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Negri F, Burelli M, Bussani R, Silvestri F, Imazio M, Sinagra G. Hidden left ventricular sarcoma manifesting itself with cardiogenic shock. J Card Surg 2022; 37:3389-3392. [PMID: 35866184 DOI: 10.1111/jocs.16789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
Cardiac sarcomas are rare and aggressive tumors that could have a multiorgan involvement and unfavorable prognosis. We present an extremely rare situation of cardiac sarcoma in a fragile elderly patient with a dramatic presentation of cardiogenic shock.
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Affiliation(s)
- Francesco Negri
- Division of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Massimo Burelli
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Rossana Bussani
- Laboratory Department of Medical and Biological Science, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Furio Silvestri
- Laboratory Department of Medical and Biological Science, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Massimo Imazio
- Division of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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2
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Luo L, Zhao W, Wang Y, Liu K. Cardiac angiosarcoma: A case report and review of the literature. Echocardiography 2021; 38:2083-2090. [PMID: 34806222 DOI: 10.1111/echo.15221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/18/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Primary cardiac tumors are extremely rare, among which malignancies comprise about 15-25%. As the most common type of primary cardiac malignancies, angiosarcomas tend to arise in the right heart, especially right atrium. In this case report, we presented a 32-year-old female with primary cardiac angiosarcoma in the right atrial appendage detected by transesophageal echocardiography, as it is difficult to display on conventional transthoracic echocardiography.
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Affiliation(s)
- Limin Luo
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China
| | - Weipeng Zhao
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China.,Department of Echocardiography, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China.,Department of Echocardiography, Zhongshan Hospital Fudan University, Shanghai, China
| | - Kun Liu
- Department of Pathology, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China
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3
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Siroky GP, Gold A, Tang D, Alam A, Simon M, Huang M, Kostis WJ. Left Pericardiophrenic Vein Pacing for Tachy-Brady Syndrome Due to an Obstructing Cardiac Angiosarcoma. JACC Case Rep 2020; 2:1771-1775. [PMID: 34317054 PMCID: PMC8312131 DOI: 10.1016/j.jaccas.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
We describe a case of a permanent pacemaker lead placement via the left pericardiophrenic vein for the treatment of tachy-brady syndrome due to a primary cardiac angiosarcoma. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Gregory P. Siroky
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Address for correspondence: Dr. Gregory P. Siroky, Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, New York 10025.
| | - Alex Gold
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Delphine Tang
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amit Alam
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mitchell Simon
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael Huang
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - William J. Kostis
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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4
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Hartvigson PE, Velamoor GR, Loggers ET, Kim E. Cardiac Angiosarcoma from a Saphenous Vein Coronary Artery Bypass Graft. Cureus 2019; 11:e5503. [PMID: 31667037 PMCID: PMC6816531 DOI: 10.7759/cureus.5503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary cardiac sarcomas (PCS) are rare and the prognosis is generally poor. Angiosarcomas are the most common cardiac sarcoma histology. The best management of PCS is poorly defined. Chronic lymphedema, foreign bodies, including Dacron grafts, and arteriovenous fistulas have been associated with angiosarcoma, and angiosarcomas arising from saphenous vein femoropopliteal bypass grafts have been reported. We present the first known case of a cardiac angiosarcoma originating from an autologous saphenous vein graft used in a coronary artery bypass. The patient’s course and the literature on primary cardiac angiosarcomas are reviewed.
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Affiliation(s)
- Pehr E Hartvigson
- Radiation Oncology, University of Washington Medical Center, Seattle, USA
| | | | | | - Edward Kim
- Radiation Oncology, University of Washington, Seattle, USA
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5
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Burns EA, Ahmed A, Sunkara A, Khan U, Sharif R, Abdelrahim M, Reardon M, Trachtenberg B. Primary cardiac angiosarcoma diagnosed in the first trimester of pregnancy. Ecancermedicalscience 2019; 13:922. [PMID: 31281419 PMCID: PMC6546259 DOI: 10.3332/ecancer.2019.922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Indexed: 11/06/2022] Open
Abstract
Primary cardiac angiosarcoma (PCAS) is a malignancy seldom seen in pregnancy. A 23-year-old G1P0 Chinese female was found to have PCAS during her first trimester when she presented with tamponade physiology. The transthoracic echocardiography (TTE) results did not indicate the presence of an intracardiac lesion, and pericardial fluid cytology analysis showed no evidence of malignancy. Cardiac magnetic resonance imaging (CMRI) exhibited a right atrial mass, and tissue biopsy indicated a high-grade angiosarcoma. MRI of the abdomen was suggestive of liver metastasis. She underwent an abortion and was started on combination chemotherapy, with a reduction in both the cardiac and liver masses. In cardiac angiosarcomas, advanced imaging modalities such as MRI should be utilised when there is high clinical suspicion or in the case of pregnancy when trying to minimise foetal harm. Prognosis is poor, and a standardised treatment protocol regardless of pregnancy continues to elude the medical community.
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Affiliation(s)
- Ethan A Burns
- Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Amna Ahmed
- Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Anusha Sunkara
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
| | - Usman Khan
- Houston Methodist Cancer Center, Houston, TX 77030, USA
| | | | | | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
| | - Barry Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
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6
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Secret Sarcoma: A Cardiac Mass Disguised as Influenza. Case Rep Cardiol 2018; 2018:8628365. [PMID: 29977622 PMCID: PMC6011128 DOI: 10.1155/2018/8628365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022] Open
Abstract
This case presentation discusses an extremely rare diagnosis presenting with common symptoms, attributed to influenza, which were not investigated further when clear cardiac symptoms developed. The patient initially presented with symptoms consistent with influenza, but when orthopnea and dyspnea on exertion developed, these cardiac symptoms continued to be attributed to a postviral syndrome and were not further evaluated. Premature closure bias contributed to a delay in diagnosing a rare cardiac condition. The diagnostic momentum, or the continuing of a diagnostic label, occurred across multiple providers and settings. This case demonstrates the risk of premature closure and diagnostic momentum and reminds clinicians to reframe the differential diagnosis as more information on history or physical exam becomes available.
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7
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Agrawal H, Schaefer JD, Carrozza JP, Mukherjee D. A rare cause of chest pain: Cardiac synovial sarcoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Echocardiography is usually the first imaging modality ordered for evaluation of a cardiac mass. Although echocardiography cannot define the histopathology of a mass, it can identify the presence, location, and tissue characteristics of the mass, which can thus narrow the differential diagnosis. Echocardiography is useful in evaluating tumor sequelae such as blood flow obstruction, valvular regurgitation, and myocardial dysfunction.
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9
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Surgery for massive malignant tumors of the left atrium - one center's experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:229-235. [PMID: 27785137 PMCID: PMC5071590 DOI: 10.5114/kitp.2016.62610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Abstract
Introduction Surgery for primary non-resectable malignant tumors of the left atrium is controversial. Today heart autotransplantation as a method of surgical treatment for patients suffering primary massive malignant tumors of the left atrium is still not sufficiently studied. Material and methods We provide information on our single-center 5-year experience in performing surgical interventions for massive malignant tumors of the left atrium and including cases of 5 patients (3 males – 60%, 2 females – 40%). One case (1/5, 20%) involved debulking surgery with partial resection of the left atrial (LA) wall and its reconstruction using a xenopericardium patch. Orthotopic heart transplantation was performed in 1 patient (1/5, 20%) and heart autotransplantation (HA) in the 3 other cases (3/5, 60%). Results Mean myocardial ischemia duration was 165.6 ±12.0 minutes (range: 137–198), cardiopulmonary bypass (CPB) duration was 248.6 ±36.6 minutes (range: 188–392), and intervention duration was 498.0 ±77.4 minutes (range: 330–780). Mean total blood loss was estimated to be 2432 ±616.5 ml (range: 1610–4880). Major in-hospital complications were registered in 4 patients (4/5, 80%). In-hospital mortality was registered in 3 patients (3/5, 60%). Survival time in 2 (2/5, 40%) patients discharged from the hospital was 29 and 9 months, respectively. Both died because of disease progression. Conclusions Surgery in patients with massive resectable primary malignant tumor of the left atrium is associated with high incidence of major hospital complications and mortality. Heart autotransplantation with radical tumor resection is the treatment of choice for these cases. The surgical approach implies thorough primary hemostasis and selection of a proper surgical approach, allowing revision of all the regions of intervention during each step. The possibility of excessive tension and bleeding in the area of bicaval anastomosis should be considered when performing heart autotransplantation, and appropriate preventive measures should be applied.
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Elsayad K, Scobioala S, Kriz J, Haverkamp U, Eich HT. Advances in Image-Guided Radiation Therapy for Primary Cardiac Angiosarcoma: The Role of PET-CT and MRI. Oncol Res Treat 2016; 39:290-4. [DOI: 10.1159/000445864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/17/2016] [Indexed: 11/19/2022]
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Primary malignant cardiac tumors. J Cancer Res Clin Oncol 2014; 140:1047-55. [DOI: 10.1007/s00432-014-1651-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology at Baylor University Medical Center in Dallas, TX
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13
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Lima PP, López-Almodóvar LF, Jiménez JI, Orradre JL, Cañas A. Sarcoma cardiaco primario que comienza como dolor abdominal e isquemia intestinal: a propósito de un caso y revisión de la literatura. CIRUGIA CARDIOVASCULAR 2013. [DOI: 10.1016/j.circv.2013.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ramalho J, Nunes S, Marques I, Marques F. Primary cardiac sarcoma after breast cancer. BMJ Case Rep 2013; 2013:bcr-2013-008947. [PMID: 23608855 DOI: 10.1136/bcr-2013-008947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary cardiac sarcomas are rare tumours carrying poor prognosis. Postradiation sarcoma has been reported in patients with breast, cervical and head and neck cancers. We report a case of a 56-year-old woman with stage IIA breast cancer diagnosed in 1997, submitted to mastectomy, adjuvant chemotherapy, radiotherapy and hormonotherapy. Pulmonary metastasis were detected in 2008 and treated with chemotherapy and hormonotherapy, being in complete remission since August 2009. She was admitted in December 2009 with a 3-week history of fever, dyspnoea, polyarthralgias and leg oedema. An echocardiography showed a mass in the left atrium. She was submitted to a surgical tumour resection and the histology revealed a sarcoma of intermediate degree of differentiation. Chemoradiation therapy was started and she remains alive after 3 years, without tumour regrowth or metastasis. This case is a therapeutic challenge, because the previous therapies for breast cancer hampered the options for extra chemoradiation therapy.
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Affiliation(s)
- Joana Ramalho
- Department of Medicine, Centro Hospitalar do Porto, Porto, Portugal.
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15
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Burnside N, MacGowan SW. Malignant primary cardiac tumours. Interact Cardiovasc Thorac Surg 2012; 15:1004-6. [PMID: 22922450 DOI: 10.1093/icvts/ivs350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Management of malignant tumours of the heart remains a poorly investigated clinical area due to the scarcity of presentations. The purpose of this series and review is to present an outline of the management emphasized by our personal experience in a regional cardiothoracic centre. METHODS We reviewed all cases presenting with primary cardiac tumours in our institution within the last 10 years, looking at presentation, management and outcomes. RESULTS Of these, the records of 3 patients, who attended the Royal Victoria Hospital in Belfast and were treated for a cardiac sarcoma, were fully evaluated. A review of current literature was conducted through a search of Pubmed and Medline databases. A review of the presentation of these patients and the generally accepted management deterioration of patients diagnosed with cardiac sarcoma is discussed. CONCLUSIONS With reference to our case series, we want to draw attention to the rapid deteriation of these patients following presentation.
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Affiliation(s)
- Nathan Burnside
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK.
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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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Kodali D, Seetharaman K. Primary cardiac angiosarcoma. Sarcoma 2011; 2006:39130. [PMID: 17251657 PMCID: PMC1698140 DOI: 10.1155/srcm/2006/39130] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 06/04/2006] [Accepted: 06/08/2006] [Indexed: 11/25/2022] Open
Abstract
Primary cardiac sarcoma is a rare clinical entity, with an
incidence of 0.0001% in collected autopsy series.
The majority of the literature describes a uniformly dismal prognosis with a
median survival of only 6 months for these aggressive tumors.
Standard surgery, adjuvant chemotherapy,
and radiotherapy have been consistently unsuccessful.
Early heart transplantation and novel radiation therapy
approaches may offer a survival benefit in nonmetastatic tumors,
but up to 80% of the patients present with systemic metastasis at diagnosis.
Though several chemotherapeutic regimens have been tried, the
role of chemotherapy is not well established and outcome
data available is minimal. Liposomal doxorubicin (PLD) has
been shown to be useful in the treatment of soft tissue sarcomas,
and our case supports its use in cardiac angiosarcoma.
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Affiliation(s)
- Dhatri Kodali
- Division of Hematology, Oncology and Transplantation,
University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
- *Dhatri Kodali: ,
| | - Kala Seetharaman
- Division of Hematology/Oncology, Worcester
Medical Center, Fallon Clinic, Worcester, MA 01608, USA
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Hamidi M, Moody JS, Weigel TL, Kozak KR. Primary cardiac sarcoma. Ann Thorac Surg 2010; 90:176-81. [PMID: 20609770 DOI: 10.1016/j.athoracsur.2010.03.065] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/18/2010] [Accepted: 03/22/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presentation, management, and outcome of patients with primary cardiac sarcomas are not well defined. Furthermore, the role of adjuvant therapy has not been delineated in the management of primary cardiac sarcomas. METHODS Patients with primary cardiac sarcoma and noncardiac sarcoma, diagnosed between 1988 and 2005, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Clinical characteristics and outcomes of primary cardiac sarcoma were defined and compared with the characteristics of noncardiac sarcomas. Univariate and multivariate methods were used to identify factors associated with primary cardiac sarcoma survival. RESULTS Compared with noncardiac sarcomas, primary cardiac sarcomas were found to occur in a younger age group and were more likely to present with advanced disease. Primary cardiac sarcomas were ten times more likely to be vessel-derived (eg, angiosarcoma), comprising almost half of all cases. Median overall survival for cardiac sarcoma patients was 6 months whereas that for noncardiac sarcoma patients was significantly longer at 93 months (p < 0.001). Furthermore, cardiac sarcoma patients who underwent surgery had a median survival of 12 months whereas those who did not undergo surgery had a median survival of 1 month (p < 0.001). CONCLUSIONS Cardiac sarcomas are a distinct, rare subset of soft tissue sarcomas with a poor prognosis. Surgery continues to be the central component of successful management. Future clinical efforts should be directed at developing approaches to permit safe radical excision and, potentially, developing effective adjuvant therapy.
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Affiliation(s)
- Maryam Hamidi
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53705, USA.
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Riberi A, Gariboldi V, Grisoli D, Collart F. [Cardiac tumors]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:95-103. [PMID: 20207301 DOI: 10.1016/j.pneumo.2009.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Primary cardiac tumor is a rare disease, with an incidence ranging from 0.001 to 0.03%. Eighty percent of them are benign tumors, and among them 70% are myxomas, the others are: fibroelastoma, rhabdomyoma, fibroma, angioma and lipoma. Primary malignant tumors of heart are in 95% of cases sarcomas, the remaining 5% are lymphomas. Cardiac's metastases are more frequent than primary tumors. Diagnosis is made by echocardiography TAC and MRI. Whereas surgery is indicated in patients with benign tumors, or localised sarcomas, chemotherapy in those with widespread disease and radiotherapy and chemotherapy in lymphoma. Prognosis is excellent in benign cardiac tumor. Mean survival for sarcomas is 11 months, and lymphoma 5 years.
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Affiliation(s)
- A Riberi
- Service de Chirurgie Cardiaque Adulte, Hôpital de la Timone, 264 rue Saint-Pierre, 13005 Marseille, France
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Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner JC, Moynihan TJ. Malignant primary cardiac tumors: review of a single institution experience. Cancer 2008; 112:2440-6. [PMID: 18428209 DOI: 10.1002/cncr.23459] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary cardiac sarcomas are uncommon. The authors undertook to review the Mayo Clinic's experience with primary cardiac sarcomas consisting of 34 patients seen over a 32-year period. METHODS The patient database at the Mayo Clinic was searched to identify patients with malignant tumors of the heart seen during the 32-year period between 1975 and 2007. Thirty-four patients with primary cardiac sarcomas were identified and their medical records reviewed for details pertaining to presenting symptoms, staging modalities, treatment approaches, and outcomes. RESULTS Of the 34 patients, 17 were men and 17 were women. The median age was 44 years. The mean duration of symptoms at the time of diagnosis was 3.6 months. The most common histologic type was angiosarcoma (41%). The median follow-up for the entire group was 12 months (range, 0-61 months). The median survival for those who underwent a complete surgical excision was 17 months compared with 6 months for those in whom a surgical complete remission could not be achieved (P = .01). Patients with angiosarcoma had a lower survival compared with patients with other histologies (5 months vs 17 months; P = .01). The median survival of patients with metastatic disease was 5 months versus 15 months in patients without metastatic disease (P = .03 by the log-rank test). CONCLUSIONS Cardiac sarcomas remain a rare but lethal disease. Compared with extracardiac sarcomas, the prognosis for patients with cardiac sarcomas remains very poor. A complete surgical excision should be performed if possible. Innovative treatment strategies are required.
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Affiliation(s)
- Lijo Simpson
- Division of Medical Oncology, Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN 55905, USA
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Nakamura-Horigome M, Koyama J, Eizawa T, Kasai H, Kumazaki S, Tsutsui H, Koiwai K, Oguchi K, Kinoshita O, Ikeda U. Successful Treatment of Primary Cardiac Angiosarcoma With Docetaxel and Radiotherapy. Angiology 2008; 59:368-71. [DOI: 10.1177/0003319707308212] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 49-year-old man was admitted for primary cardiac angiosarcoma with a cardiac tamponade. Transthoracic echocardiography and contrast-enhanced computed tomography scan demonstrated a large mass in the right atrium and thickening of the right ventricular wall. 18F-labeled deoxyglucose (FDG) positron emission tomography (PET) scan showed increased FDG uptake in the mediastinum and over the heart. The patient responded to combination therapy with docetaxel and radiotherapy and tolerated the treatment well, except for radiation esophagitis, which required a soft diet and resolved 1 month after treatment. This combination therapy resulted in a minimal response with slight regression in the tumor size, but FDG-PET initially showed an increase in FDG uptake by the tumor that was no longer seen after combination therapy. There is no evidence of progression or metastasis even at 12 months after diagnosis.
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Affiliation(s)
| | - Jun Koyama
- Division of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Takayuki Eizawa
- Division of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hiroki Kasai
- Division of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Setsuo Kumazaki
- Division of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hiroshi Tsutsui
- Division of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | | | - Osamu Kinoshita
- Division of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Uichi Ikeda
- Division of Cardiovascular Medicine, Shinshu University School of Medicine
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Azimi NA, Selter JG, Abott JD, Cabin HS, Hutner A, Copel J, Setaro JF. Angiosarcoma in a pregnant woman presenting with pericardial tamponade--a case report and review of the literature. Angiology 2006; 57:251-7. [PMID: 16518537 DOI: 10.1177/000331970605700219] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although asymptomatic pericardial effusions are relatively common in pregnancy, their true incidence is not known. Symptomatic effusions are, however, rare in pregnancy. The authors present a rare case of pericardial tamponade complicating pregnancy with resulting diagnosis of angiosarcoma. They review the literature involving pericardial disease in pregnancy and discuss important issues in management and include a discussion of angiosarcoma.
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Affiliation(s)
- Nassir A Azimi
- Yale University School of Medicine, Division of Cardiovascular Medicine, Yale-New Haven Hospital, New Haven, CT 06520, USA
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Abstract
Primary cardiac tumours are rare, with an autopsy incidence ranging from 0.001% to 0.030%. Three-quarters of these tumours are benign and nearly half of the benign tumours are myxomas. Metastases to the heart are far more common than primary cardiac tumours. Primary cardiac tumours present with one or more of the symptoms of the classic triad of: cardiac symptoms and signs resulting from intracardiac obstruction; signs of systemic embolisation; and systemic or constitutional symptoms. They are diagnosed by use of transthoracic and transoesophageal echocardiograms, MRI, and CT scan. Whereas surgery is indicated in patients with benign tumours, systemic chemotherapy is indicated in those who have widespread or unresectable malignant disease, and chemotherapy and radiotherapy are usually combined in treatment of patients with primary cardiac lymphomas. The prognosis after surgery is usually excellent in the case of benign tumours but is unfortunately still limited in localised malignant diseases. Patients with sarcomas live for a mean of 3 months to 1 year, and those with lymphomas live up to 5 years if treated, but usually die within 1 month if untreated.
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Vaporciyan AA, Rice D, Correa AM, Walsh G, Putnam JB, Swisher S, Smythe R, Roth J. Resection of advanced thoracic malignancies requiring cardiopulmonary bypass. Eur J Cardiothorac Surg 2002; 22:47-52. [PMID: 12103372 DOI: 10.1016/s1010-7940(02)00204-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Patients with malignancies involving cardiac structures have limited therapeutic options and significant risk of mortality. The decision to offer radical palliative or curative resection must be made only after consideration of the substantial surgical risks. The purpose of this retrospective study was to determine the feasibility and benefits of resection with cardiopulmonary bypass (CPB) of metastatic or non-cardiac primary malignancies extending directly into or metastasizing to the heart in select patients. Our results were examined to assess the risks and benefits of such radical therapy. METHODS We retrospectively reviewed patient charts and identified all patients with malignancies involving the cardiac chamber or great vessels (excluding renal carcinomas with caval extension) or with substantial cardiac compression who had undergone resection with CPB at The University of Texas M.D. Anderson Cancer Center between January 1995 and July 2000. We evaluated demographic data, symptomatology, tumor characteristics, and outcomes. RESULTS Nineteen patients (six males and 13 females; median age of patients, 47 years; age range, 17-67 years) were included in the study. Eleven patients underwent surgery with curative intent, and eight underwent surgery with palliative intent. Seventeen patients had tumors that required CPB because their tumors directly involved the heart and/or great vessels (nine sarcomas, seven epithelial carcinomas, and one unclassified), and two patients (both with sarcomas) required CPB to relieve tumor tamponade. The technique included CPB (n=5), CPB with diastolic arrest (n=12), and CPB with hypothermic circulatory arrest (n=2). Five patients underwent concomitant pneumonectomy, and three underwent lobectomy. Two patients (11%) died in the hospital after resection with palliative intent. Of the 11 patients who underwent resection with curative intent, ten (91%) had complete resections. The median time in the intensive care unit was 5.3 days (range, 0-37 days) and the median length of hospital stay was 17.2 days (range, 0-107 days). Major complications occurred in 11 patients (58%); the most common major complications were pneumonia (n=7 patients), mediastinal hematoma (n=4 patients), and acute respiratory distress syndrome (n=2 patients). The median follow-up duration was 27 months. The overall 1- and 2-year survival rates were 65 and 45%, respectively. CONCLUSIONS Extensive thoracic tumors involving cardiac structures can be resected with acceptable risk. When resection was performed with curative intent, excellent 1- and 2-year cumulative survival rates were achieved. Although resection with palliative intent was associated with greater mortality rates, some patients survived for 1 and 2 years. The use of CPB in selected patients with thoracic malignancies should be considered, especially when complete resection can be achieved.
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Affiliation(s)
- Ara A Vaporciyan
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77025, USA.
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Shibata T, Suehiro S, Hattori K, Hosono M, Inoue K, Kinoshita H. Metastatic synovial sarcoma of the left ventricle. JAPANESE HEART JOURNAL 2001; 42:387-91. [PMID: 11605777 DOI: 10.1536/jhj.42.387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A metastatic synovial sarcoma of the left ventricle is described. A 26-year-old Japanese woman underwent resection of a synovial sarcoma of the right thigh 8 years prior to admission, which was followed by multiple surgical procedures for pulmonary metastasectomy. Echocardiography demonstrated obstruction of the outflow tract of the left ventricle caused by a metastatic tumor, which was surgically resected on the day of admission. The histologic characteristics of the cardiac tumor were identical to those of the pulmonary metastases. Additional cardiac metastasectomy was performed 9 months later. She complained of dyspnea on exertion 8 months after the second cardiac metastasectomy due to recurrence in the heart. Radiotherapy with LINAC (a total dose: 50 Gy) diminished the size of the tumor temporarily. The patient died 20 months after the initial cardiac metastasectomy.
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Affiliation(s)
- T Shibata
- Division of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Japan
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Alvarez JM, Yew MK, Brahmbhatt R, Rajesh B, Ireland M. Cardiac angiosarcoma: Too little known, too late treatment or just too bad a tumour? Heart Lung Circ 2001; 10:30-4. [PMID: 16352022 DOI: 10.1046/j.1444-2892.2001.00057.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac angiosarcoma is a rare tumour. Current imaging techniques (magnetic resonance imaging, MRI; computed axial tomography, CAT; 2-D echocardiography), although useful in delineating the extent of tumour involvement, do not correlate well with intraoperative findings of resectability. We report a case were palliative surgical resection was technically possible, contrary to expectations from CAT and MRI findings. However, the patient was clinically in extremis, with advanced ventricular dysfunction, and died. Despite the short-term risk involved in surgery, if palliative resection is possible, a multidisciplinary approach with adjuvant chemotherapy and radiation can result in mid-term survival.
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Affiliation(s)
- J M Alvarez
- Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.
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Abstract
Primary tumors of the heart, with the exception of atrial myxomas, occur rarely; tumors metastatic to or directly invasive of the heart are far more common. About 75% of primary tumors are benign, and 75% of these are atrial myxomas. The benign tumors include rhabdomyomas, fibromas, papillary fibroelastomas, hemangiomas, pericardial cysts, lipomas, hamartomas, teratomas, mesotheliomas, and paragangliomas or pheochromocytomas. The last 3 may also be malignant. The malignant tumors consist of various sarcomas: myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, undifferentiated sarcoma, reticulum cell sarcoma, neurofibrosarcoma, and malignant fibrous histiocytoma. Cardiac tumors produce a large variety of symptoms through any of 4 mechanisms. Their mass can obstruct intracardiac blood flow or interfere with valve function. Local invasion can lead to arrhythmias or pericardial effusions with tamponade. Bits of tumor can embolize, causing systemic deficits when the tumors are on the left side of the heart. Finally, the tumors may cause systemic or constitutional symptoms. Some tumors, of course, produce no symptoms and become evident as incidental findings. The most useful diagnostic tool is the echocardiogram, which in almost all cases precisely locates the tumor and defines its extent. The echocardiographic appearance may also allow quite accurate prediction of the tumor type and whether it is malignant or benign. Magnetic resonance imaging serves as the next most important test where the density of T1 and T2 images may allow tumor cell type identification. With few exceptions, these tumors require operative excision. Most benign tumors can be resected completely; a few, because of their large size, cannot be, and only tumor debulking may be possible. Heart transplantation should be considered for these patients. Many of the malignant tumors cannot be resected completely, either because of the extent of local spread and invasion or because of the frequent distant metastases. Transplantation may also be an option for those with extensive local disease. The long-term results for resected benign tumors are excellent; the long-term results for sarcomas are very poor, and there are few survivors. For patients with unresectable sarcomas, radiation and chemotherapy may be used, but without great expectation of successful results.
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Affiliation(s)
- T J Vander Salm
- Division of Cardiothoracic Surgery, University of Massachusetts Medical School, Worcester 01655-0304, USA
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Ceresoli G, Passoni P, Benussi S, Alfieri O, Dell'Antonio G, Bolognesi A. Primary cardiac sarcoma in pregnancy: a case report and review of the literature. Am J Clin Oncol 1999; 22:460-5. [PMID: 10521059 DOI: 10.1097/00000421-199910000-00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary cardiac sarcoma (PCS) is a rare disease with a poor prognosis, because of diagnostic delay, therapeutic difficulties, and high metastatic potential. Surgery is the standard treatment. A case of PCS in pregnancy is reported, with a review of published surgical series of PCSs, focusing on the role of surgery and adjuvant therapy. Prompt surgery improved cardiac function and patients' outcome in comparison with untreated cases. The role of adjuvant treatment was analyzed only in a few series, mainly without distinction between postoperative chemotherapy and radiotherapy; adjuvant therapy improved survival in the larger series of resected PCSs. Only three other cases of PCS in pregnancy were reported. In the present case, resection was performed with no major complication for the mother and the infant. Even if the patient's survival was short, cardiac surgery allowed prolonging of pregnancy until an acceptable possibility of fetal survival was reached. Although resection is not curative in most cases, surgery remains the treatment of choice for PCS and has a definite palliative significance. The role of postoperative chemotherapy and radiotherapy is difficult to ascertain; however, adjuvant chemotherapy seems advisable in high-grade tumors.
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Affiliation(s)
- G Ceresoli
- Department of Radiochemotherapy, San Raffaele H Scientific Institute, Milan, Italy
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