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Wu H, Zhuo K, Guo L, Jiang F, Zhang B, Wang Y, Cheng D. Imaging-Guided Percutaneous Endovascular Biopsy Applied in Patients with Pulmonary Artery Masses: A Review. Adv Ther 2024; 41:3028-3038. [PMID: 38861217 DOI: 10.1007/s12325-024-02903-z] [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] [Received: 03/04/2024] [Accepted: 05/14/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Pulmonary artery (PA) masses are rare. Distinguishing PA tumours from embolism is sometimes difficult, and surgical biopsy is expensive and risky. We aimed to evaluate the efficacy of imaging-guided percutaneous endovascular biopsy (PEB) for obtaining tissues for histological diagnosis. METHODS We searched Cochrane, Medline, Embase, and Web of Science for PEB trials involving patients with PA masses, published from the inception of the database until August 2023. RESULTS We retrospectively reviewed 33 studies including 87 patients (median age 55 ± 69.3 years, 44 men) with PA masses who underwent a total of 110 PEBs. Of these patients, 34.5% (n = 38) underwent PEB-catheter aspiration (PEB-CA), 50.9% (n = 56) underwent PEB-forceps biopsy (PEB-FB) and 2.7% (n = 3) underwent PEB-directional atherectomy (PEB-DA). The most common histological aetiology of PA masses was mesenchymal tumours (n = 67, 75.9%). Tumour embolism (n = 6, 6.9%) and pulmonary embolism (n = 3, 3.4%) were the second and third most common types of PA masses, respectively. The technical success rates of PEB-CA, PEB-FB and PEB-DA were 92.1%, 94.6% and 100% (p = 0.796), respectively. Histopathological analysis provided clinical diagnostic success rates of 44.7%, 85.7% and 100% for PEB-CA, PEB-FB and PEB-DA (p < 0.001), respectively. In pairwise comparison, PEB-FB had a higher success rate in pathological diagnosis than PEB-CA (p = 0.000). Apart from one patient suffering from haemorrhagic cardiac tamponade, no other complications occurred. CONCLUSION Imaging-guided PEB is a safe and effective technique for the early pathological diagnosis of PA masses.
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Affiliation(s)
- Hongxia Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
| | - Kaiquan Zhuo
- Department of Neurology, The People's Hospital of Pengzhou, Chengdu, China
| | - Li Guo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
| | - Faming Jiang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of Respiratory, Traditional Chinese Medicine Hospital of Meishan, Meishan, China
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China.
| | - Deyun Cheng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China.
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Başar V, Ermerak NO, Olgun Yıldızeli Ş, Bozkurtlar E, Ercelep Ö, Mutlu B, Kocakaya D, Bekiroğlu GN, Taş S, Yanartaş M, Sunar H, Ak K, Küçükoğlu S, Yıldızeli B. Results of surgical treatment of pulmonary artery sarcomas: Does histology affect survival? TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:388-397. [PMID: 37664762 PMCID: PMC10472466 DOI: 10.5606/tgkdc.dergisi.2023.23906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/16/2022] [Indexed: 09/05/2023]
Abstract
Background In this study, we aimed to describe our experience with primary pulmonary artery sarcoma in patients who underwent pulmonary endarterectomy and to evaluate clinical features, treatment, outcomes, and survival rates according to the histological subtypes of this malignant disease. Methods Between March 2011 and May 2022, a total of 13 patients (7 males, 6 females; mean age: 52.6±13.0 years; range, 30 to 69 years) who underwent pulmonary endarterectomy and diagnosed with a pulmonary artery sarcoma were retrospectively analyzed. The diagnosis was confirmed histopathologically in all patients. Data including demographics, clinical characteristics, intra- and postoperative complications, length of hospital stay, morbidity, mortality, and short-term and long-term outcomes were recorded. Operative mortality was defined as death in the hospital or within 30 days of surgery. Results Mortality was observed in one patient due to massive hemoptysis. Morbidity developed in two patients due to acute respiratory distress. Pulmonary vascular resistance improved significantly from 508 dyn/s/cm-5 to 191 dyn/s/cm-5 (p<0.004). All patients received chemotherapy following surgery. Median followup was 14 months. Median survival for the entire series was 18 months. One-year and three-year survival rates were 60.6% and 30.3%, respectively. Median survival for leiomyosarcomas (n=6) was seven months, while it was 44 months for intimal sarcomas (p=0.004). Three-year survival was 66.7% for intimal sarcomas and 0% for leiomyosarcomas. Conclusion Pulmonary artery sarcoma may mimic chronic thromboembolic pulmonary hypertension. Patients with a suspected diagnosis of pulmonary artery sarcoma should be referred to expert pulmonary endarterectomy centers for surgery where a multidisciplinary team is available. Pulmonary endarterectomy has both diagnostic and therapeutic value and may improve survival and quality of life. Patients with intimal sarcoma have longer survival compared to those with leiomyosarcoma.
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Affiliation(s)
- Veysel Başar
- Department of Cardiovascular Surgery, University of Health Sciences, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - N. Onur Ermerak
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Şehnaz Olgun Yıldızeli
- Department of Pulmonology and Intensive Care, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Emine Bozkurtlar
- Department of Pathology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Özlem Ercelep
- Department of Medical Oncology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Bülent Mutlu
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Türkiye
| | - Derya Kocakaya
- Department of Pulmonology and Intensive Care, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - G. Nural Bekiroğlu
- Department of Biostatistics, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Serpil Taş
- Department of Cardiovascular Surgery, University of Health Sciences, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Mehmed Yanartaş
- Department of Cardiovascular Surgery, University of Health Sciences, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Hasan Sunar
- Department of Cardiovascular Surgery, University of Health Sciences, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Koray Ak
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Serdar Küçükoğlu
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Türkiye
| | - Bedrettin Yıldızeli
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Türkiye
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Improving the imaging diagnostic strategy for pulmonary artery masses based on 18F-FDG PET/CT integrated with CTPA. Eur J Nucl Med Mol Imaging 2022; 49:4109-4121. [PMID: 35732973 DOI: 10.1007/s00259-022-05851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of computed tomography pulmonary angiography (CTPA) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for pulmonary artery (PA) masses. METHODS Of 2889 patients with PA filling defects of PA on CTPA, 79 consecutive patients suspicious for PA malignancy who subsequently underwent 18F-FDG PET/CT were enrolled. All masses were diagnosed on the basis of pathological findings or clinical imaging follow-up. For each mass, morphological CT signs, standardized uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on 18F-FDG PET/CT were used as diagnostic markers. RESULTS Expansive growth, irregular margin, invasion, CT contrast uptake, and wall eclipse sign were strongly associated with the malignant nature of masses. The coexistence of at least 5 CT signs perfectly identified malignant masses, whereas the detection of no more than 4 CT signs did not accurately discriminate between the natures of masses. Mean SUVmax, SUVmean, MTV, and TLG values were significantly higher in malignant masses compared to those in benign masses. The diagnostic accuracy of 18F-FDG PET/CT parameters (SUV, MTV, and TLG) was excellent in detecting malignant masses. Among patients with 3 or 4 pathological CT signs, SUVmax > 3.4 significantly increased the identification of malignancies. CONCLUSIONS CTPA is a useful imaging modality for diagnosing PA masses, especially when at least 5 abnormal CT signs are identified. Similarly, 18F-FDG PET/CT accurately identified malignant masses and provided additional valuable information on diagnostic uncertainties after CTPA.
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Yanartaş M, Karakoç AZ, Zengin A, Taş S, Olgun Yildizeli Ş, Mutlu BL, Ataş H, Alibaz-Öner F, Inanç N, Direskeneli H, Bozkurtlar E, Erkilinç A, Çimşit Ç, Bekiroğlu GN, Yildizeli B. Multimodal Approach of Isolated Pulmonary Vasculitis: A Single-Institution Experience. Ann Thorac Surg 2021; 114:1253-1261. [PMID: 34506746 DOI: 10.1016/j.athoracsur.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/11/2021] [Accepted: 08/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Isolated pulmonary vasculitis (IPV) is a single-organ vasculitis of unknown etiology and may mimic chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to review our clinical experience with pulmonary endarterectomy in patients with CTEPH secondary to IPV. METHODS Data were collected prospectively for consecutive patients who underwent pulmonary endarterectomy and had a diagnosis of IPV at or after surgery. RESULTS We identified nine patients (six female, median age 48 (23-55) years) with IPV. The diagnosis was confirmed after histopathological examination of all surgical materials. The mean duration of disease before surgery was 88.0 ±70.2 months. Exercise-induced dyspnea was the presenting symptom in all patients. Pulmonary endarterectomy was bilateral in six patients and unilateral in three. No mortality was observed, however, one patient had pulmonary artery stenosis and stent implantation was performed. All patients received immunosuppressive therapies after surgery. Mean pulmonary artery pressure decreased significantly from 30(19-67) mm Hg to 21(15-49) mm Hg after surgery (p <0.05). Pulmonary vascular resistance also improved significantly from 270 (160-1600) to 153 (94-548) dyn/s/cm-5 (p<0.05). After a median follow-up of 41 months, all but one patient had improved to the New York Heart Association functional class I. CONCLUSIONS Isolated pulmonary vasculitis can mimic CTEPH, and these patients can be diagnosed with pulmonary endarterectomy. Furthermore, surgery has not only diagnostic but also therapeutic value for IPV when stenotic and/or thrombotic lesions are surgically accessible. A multidisciplinary experienced CTEPH team is critical for management of these unique patients.
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Affiliation(s)
- Mehmed Yanartaş
- University of Health Sciences,Kartal Koşuyolu Teaching and Education Hospital,Department of Cardiovascular Surgery, Istanbul.
| | - Ayşe Zehra Karakoç
- University of Health Sciences,Kartal Koşuyolu Teaching and Education Hospital,Department of Cardiovascular Surgery, Istanbul
| | - Ahmet Zengin
- University of Health Sciences,Kartal Koşuyolu Teaching and Education Hospital,Department of Cardiovascular Surgery, Istanbul
| | - Serpil Taş
- University of Health Sciences,Kartal Koşuyolu Teaching and Education Hospital,Department of Cardiovascular Surgery, Istanbul
| | - Şehnaz Olgun Yildizeli
- Marmara University School of Medicine,Department of Department of Pulmonology and Intensive Care, Istanbul
| | - Bu Lent Mutlu
- Marmara University School of Medicine,Department of Cardiology, Istanbul
| | - Halil Ataş
- Marmara University School of Medicine,Department of Cardiology, Istanbul
| | - Fatma Alibaz-Öner
- Marmara University School of Medicine,Department of Internal Medicine,Division of Rheumatology, Istanbul
| | - Nevsun Inanç
- Marmara University School of Medicine,Department of Internal Medicine,Division of Rheumatology, Istanbul
| | - Haner Direskeneli
- Marmara University School of Medicine,Department of Internal Medicine,Division of Rheumatology, Istanbul
| | - Emine Bozkurtlar
- Marmara University School of Medicine,Department of Pathology, Istanbul
| | - Atakan Erkilinç
- University of Health Sciences,Kartal Koşuyolu Teaching and Education Hospital,Department of Anesthesia, Istanbul
| | - Çagatay Çimşit
- Marmara University School of Medicine,Department of Radiology, Istanbul
| | - G Nural Bekiroğlu
- Marmara University School of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Bedrettin Yildizeli
- Marmara University School of Medicine,Department of Thoracic Surgery, Istanbul
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Haramati A, Haramati LB. Imaging of Chronic Thromboembolic Disease. Lung 2020; 198:245-255. [PMID: 32166427 DOI: 10.1007/s00408-020-00344-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity. The most common long-term complication of acute PE is chronic thromboembolic disease, a heterogenous entity which ranges from asymptomatic imaging sequelae to persistent symptoms. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that can develop in this population and represents the only treatable type of pulmonary hypertension. Recognition of the characteristic findings of chronic pulmonary embolism and CTEPH provides not only diagnostic information, but is also crucial for guiding therapy. The present state-of-the-art review focuses on the multimodality imaging features of chronic pulmonary embolism. Detailed description and illustrations of relevant imaging findings will be demonstrated for ventilation/perfusion (V/Q) scan, CT scan and Dual-Energy CT and MRI and features that distinguish chronic PE from common imaging mimics.
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Affiliation(s)
- Adina Haramati
- Department of Radiology, Northwell Health, Manhasset, NY, USA.
| | - Linda B Haramati
- Departments of Radiology and Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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Skiba R, Stamp N, Kehoe M, Merry C. A Rare Pulmonary Artery Sarcoma Masquerading as Pulmonary Embolus. Ann Thorac Surg 2019; 109:e103-e105. [PMID: 31279785 DOI: 10.1016/j.athoracsur.2019.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/26/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
We present the case of a 46-year-old woman with a presumed diagnosis of multiple unprovoked pulmonary emboli. Her cardiorespiratory function continued to deteriorate despite optimal medical therapy. At surgical thrombectomy she was identified to have an intimal soft tissue lesion arising from the right pulmonary artery. This lesion was subsequently diagnosed as a pulmonary artery sarcoma, a rare neoplasm that carries a poor prognosis. It typically presents at an advanced stage with pulmonary vascular obstruction. Surgical debulking is the mainstay of therapy to restore ventilation perfusion mismatching and relieve right-sided heart strain. Median survival of these patients is 20 months with adjuvant chemoradiotherapy. At 9 months after surgery, she has undergone 6 cycles of chemotherapy and has stable disease with no metastases.
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Affiliation(s)
- Rohen Skiba
- Bendat Respiratory Research and Development Fund, St John of God Healthcare, Subiaco, Western Australia, Australia; Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
| | - Nikki Stamp
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Molly Kehoe
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Chris Merry
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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7
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Zhang G, Gao Q, Chen S, Chen Y. Intimal sarcoma of the inferior vena cava with extension to the right atrium, bilateral renal vasculature, and bilateral venae iliaca communis, accompanied by severe thrombocytopenia. J Card Surg 2019; 34:506-510. [DOI: 10.1111/jocs.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/08/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Guodong Zhang
- Department of Cardiac SurgeryPeking University People's HospitalBejing China
| | - Qing Gao
- Department of Cardiac SurgeryPeking University People's HospitalBejing China
| | - Shenglong Chen
- Department of Cardiac SurgeryPeking University People's HospitalBejing China
| | - Yu Chen
- Department of Cardiac SurgeryPeking University People's HospitalBejing China
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Imaging and Surgical Treatment of Primary Pulmonary Artery Sarcoma. Int J Cardiovasc Imaging 2018; 35:1429-1433. [PMID: 30535656 DOI: 10.1007/s10554-018-1489-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/30/2018] [Indexed: 02/08/2023]
Abstract
Primary pulmonary artery sarcoma is a rare tumor originating from the pulmonary artery tree. Given the low incidence, few centers have reported on more than a handful of cases. Because of its rarity it is also commonly misdiagnosed as pulmonary embolism. Multi-modality diagnostic imaging and recognition of specific imaging characteristics along with a high index of suspicion is required to make the correct diagnosis and expedite treatment. The primary imaging modality for most cardiac tumors such as primary pulmonary artery sarcoma is now MRI. It provides superb spatial resolution as well as functional assessment of the heart and pulmonary circulation. CT imaging also is part of routing imaging and remains as the most pertinent imaging modality to evaluate the lung parenchyma and presence of metastatic disease. Here we review the pertinent imaging modalities and tissue characteristics that facilitate recognition of primary pulmonary artery sarcoma. We also provide a short overview of surgical resection and reconstruction, which is the mainstay therapy, for this rare tumor.
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Pomoni A, Sotiriadis C, Gay F, Jouannic AM, Qanadli SD. Percutaneous endovascular biopsy of intravascular masses: efficacy and safety in establishing pre-therapy diagnosis. Eur Radiol 2017; 28:301-307. [DOI: 10.1007/s00330-017-4983-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/28/2017] [Accepted: 07/10/2017] [Indexed: 12/20/2022]
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10
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Plata MC, Lucía Rey D, Villaquirán C, Rosselli D. Intimal sarcoma of the pulmonary artery presenting as pulmonary embolism. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n3a10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Xie WM, Zhai ZG, Wang LF, Wan J, Yang YH, Wang C. Endovascular Catheter-guided Forceps Biopsy for the Diagnosis of Suspected Pulmonary Artery Sarcoma: A Preliminary Study of Eight Cases. Chin Med J (Engl) 2017; 129:2246-9. [PMID: 27625099 PMCID: PMC5022348 DOI: 10.4103/0366-6999.189910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Wan-Mu Xie
- Department of Respiratory and Critical Care Medicine, China - Japan Friendship Hospital, Beijing 100029; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China
| | - Zhen-Guo Zhai
- Department of Respiratory and Critical Care Medicine, China - Japan Friendship Hospital, Beijing 100029; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China
| | - Le-Feng Wang
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Jun Wan
- Department of Respiratory and Critical Care Medicine, China - Japan Friendship Hospital, Beijing 100029; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China
| | - Yuan-Hua Yang
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders; Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Chen Wang
- Department of Respiratory and Critical Care Medicine, China - Japan Friendship Hospital, Beijing 100029; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China
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Lee Y, Kim HJ, Yoon H, Choi CM, Oh YM, Lee SD, Lim CM, Kim WS, Koh Y, Lee JS. Clinical Characteristics and Treatment Outcomes of Primary Pulmonary Artery Sarcoma in Korea. J Korean Med Sci 2016; 31:1755-1760. [PMID: 27709853 PMCID: PMC5056207 DOI: 10.3346/jkms.2016.31.11.1755] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/20/2016] [Indexed: 01/18/2023] Open
Abstract
Pulmonary artery sarcomas (PAS) are rare malignant neoplasms. Right heart failure due to tumour location is the main cause of death in PAS patients. The hemodynamic influence of PAS may effect prognosis, but this has not been proven. We aimed to identify the clinical characteristics and prognostic factors of PAS in Korea, their association with pulmonary hypertension (PH). PAS patients treated at the Asan Medical Center between 2000 and 2014 were reviewed. We examined demographic characteristics, diagnostic and treatment modalities. Potential prognostic factors were evaluated by univariate and multivariate analysis. Twenty patients were diagnosed with PAS. Ten patients were male, the median age was 54 years (range, 33-75 years). The most common symptom observed was dyspnea (65%). The most common histologic type was spindle cell sarcoma (30%). Ten patients had a presumptive diagnosis of pulmonary embolism (PE) and received anticoagulation therapy. Seventeen patients underwent surgery, but only 5 patients had complete resection. Eleven patients received post-operative treatment (chemotherapy = 3, radiotherapy = 5, chemoradiotherapy = 3). PH was observed in 12 patients before treatment and in 6 patients after treatment. Overall median survival was 24 months. Post-treatment PH was associated with poor prognosis (HR 9.501, 95% CI 1.79-50.32; P = 0.008) while chemotherapy was negatively associated with mortality (HR 0.102, 95% CI 0.013-0.826; P = 0.032) in univariate analysis. Post-treatment PH was also associated with poor prognosis in multivariate analysis (HR 5.7, 95% CI 1.08-30.91; P = 0.041). PAS patients are frequently misdiagnosed with PE in Korea. Post-treatment PH is associated with a poor prognosis.
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Affiliation(s)
- Yunkyoung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Heeyoung Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Min Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yeon Mok Oh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chae Man Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Seung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) occurs when a pulmonary embolism fails to undergo complete thrombolysis leading to vascular occlusion and pulmonary hypertension. Despite the fact that CTEPH is a potential consequence of pulmonary embolism, diagnosis requires a high degree of vigilance as many patients will not have a history of thromboembolic disease. The ventilation perfusion scan is used to evaluate for the possibility of CTEPH although right heart catheterization and pulmonary artery angiogram are needed to confirm the diagnosis. Pulmonary thromboendarterectomy is the first-line treatment for patients who are surgical candidates. Recently, riociguat has been approved for patients with nonsurgical disease or residual pulmonary hypertension despite surgical intervention. This review describes the pathophysiology, risk factors, diagnosis, and management of CTEPH.
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14
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Fred HL. More on Pulmonary Artery Sarcoma. Tex Heart Inst J 2014; 41:514. [DOI: 10.14503/thij-14-4635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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