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Karigyo CJT, Pessoa BMS, Nicacio SP, Terwilliger E, Costa P, dos Santos PR, Ernani V, Seetharam M, Murakami AN, Batalini F. Cardiac Tumors: Review. Braz J Cardiovasc Surg 2024; 39:e20230405. [PMID: 39038269 PMCID: PMC11262154 DOI: 10.21470/1678-9741-2023-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 07/24/2024] Open
Abstract
Cardiac tumors are rare and encompass a variety of presentations. Clinica symptoms are usually nonspecific, but they can present as obstructive, embolic, or constitutional symptoms. Treatment options and prognosis vary highly depending on the subtype, tumor size, and location. Surgical resection is usually the first-line therapy, except for cardiac lymphomas, and provides favorable long-term prognosis in most benign tumors. Cardiac sarcomas, however, are usually diagnosed in advanced stages, and the treatment relies on a multimodal approach with chemotherapy and radiotherapy. Metastatic cardiac tumors are usually related to advanced disease and carry an overall poor prognosis.
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Affiliation(s)
- Carlos J. T. Karigyo
- Engineering Center for Circulatory Assistance, Instituto Dante
Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
- Postgraduate Program in Medicine/Technology and Intervention in
Cardiology, Universidade de São Paulo, São Paulo, São Paulo,
Brazil
| | | | | | - Emma Terwilliger
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota,
United States of America
| | - Philippos Costa
- Division of Hematology and Oncology, Yale University Yale Cancer
Center, New Haven, Connecticut, United States of America
| | - Pedro Reck dos Santos
- Division of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix,
Arizona, United States of America
| | - Vinicius Ernani
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | - Mahesh Seetharam
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | | | - Felipe Batalini
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
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Kobayashi A, Araki Y, Terada T, Terazawa S, Kawaguchi O. Surgical and multitreatment approach in a case of primary cardiac angiosarcoma: A case report. Int J Surg Case Rep 2022; 96:107349. [PMID: 35772263 PMCID: PMC9284058 DOI: 10.1016/j.ijscr.2022.107349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary cardiac angiosarcoma is extremely rare, and its prognosis remains poor, with a mean life expectancy of only a few months. Here, we report a case of primary cardiac angiosarcoma. CASE PRESENTATION A 49-year-old Japanese woman with a month-long history of dyspnea was admitted to our hospital for pericardial effusion. Chest computed tomography and cardiac magnetic resonance imaging showed a mass in the right atrium. The patient underwent surgical resection of the tumor, and the pathological diagnosis was angiosarcoma. The patient received radiotherapy after surgery. Six months following surgery, she underwent chemotherapy following the diagnosis of lung metastasis. The patient died 18 months after the initial diagnosis. CLINICAL DISCUSSION Cardiac angiosarcoma is rare and difficult to diagnose early because it is associated with few symptoms. Moreover, there are currently no established guidelines for the treatment of this disease because of its rarity and sparse descriptive literature Therefore, multidisciplinary therapies should be considered, including surgery, radiotherapy, and chemotherapy. CONCLUSION There is no standard treatment for cardiac angiosarcoma, but surgical resection, chemotherapy, radiation therapy, or a combination of these therapies may be useful.
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Affiliation(s)
- Akihiro Kobayashi
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan.
| | - Yoshimori Araki
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan
| | - Takafumi Terada
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Osamu Kawaguchi
- Department of Cardiac Surgery, Toyota Kosei Hospital, Ibobara 500-1, Jousui-cho, Toyota, Aichi 470-0396, Japan
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Gonçalves I, Nunes C, Vieira C, Freitas D, Pinto L. Primary Cardiac Angiosarcoma: A Rare and Fatal Diagnosis. Cureus 2021; 13:e20816. [PMID: 35111478 PMCID: PMC8794415 DOI: 10.7759/cureus.20816] [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] [Accepted: 12/29/2021] [Indexed: 11/08/2022] Open
Abstract
Primary cardiac angiosarcoma is a rare malignant neoplasm and occurs most frequently in middle-aged males. It has an aggressive nature, with highly variable clinical features, which results in delayed diagnosis and high mortality. We report a 19-year-old man presented to the ED with a three-month history of hemoptysis and one-week history of anterior chest pain. Additionally, an aortic diastolic murmur grade II/VI was found on physical examination. Thoracic CT scan revealed bilateral dispersed hypodense pulmonary nodes with peripheral halo, alveolar densification, and pericardial effusion. The transthoracic echocardiogram confirmed sizeable pericardial effusion and bicuspid aortic valve, without other significant findings. A pericardiocentesis removed 1300 mL of hemorrhagic fluid, consistent with an exudate without malignant cells. Both cardiac magnetic resonance and transesophageal echocardiogram revealed a large mass on the right atrium’s anterior wall. Mass biopsy was performed, revealing malignant cardiac angiosarcoma. The biopsy of the lung lesions was compatible with lung metastasis of primary cardiac angiosarcoma. The patient was submitted to palliative chemotherapy but died 12 months after the diagnosis.
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Suzuki T, Yamamoto Y, Sakamoto N, Suzuki H, Tajiri K, Ishizu T, Fujisawa Y, Noguchi M, Ieda M, Hiramatsu Y, Sekine I. Dramatic Recovery from Cardiovascular Collapse: Paclitaxel as an Urgent Treatment for Primary Cardiac Angiosarcoma. Intern Med 2021; 60:67-71. [PMID: 32830183 PMCID: PMC7835460 DOI: 10.2169/internalmedicine.5420-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report three patients with cardiac angiosarcoma who were directly admitted to the intensive-care unit for hemodynamic instability with circulatory collapse. Using a multidisciplinary cardio-oncologic approach, we diagnosed their condition as angiosarcoma by an invasive biopsy and urgently started weekly paclitaxel administration despite their poor performance status. Their vital signs were soon stabilized, leading to the patients' discharge from the hospital. Although no treatment guidelines for cardiac angiosarcoma have been established, chemotherapy with paclitaxel can be an option for cases presenting with hemodynamic instability.
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Affiliation(s)
- Toshio Suzuki
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yoshiyuki Yamamoto
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Noriaki Sakamoto
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hideo Suzuki
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazuko Tajiri
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Japan
| | - Masayuki Noguchi
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Japan
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Oliveira WR, Machado CP, Moreira MMLC, de Siqueira EC, de Souza FTA, Prado FFM, Álvares MCB, Antunes PRB, Faleiro CSF. Cardiac angiosarcoma in a female adolescent: a case report. SURGICAL AND EXPERIMENTAL PATHOLOGY 2019. [DOI: 10.1186/s42047-019-0042-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractWe report a rare case of cardiac angiosarcoma in a female adolescent patient that is an unusual case of cardiac angiosarcoma. As the initial symptoms are nonspecific our case demonstrated difficulty to establish the correct diagnosis. Our patient has in addition to these, malaise, diarrhea and hemoptysis which was mistakenly diagnosed with pneumonia. Here, we discuss aspects of computed tomography with a definitive diagnosis confirmed by immunohistochemistry, through a transthoracic radioguided biopsy. The patient presented improvement after urgent chemotherapy, however, she died 4 months after initial symptoms. In view of these aspects, it is clear the need for early diagnosis and a definition of optimized treatment in order to extend the survival of these patients.
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Cunha-Silva M, Mazo DFDC, Gomes ILC, Imbrizi MR, Sevá-Pereira T, Vaz NF, Lourenço MS, Eloy da Costa LB, Escanhoela CAF, Almeida JRDS. Multiple hepatic metastases of cardiac angiosarcoma. AUTOPSY AND CASE REPORTS 2019; 8:e2018048. [PMID: 30775323 PMCID: PMC6360823 DOI: 10.4322/acr.2018.048] [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: 07/13/2018] [Accepted: 09/02/2018] [Indexed: 11/23/2022] Open
Abstract
The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson's capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome.
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Affiliation(s)
- Marlone Cunha-Silva
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Daniel Ferraz de Campos Mazo
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Igor Logetto Caetité Gomes
- University of Campinas (Unicamp), School of Medical Sciences, Department of Internal Medicine. Campinas, SP, Brazil
| | - Marcello Rabello Imbrizi
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Tiago Sevá-Pereira
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Nayana Fonseca Vaz
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Mariana Sandoval Lourenço
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | | | | | - Jazon Romilson de Souza Almeida
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
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Liu C, Zhao Y, Yin Z, Hu T, Ren J, Wei J, Xie L, Xiong J, Wu H, Dai X, Fei S. Right atrial epithelioid angiosarcoma with multiple pulmonary metastasis confirmed by multimodality imaging-guided pulmonary biopsy: A case report and literature review. Medicine (Baltimore) 2018; 97:e11588. [PMID: 30045289 PMCID: PMC6078731 DOI: 10.1097/md.0000000000011588] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Primary cardiac tumors are very rare, and angiosarcoma accounts for about 33% of all primary malignant cardiac tumors. Primary cardiac epithelioid angiosarcoma is a highly aggressive and difficult to diagnose tumor, with early systemic metastasis and poor prognosis. PATIENT CONCERNS A 35-year-old Han male experienced sudden severe palpitation and moderate dyspnea. The patient received a whole body F-18 fluoro-deoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) scan, the scan showed a large mass in the right atrium (RA) and numerous pulmonary nodules in both lungs. DIAGNOSES The patient was diagnosed as right atrial epithelioid angiosarcoma with multiple pulmonary metastasis by pulmonary biopsy through CT-guided percutaneous transthoracic fine needle aspiration. INTERVENTIONS The patient received a cycle of chemotherapy with docetaxel and gemcitabine, followed by another cycle with epirubicin and ifosfamide. OUTCOMES The chemotherapy was ineffective. After the two cycles, the bilateral pleural effusion steadily increased, the patient had severe dyspnea and palpitation, and died three weeks later, with an overall survival of 2.5 months. LESSONS Primary angiosarcoma of heart is a very rare and aggressive disease, and its diagnosis and treatment are difficult. Most patients may have systemic metastasis at diagnosis, and have a very short survival without surgical resection. Hence, early diagnosis and surgical resection is extremely important to treat this disease.
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