S, Gumrukcu G, Eren M. Right atrial mass presenting as cardiac tamponade. Int J Cardiol 2006; 112:e20-2. [PMID: 16884795 DOI: 10.1016/j.ijcard.2006.02.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Accepted: 02/24/2006] [Indexed: 11/25/2022]
Abstract
Intracavitary tumors such as angiosarcomas are prone to embolize, and occlude valves and vessels. Intramyocardial tumors cause cardiac failure and arrhythmias. Pericardial tumors cause effusions which result in tamponade. It is very rare that an intracavitary tumor presents itself with a cardiac tamponade. A 32-year old woman presented to the emergency room with palpitation and shortness of breath. Her physical examination revealed pulsus paradoxus and jugular venous distention. The transthoracic echocardiography showed normal left ventricular function, and an intracavitary right atrial mass. As the patients clinical status deteriorated an emergency operation was performed. The hemorrhagic pericardial fluid was cytologically positive for malignant cells. Histopathological findings were indicative of an angiosarcoma.
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Affiliation(s)
- Duane S Pinto
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Fortmann T. H�morrhagisch unspezifischer Perikarderguss als Vorbote eines H�mangiosarkoms des rechten Herzens. ACTA ACUST UNITED AC 2004; 93:807-12. [PMID: 15492896 DOI: 10.1007/s00392-004-0124-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 05/19/2004] [Indexed: 10/26/2022]
Abstract
HISTORY A 45-year old woman presented at our hospital with intermittent fever in the last three weeks and progressive exertional dyspnea. In addition she suffered from physical asthenia. Seven months ago the patient was treated for symptomatic pericardial effusion in our clinic. INVESTIGATIONS Physical examination revealed a pale skin color, epigastric pain on palpation and intense exertional dyspnea. Laboratory tests indicated microcytic anemia and high levels of LDH and CRP. The diagnosis of a large tumor of the right atrium and ventricle was based on the transthoracic echocardiogram and thoracic CT scan. The extent of the right atrial and ventricular mass of 9 x 8 cm was detected by trans-esophageal echocardiography. The thoracic and abdominal CT scan showed multiple nodular infiltrates in the basal lung fields and a cystic tumorous mass in the liver. DIAGNOSIS The tumor developed in the short time of 7 months. Half a year ago, the transthoracic echocardiographic exam showed pericardial effusion with normal cardiac size, normal left ventricular function and no evidence of right ventricular outflow obstruction. No cardiac masses were observed. At that time pericardiocentesis was performed, but the pericardial fluid was cytologically negative for tumor cells. The diagnosis of angiosarcoma was made after surgical excision of the tumor and histological examination. There was only the possibility of a palliative therapy, because of the existence of pulmonary and liver metastases. CONCLUSIONS Primary malignant cardiac tumors are rare and their prognosis is very poor. The heart angiosarcoma is often disseminated into the lungs and the liver at the time of clinical presentation. This case indicates that hemorrhagic nonspecific pericardial effusion, negative for tumor cells, can appear any time before a heart angiosarcoma is detectable by echocardiography.
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Affiliation(s)
- T Fortmann
- Klinik für Kardiologie/Angiologie am Zentrum für Innere Medizin, Klinikum Lüdenscheid, Paulmannshöher Str. 14, 58515 Lüdenscheid, Germany
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Ohta M, Hazama K, Kagisaki K, Matsumiya G, Nakayama H, Matsuda H. Combined right atrial resection for lung cancer that developed intractable atrial flutter. Gen Thorac Cardiovasc Surg 2003; 51:117-9. [PMID: 12691123 DOI: 10.1007/s11748-003-0085-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We have encountered a patient with primary lung cancer with invasion into the right atrial wall with N2 disease. Complete resection of the tumor combined with the right atrial wall was achieved under cardiopulmonary bypass after induction chemoradiotherapy. Pathological results confirmed ypT0N0M0. Postoperatively, atrial flutter resistant to rate control with calcium-antagonists and beta-blockers was treated with catheter ablation of the atrioventricular node.
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Affiliation(s)
- Mitsunori Ohta
- The Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Val-Bernal JF, Figols J, Arce FP, Sanz-Ortiz J. Cardiac epithelioid angiosarcoma presenting as cutaneous metastases. J Cutan Pathol 2001; 28:265-70. [PMID: 11401670 DOI: 10.1034/j.1600-0560.2001.028005265.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cardiac angiosarcoma is a rare tumor that has a predilection for middle-aged males and a marked predominance in the right atrium. The tumor may present abruptly with a fulminant clinical course. Initial presentation with metastatic disease is rare. Only one case has been reported of a patient who presented with cutaneous metastases. METHODS AND RESULTS We here report the case of a 51-year-old man who initially presented with cutaneous metastases in the absence of cardiac symptoms. The skin biopsy was diagnosed as metastatic undifferentiated sarcoma. The patient died 26 days later with widely disseminated disease. At autopsy a tumor arising in the wall of the left atrium and in the interatrial septum was found. After an immunohistochemical study including CD31 and CD34 stains the diagnosis of cardiac pure epithelioid angiosarcoma was made. To the best of our knowledge this tumor variant has not been documented in the heart until now. CONCLUSION Although cardiac angiosarcoma is a rare neoplasm, its presence should be suspected in patients with cutaneous metastatic angiosarcoma without an evident source of the tumor, even in absence of cardiac symptoms.
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Affiliation(s)
- J F Val-Bernal
- Department of Anatomical Pathology, and Service of Oncology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain.
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