Right atrial metastasis of uterine leiomyosarcoma causing obstructive shock

A novel case of left atrial and right lung mass turned out to be unconventional metastasis of uterine leiomyosarcoma with a review of literature

Uterine leiomyosarcoma (ULMS) is a rare malignancy arising from the myometrial smooth muscle wall, and cardiac metastases are extremely rare. Metastasis to the heart is a very unusual finding, and atrial metastasis is even rarer. Here, we report a case of a 45 year old woman who presented with dyspnea and pleural effusion and had a significant history of hysterectomy done for ULMS. Magnetic resonance imaging revealed a left atrial mass, which was resected and revealed to be a metastasis of leiomyosarcoma on histopathology and immunohistochemistry. Metastatic ULMS may rarely present as a left atrial mass with acute clinical presentation. Detailed clinical history and accurate diagnosis are vital for further management.

Right ventricular outflow tract obstruction due to a leiomyosarcoma

A 65-year-old female presenting with worsening dyspnea and notable weight loss were found to have a systolic murmur on physical examination. On workup with computed tomography (CT) angiogram, a solid mass was found extending from the inferior vena cava into the right ventricle. Transesophageal echocardiography demonstrated this mass extension causing right ventricular outflow tract obstruction. After surgical removal, the pathology of the mass was endometrial leiomyosarcoma.

Successful surgical treatment of cardiac metastasis from uterine leiomyosarcoma: A case report and literature review

Uterine leiomyosarcoma is a malignant soft tissue tumor resembling uterine fibroma clinically and is difficult to diagnose preoperatively. Since metastatic cardiac tumors are very rare and asymptomatic, most cardiac metastases are detected at autopsy after death due to other diseases. A 49-year-old woman presented with menorrhagia and anemia, and a uterine tumor. Total hysterectomy was performed for the uterine tumor. Histopathological examination revealed the tumor to be a leiomyosarcoma. Postoperative computed tomography showed multiple lung metastases and a metastatic cardiac tumor. The cardiac tumor, which was located within and almost entirely occluded the right ventricle, was 49 × 26 mm. To prevent sudden death, cardiac tumorectomy was performed semi-emergently. Chemotherapy was initiated in the early postoperative period, and the patient currently maintains a complete response. Cases with lung and cardiac metastases rarely undergo surgical resection of metastatic tumors. However, emergent surgical resection of cardiac metastatic tumors should be considered to prevent sudden death.

Unusual cardiac metastasis of uterine leiomyosarcoma: case report and literature review

BACKGROUND

Uterine leiomyosarcoma (LMS) is a rare malignancy of mesenchymal tissues and in advanced stages its prognosis is very poor. Surgery followed by radiotherapy and/or chemotherapy is the treatment of choice for advanced disease. Cardiac metastases are very uncommon and only a few cases have been described to date.

CASE

A 55-year-old woman was referred to our center for a uterine LMS with lung metastases at diagnosis. After 3 lines of chemotherapy for persistent lung disease, CT scan showed suspected thrombosis in the right pulmonary vein, along with disease progression in the lungs. The patient started treatment with low-molecular-weight heparin and a fourth line of chemotherapy. After 3 months of therapy, a new CT scan showed a larger thrombus and she underwent a cardiology visit that revealed an intracardiac mass. Submitting the patient to palliative surgery or radiation therapy was not possible because of the aggressiveness of the lung metastases, so she continued chemotherapy, resulting in disease stabilization.

CONCLUSIONS

Surgery is the best option for intracardiac dissemination of uterine LMS, but when this is not possible based on the performance status of the patient and spread of the disease, the combination of chemotherapy and radiotherapy seems to be the best option according to the literature. In our case we treated the patient only with chemotherapy.

A rare presentation of acute heart failure secondary to aggressive uterine leiomyosarcoma metastatic to the myocardium initially diagnosed as hypertrophic obstructive cardiomyopathy

Uterine sarcoma is the cause of 3-9% of all uterine malignant neoplasms and has a 2-fold higher incidence in black women as compared to white women. Cellular atypia and abundant mitoses (≥10 per 10 high power fields) as seen in this patient are associated with an increased risk for metastases. Metastases to the heart are infrequently reported with a handful of cases in the literature. We present a case of a 51-year-old woman with aggressively metastatic uterine leiomyosarcoma causing acute heart failure 4 months after initial presentation.

Cardiac tumors: leiomyosarcoma - a case report

We present a case report of a 60-year-old woman with a long history of leiomyosarcoma in different locations. She was admitted to the clinic due to a left ventricular tumor diagnosed in ECHO examination. The patient was qualified for radical tumor resection. The early postoperative period was complicated due to low cardiac output syndrome and bradyarrhythmia requiring temporary cardiac pacing. Optimized pharmacological therapy resulted in a gradual reduction of symptoms and a clinical improvement of congestive heart failure (NYHA III - NYHA II). Due to the radical nature of the surgery, the patient was not referred for supplementary treatment. The follow-up currently exceeds 12 months - no new metastases have been found. This case provides an example of how to diagnose and treat heart tumors.

MMPs and angiogenesis affect the metastatic potential of a human vulvar leiomyosarcoma cell line

Gynaecological leiomyosarcoma (gLMS) represent a heterogeneous group of soft tissue sarcoma, characterized by rare incidence, high aggressiveness and propensity to infiltrate secondary organs, poor prognosis and lethality, because of the lack of biological mechanisms that underlying their progression and effective pharmaceutical treatments. This study was focused on some of the aspects of progression and dissemination of a subtype of gLMS namely vulvar LMS (vLMS). We therefore used a vulvar LMS-derived cell line namely SK-LMS-1, coupled with in vitro and in vivo assays. We observed that SK-LMS-1 cells have a strong invasive capacity in vitro, through the activity of matrix metalloproteinases 2 and 9, while in vivo these cells induce a strong angiogenic response and disseminate to the chick embryo liver. Therefore, we postulate that metalloproteinases are involved in the spreading behaviour of SK-LMS-1. Further investigations are necessary to better understand the molecular and cellular machinery involved in the progression of this malignancy.

Cardiac metastasis of uterine cervical squamous cell carcinoma: A case report and review of the literature

A 48-year-old woman was referred to the cardiology department due to a large mobile mass in the right ventricle. The patient had undergone radical hysterectomy and bilateral salpingo-oophorectomy for a uterine squamous cell carcinoma approximately 3.5 years before. In order to protect the patient from circulatory collapse, the intracardiac mass was resected surgically. A diagnosis of cardiac metastasis of the uterine cervical squamous cell carcinoma was confirmed histologically. Herein we discuss the possible therapeutic approach to and prognosis of this rare condition by reviewing 24 papers on intracardiac uterine cancer metastasis published in the past 10 years. <Learning objective: A woman who had undergone radical hysterectomy and bilateral salpingo-oophorectomy for a uterine squamous cell carcinoma 3.5 years before was referred to the cardiology department due to a large mass in the right ventricle. The diagnosis of cardiac metastasis of the uterine cervical squamous cell carcinoma was confirmed histologically. Although metastasis of cervical carcinoma to the cardiac cavity is rare, we should not overlook this possibility during the post-operative patient follow-up.>.