1
|
Talbot S, Bandaru V, Nguyen T, Arif D, Sethi P. Rapid Development of Primary Right Atrial Angiosarcoma. Cureus 2024; 16:e64273. [PMID: 39131000 PMCID: PMC11315593 DOI: 10.7759/cureus.64273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Cardiac angiosarcomas are rare and generally followed by a high level of metastasis with poor median survival outcomes. Echocardiograms, CT scans, and MRIs are the standard methods for finding sites of cardiac tumors; however, immunohistochemical confirmation is necessary for a definitive diagnosis of angiosarcoma. A 58-year-old male presented to the emergency room with one week of dyspnea on moderate exertion accompanied by chest pain and alleviated with rest. A workup done to evaluate mass found a single 5 x 3.5 x 4.8 cm mass heavily vascularized by the right coronary artery and left circumflex involving the free wall of the right atrium with no extension to the tricuspid valve. Surgical resection was performed, and immunohistochemistry was consistent with a primary cardiac angiosarcoma. An exudative fluid analysis on pericardial and pleural fluid analysis may warrant screening for malignancy more frequently in concurrence with a patient's history and presentation. Although the time from onset of symptoms to diagnosis of cardiac angiosarcoma is not well established, further investigation of such correlation may offer insight into survival post-treatment.
Collapse
Affiliation(s)
- Sophie Talbot
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Vishal Bandaru
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Tung Nguyen
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Dauod Arif
- Pathology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Pooja Sethi
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| |
Collapse
|
2
|
Khan Z. Recurrent Pericardial Effusion Secondary to Cardiac Angiosarcoma. Cureus 2024; 16:e60460. [PMID: 38883119 PMCID: PMC11179953 DOI: 10.7759/cureus.60460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Cardiac angiosarcoma is a malignant cardiac tumour. We present the case of a young patient in his mid-30s with recurrent pericardial effusion. He had flu-like symptoms a month earlier and had shortness of breath, lethargy, and tightness in his throat for the past ten days. Echocardiography demonstrated global pericardial effusion > 4 cm with tamponade features, and the patient was blue-lighted to our hospital. He underwent emergency pericardiocentesis, and > 1 litre of pericardial fluid was drained. Computed tomography of the chest, abdomen, and pelvis revealed small-volume ascites and moderate right-sided pleural effusion, with associated lobar collapse. The patient presented to the hospital with global pericardial effusion requiring emergency pericardiocentesis three weeks later and underwent cardiac magnetic resonance imaging demonstrating global pericardial effusion and a 48 × 26 mm pericardial space mass adjacent to the right atrium. He underwent surgical resection of the tumour, followed by chemotherapy, and tolerated the treatment well. The patient is currently under follow-up.
Collapse
Affiliation(s)
- Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Bart's Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
| |
Collapse
|
3
|
Guo Y, Liu Q, Wu H. Primary cardiac tumor: a case report of right atrial angiosarcoma and review of the literature. Front Oncol 2023; 13:1164153. [PMID: 37305576 PMCID: PMC10250602 DOI: 10.3389/fonc.2023.1164153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Primary cardiac angiosarcoma is a relatively rare tumor with early metastasis and poor prognosis. Radical resection of the primary tumor remains the primary approach for the optimal survival of patients with early-stage cardiac angiosarcoma without evidence of metastasis. This case involves a 76-year-old man with symptoms of chest tightness, fatigue, pericardial effusion, and arrhythmias who achieved good results after surgery to treat the angiosarcoma in the right atrium. In addition, literature analysis showed that surgery remains an effective way of treating primary early angiosarcoma.
Collapse
Affiliation(s)
- Yujian Guo
- Department of Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi, China
| | - Qianzhen Liu
- Department of Pathology, The First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Haibo Wu
- Department of Cardiothoracic Surgery, Changzhi People’s Hospital, Changzhi, Shanxi, China
| |
Collapse
|
4
|
Maliszewska O, Roszkowska A, Lipiński M, Treder N, Olędzka I, Kowalski P, Bączek T, Bień E, Krawczyk MA, Plenis A. Profiling Docetaxel in Plasma and Urine Samples from a Pediatric Cancer Patient Using Ultrasound-Assisted Dispersive Liquid-Liquid Microextraction Combined with LC-MS/MS. Pharmaceutics 2023; 15:pharmaceutics15041255. [PMID: 37111740 PMCID: PMC10143245 DOI: 10.3390/pharmaceutics15041255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
In recent years, therapeutic drug monitoring (TDM) has been applied in docetaxel (DOC)-based anticancer therapy to precisely control various pharmacokinetic parameters, including the concentration of DOC in biofluids (e.g., plasma or urine), its clearance, and its area under the curve (AUC). The ability to determine these values and to monitor DOC levels in biological samples depends on the availability of precise and accurate analytical methods that both enable fast and sensitive analysis and can be implemented in routine clinical practice. This paper presents a new method for isolating DOC from plasma and urine samples based on the coupling of microextraction and advanced liquid chromatography with tandem mass spectrometry (LC-MS/MS). In the proposed method, biological samples are prepared via ultrasound-assisted dispersive liquid-liquid microextraction (UA-DLLME) using ethanol (EtOH) and chloroform (Chl) as the desorption and extraction solvents, respectively. The proposed protocol was fully validated according to the Food and Drug Administration (FDA) and the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) requirements. The developed method was then applied to monitor the DOC profile in plasma and urine samples collected from a pediatric patient suffering from cardiac angiosarcoma (AS) with metastasis to lungs and mediastinal lymph nodes, who was receiving treatment with DOC at a dose of 30 mg/m2 body surface area. Due to the rarity of this disease, TDM was carried out to determine the exact levels of DOC at particular time points to ascertain which levels were conducive to maximizing the treatment's effectiveness while minimizing the drug's toxicity. To this end, the concentration-time profiles of DOC in the plasma and urine samples were determined, and the levels of DOC at specific time intervals up to 3 days after administration were measured. The results showed that DOC was present at higher concentrations in the plasma than in the urine samples, which is due to the fact that this drug is primarily metabolized in the liver and then eliminated with the bile. The obtained data provided information about the pharmacokinetic profile of DOC in pediatric patients with cardiac AS, which enabled the dose to be adjusted to achieve the optimal therapeutic regimen. The findings of this work demonstrate that the optimized method can be applied for the routine monitoring of DOC levels in plasma and urine samples as a part of pharmacotherapy in oncological patients.
Collapse
Affiliation(s)
- Olga Maliszewska
- Department of Analytical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Anna Roszkowska
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Marcin Lipiński
- Department of Pharmaceutical Biochemistry, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Natalia Treder
- Department of Analytical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Ilona Olędzka
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Piotr Kowalski
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Małgorzata Anna Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Alina Plenis
- Department of Analytical Chemistry, Medical University of Gdansk, 80-416 Gdańsk, Poland
| |
Collapse
|
5
|
Jiang X, Yan M. Surgical treatment for improved 1-year survival in patients with primary cardiac sarcoma. Anatol J Cardiol 2021; 25:796-802. [PMID: 34734813 DOI: 10.5152/anatoljcardiol.2021.60378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Surgery is considered a relative contraindication in sarcoma tumor. Because of the unique characteristics of heart, whether surgery is optimally chosen in primary cardiac sarcoma (PCS) is unknown. In this study, we aimed to evaluate the 1-year survival after surgery for PCS. METHODS Patients with PCS from the Surveillance, Epidemiology, and End Results Database (SEER) between 1975 and 2015 were recruited. The endpoints were defined as 1-year all-cause mortality (ACM) and 1-year cancer-specific mortality (CSM). RESULTS The study population consisted of 335 patients diagnosed with PCS. The 1-year ACM and CSM were 49.0% and 42.1% respectively. The Kaplan-Meier curves revealed that decreased 1-year ACM-CSM were significantly associated with surgical treatment. Multiple COX regression analysis, surgery, and chemotherapy showed a significantly decreased rate of 1-year ACM and CSM. The adjusted hazard ratio of surgery was significant when the year of diagnosis was ≥2000, patients were aged <50 years, SEER stage was localized, and patients did not undergo chemotherapy (all p<0.05), and was insignificant when the year of diagnosis was <2000, patients were aged ≥50 years, SEER stage was distance, regional, and unstaged/unknown, and the patients underwent chemotherapy (all p>0.05). No interaction effects were detected between the variables and surgery (all p for interaction >0.05). CONCLUSION Surgery should be highly recommended in patients with PCS to improve the 1-year survival rate, especially in younger patients with localized SEER stage and non-chemotherapy management.
Collapse
Affiliation(s)
- Xiaowei Jiang
- Department of Cardiology, Xiangya Hospital, Central South University; Changsha-China
| | - Min Yan
- Department of Internal Medicine, Changsha Medical University; Changsha-China
| |
Collapse
|
6
|
Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
Collapse
|
7
|
Razera RJ, Araújo AMD, Bernardes VP, Moisés FM, Mundim LS, Araújo RA. High-Grade Pleomorphic Sarcoma of the Left Atrium after Incomplete Resection and Adjuvant Chemotherapy. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200140] [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
|
8
|
Dulal Karki S, Westhoff M, Maschek H, Augustyniak J, Gupta V, Welter S. A rare diagnostic challenge in a female patient with a rapid recurrent pleural effusion: Autopsy revealed cardiac angiosarcoma with bilateral pleural and pulmonary metastases. A case report. Int J Surg Case Rep 2021; 78:278-283. [PMID: 33373923 PMCID: PMC7776125 DOI: 10.1016/j.ijscr.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION We present a very rare case with diffuse cardiac angiosarcoma. Because all symptoms are often non-specific, this diagnosis is difficult to establish. To our knowledge this is the first clinical description of this rare disease. PRESENTATION OF CASE A 47-year-old female presented with bilateral pulmonary infiltrates and non-specific symptoms as fever, chest pain and dyspnoea on exertion. She was treated with antibiotics for suspected lung infection but deteriorated developing rapid recurrent pleural effusion. Her transthoracic- and transoesophageal-echocardiography as well as the thoracentesis and endobronchial ultrasound findings were normal. A minimally invasive pulmonary wedge resection, partial pleurectomy and pericardial fenestration was performed. The pathologic interpretation of these specimen was very difficult and a correct diagnosis could be made only by the second reference pathologist. While awaiting reference histology report she was administered high-flow oxygen therapy for hypoxia, antibiotics, catecholamines and corticosteroids. The patient deteriorated very rapidly and died in the ICU. DISCUSSION As in earlier studies, misdiagnosis delayed the actual diagnosis, especially because there was no clinical suspicion for angiosarcoma. Pathologic evaluation may be difficult because different growth patterns may be present in the same tumour and pleural or lung specimen may show only very tiny tumour formations within a fibrosing tissue changes. CONCLUSION This case report highlights the difficulties to establish a diagnosis of diffuse angiosarcoma in time. An early diagnosis, to initiate oncologic treatment, require a high level of clinical suspicion and a histological proof from pericardial or myocardial biopsy.
Collapse
Affiliation(s)
| | | | | | | | - Varun Gupta
- Department of Thoracic Surgery, Lungenklinik Hemer, Hemer, Germany
| | - Stefan Welter
- Department of Thoracic Surgery, Lungenklinik Hemer, Hemer, Germany.
| |
Collapse
|
9
|
Di Buono G, Randisi B, Romano G, Ricupati F, Buscemi S, Agrusa A. Recurrent intussusception of small bowel in a young patient due to metastases from cardiac undifferentiated pleomorphic sarcoma: A first ever case report. Int J Surg Case Rep 2020; 77S:S13-S16. [PMID: 32972888 PMCID: PMC7876920 DOI: 10.1016/j.ijscr.2020.09.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Undifferentiated metastatic pleomorphic sarcoma (Malignant Fibrous Histiocytoma) is a rare entity in the small intestine, especially when the primary tumor is of cardiac origin. CASE REPORT We report a case of metastatic intestinal undifferentiated pleomorphic sarcoma in a young patient with a history of primary cardiac tumor in the left atrium and recurrent small bowel intussusception. He was admitted for abdominal pain and constipation. A segmental resection of the small intestine was performed with side-to-side entero-enteroic anastomosis. DISCUSSION Intussusception of the small bowel is rare in adults and it represents about 1-3% of intestinal obstructions. It mainly affects the fifth decade with a male/female ratio of 1:5 More than 60% of patients with intussusception have a tumor with 50% being malignant. This type of intussusception can be diagnosed on the CT abdominalscan. Radiological features include a typical "target" sign with overdistention of the proximal intestine and air-fluid levels, but the diagnosis of certainty is made by exploratory laparotomy. CONCLUSION The metastatic tumors that cause intussusception represent a rare clinical condition in adult patients, but much more common than primary ones. Metastasis to the small intestine are part of differential diagnosis in patient with a history of tumor who present with intussusception.
Collapse
Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Brenda Randisi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Federica Ricupati
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| |
Collapse
|
10
|
Morka A, Kohut J, Radzymińska-Chruściel B, Mroczek T, Gładki M, Weryński P, Rudziński A, Skalski J, Szydłowski L. Echocardiography and Newer Imaging Techniques in Diagnosis and Long-Term Follow-Up of Primary Heart Tumors in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155471. [PMID: 32751243 PMCID: PMC7432637 DOI: 10.3390/ijerph17155471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
Abstract
Background: Primary heart tumors (PHTs) in the pediatric population are very rare and do not manifest any characteristic symptoms. Methods: A retrospective analysis of 61 cases was undertaken. Data from three centers for the years 2003–2018 were gathered. The tumors’ clinical course, location, number, hemodynamic, treatment, and follow-up were evaluated. Echocardiography was complemented with magnetic resonance imaging, computer tomography, and histopathological examination. Results: Out of 61 PHT diagnoses, 56 (91.8%) were circumstantial including all 16 (26.2%) prenatal tumors. The reasons for cardiological consultations were arrhythmia, syncopes, lowered physical performance, and murmurs. Only five patients (8.2%) were suspected of tumors based on previous symptoms of sclerosis tuberosa. Rhabdomyoma was the most frequently found PHT (60.7%). The tumors were predominantly located in the ventricles (49.1%) and intraventricular septum (14.9%) and tended to be single (70.5%). About 37.7% of patients suffered from coexistent multi-organ problems, two (3.28%) from congenital heart defects and one (1.64%) from Carney’s syndrome. Tumor resection was performed on 26 (42.7%) patients, of which 16 (61.5%) underwent total and 10 (38.5%) partial tumor resection. During the follow-up (mean 4.3 years), 54 patients (88.5%) have improved or were stable, while seven (11.5%) died. Conclusions: Primary pediatric heart tumors are diagnosed completely circumstantially, and the most common is rhabdomyoma, although arrhythmia may suggest fibroma. Diagnosis of a heart tumor in children is not synonymous with fatal prognosis, and most of them require only constant observation. Life-saving operation allows improvement, while the prognosis for malignant tumors in children is definitely unfavorable.
Collapse
Affiliation(s)
- Aleksandra Morka
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, Faculty of Health Sciences, Jagiellonian University Medical College, 30-663 Kraków, Poland
- Correspondence:
| | - Joanna Kohut
- Department of Pediatric Cardiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (J.K.); (L.S.)
| | | | - Tomasz Mroczek
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (T.M.); (J.S.)
| | - Marcin Gładki
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, 30-663 Kraków, Poland;
| | - Piotr Weryński
- Department of Pediatric Cardiology, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (P.W.); (A.R.)
| | - Andrzej Rudziński
- Department of Pediatric Cardiology, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (P.W.); (A.R.)
| | - Janusz Skalski
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (T.M.); (J.S.)
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (J.K.); (L.S.)
| |
Collapse
|
11
|
|
12
|
Kumar P, Singh A, Deshmukh A, Kumar S. Cardiac MRI for the evaluation of cardiac neoplasms. Clin Radiol 2020; 75:241-253. [PMID: 31902480 DOI: 10.1016/j.crad.2019.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022]
Abstract
Primary cardiac neoplasms are extremely rare and are far outnumbered by metastases. These are difficult to diagnose and differentiate clinically due to lack of specific clinical manifestations. Technological advances have revolutionised cardiac imaging, with the cardiac magnetic resonance imaging (CMRI) showing promising results in the non-invasive evaluation of cardiac masses. Further, CMRI may envisage the malignant potential of a lesion based on its location, morphology, and signal characteristics, in addition to determining its impact on cardiac function. With the ever-increasing application of CMRI in the evaluation of neoplasms, comprehensive knowledge of their imaging characteristics becomes crucial.
Collapse
Affiliation(s)
- P Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - A Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - A Deshmukh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| |
Collapse
|
13
|
Primary Cardiac Angiosarcoma: Authors' Perspective Following Synthesis of Available Literature. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
The impact of postoperative therapy on primary cardiac sarcoma. J Thorac Cardiovasc Surg 2018; 156:2194-2203. [PMID: 30454911 DOI: 10.1016/j.jtcvs.2018.04.127] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/16/2018] [Accepted: 04/24/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Primary cardiac sarcomas (PCS) are extremely rare, portend a very poor prognosis, and have limited outcomes data to direct management. This study evaluated the impact of postoperative chemotherapy and/or radiotherapy on survival for PCS. METHODS A retrospective chart review was conducted of 12 patients diagnosed with and who underwent resection for PCS at a single institution between 2000 and 2016. Data were collected on patient/tumor characteristics and analyzed with respect to treatment and outcome using Kaplan-Meier methods. RESULTS Median age was 43 (range 21-73 years) with a 50:50 male-to-female ratio. The most common subtype was angiosarcoma (42%), and 25% presented with distant metastases (DMs). The initial treatment modality for all patients was surgery, with 58% having macroscopically positive (R2) margins. In total, 75% received postoperative chemotherapy and/or radiotherapy. Median progression-free survival (PFS) was 5.9 months, and median overall survival (OS) was 12.0 months. Achieving negative or microscopically positive margins (R0/R1) as compared with R2 resection significantly improved PFS (12.6 vs 2.7 months, P = .008) and OS (21.8 vs 7.2 months, P = .006). DM at presentation demonstrated a significantly shorter OS (7.0 vs 16.9 months, P = .04) and PFS (0.7 vs 7.9 months, P = .003) compared with localized disease. Patients given postoperative therapy had longer OS compared with surgery only, but this difference was not statistically significant (15.5 vs 2.6 months, P = .12). CONCLUSIONS Gross total surgical resection can significantly improve PFS and OS in PCS, but DM at diagnosis is an extremely poor prognostic sign. Postoperative therapy should be considered, although this study was likely underpowered to demonstrate a statistically significant benefit.
Collapse
|
15
|
Chen Z, Chen R, Ng C, Shi H. Primary pericardial primitive neuroectodermal tumor: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:2155-2159. [PMID: 31938326 PMCID: PMC6958199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/23/2018] [Indexed: 06/10/2023]
Abstract
Primitive neuroectodermal tumor (PNET) is a rare, high-grade malignant tumor that most commonly occurs in the peripheral nervous system, bone, and deep soft tissues. It is extremely rare in the pericardium. To the best of our knowledge, only two patients with primary PNET of the pericardium have been reported so far in the literature. We report a case of PNET of the pericardium in a 13-year-old female patient, who was referred to our hospital for dyspnea and edema of lower extremities. Computer tomography (CT) scanning revealed a soft tissue mass in the pericardium which was surgically removed. The diagnosis of PNET was confirmed by histology, immunohistochemistry and molecular study. The patient was alive and well at follow up 8 months after surgery.
Collapse
Affiliation(s)
- Zhenwei Chen
- Department of Pathology, Jinhua Municipal Central HospitalJinhua, Zhejiang Province, P. R. China
| | - Rongming Chen
- Department of Pathology, The People’s Hospital of Changfeng CountyChangfeng County, Anhui Province, P. R. China
| | - Chising Ng
- Department of Pathology St, Teresa’s HospitalKowloon, Hong Kong, P. R. China
| | - Hongqi Shi
- Department of Pathology, Jinhua Municipal Central HospitalJinhua, Zhejiang Province, P. R. China
| |
Collapse
|
16
|
Parashi HS, Joshi MM, Bhosle KN, Rawekar KH, Jadhao MR, Mundhe MB. Primary cardiac liposarcoma in the right ventricular outflow tract. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
17
|
Abstract
BACKGROUND While echocardiography is effective for initial identification of anatomic location, magnetic resonance imaging (MRI) is a more advantageous modality for delineating tumor expanse, spread, and blood supply preoperatively. Emerging patterns may even help generate a specific diagnosis prior to biopsy and histopathology. CASE PRESENTATION Our case of a 67-year-old male referred for cardiac magnetic resonance to further evaluate a cardiac mass highlights the sophisticated level of data which can be collected. Our case highlights the perfusion related findings associated with cardiac angiosarcoma. CONCLUSION In this case, we present the diagnosis of right atrial cardiac angiosarcoma by multiple imaging modalities including MRI and subsequent angiography, allowing for prompt surgical intervention and initiation of adjuvant therapy that resulted in a survival time of 19 months.
Collapse
Affiliation(s)
- Jennifer Lindsey
- Departments of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Richard B Stacey
- Departments of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
18
|
Joseph AL, Wilklow FE, Olivier JJ, Joseph GJ, Glancy DL. Angiosarcoma of the Heart Presenting as Subacute Pericarditis. Am J Cardiol 2017; 119:941-943. [PMID: 28043397 DOI: 10.1016/j.amjcard.2016.11.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 11/25/2022]
Abstract
A young woman, who presented with what appeared to be subacute pericarditis, was found to have primary angiosarcoma of the heart, a condition that is nearly always fatal regardless of the therapy.
Collapse
|
19
|
Kukla P, Pleva L, Porzer M, Brát R, Handlos P, Buzrla P, Plášek J, Mrozek J, Homza M. Inferior vena cava leiomyosarcoma with right atrium tumorous mass presenting as heart failure in a 70-year-old man: A case report. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
20
|
Petrovic M, Zhao B, Thangam M, Loyalka P, Buja LM, Kar B, Gregoric ID. Ewing Sarcoma in the Right Ventricle. Tex Heart Inst J 2016; 43:458-460. [PMID: 27777536 DOI: 10.14503/thij-15-5330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ewing sarcoma is the second most prevalent malignant primary bone tumor but constitutes only a small proportion of cardiac metastases. We present a case of asymptomatic Ewing sarcoma metastatic to the right ventricle. A 36-year-old man presented for evaluation and resection of a pedunculated right ventricular cardiac tumor. Three years before, he had been diagnosed with translocation-negative Ewing sarcoma, for which he had undergone chemotherapy and amputation of the left leg below the knee. We resected the right ventricular tumor. Analysis of the resected mass supported the diagnosis of metastatic Ewing sarcoma. Postoperative transthoracic echocardiograms showed normal biventricular size and function. One year later, the patient had no recurrence of the sarcoma. In addition to discussing this case, we review the relevant medical literature.
Collapse
|
21
|
Zupan Mežnar A, Berden P, Lainščak M. Left ventricular metastasis of soft tissue sarcoma causing heart failure: Presentation of two cases. Int J Cardiol 2016; 219:119-20. [DOI: 10.1016/j.ijcard.2016.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 02/06/2023]
|
22
|
Esfehani MH, Mahmoodzadeh H, Omranipour R. Small intestine and ovarian metastasis in a patient with a history of cardiac fibrosacoma. J Egypt Natl Canc Inst 2015; 27:171-2. [PMID: 25936897 DOI: 10.1016/j.jnci.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 12/18/2022] Open
Abstract
Metastatic tumors involving the small bowel are much more common than primary neoplasms. The most common metastases to the small intestine are those arising from other intra-abdominal organs. Metastases from extra-abdominal tumors are rare but may be found in patients with adenocarcinoma of the breast and carcinoma of the lung. Cutaneous melanoma is the most common extra-abdominal source involving the small intestine, with involvement of the small intestine noted in more than half of the patients dying from malignant melanoma [1]. While intestinal metastasis from sarcoma has been described, this is an extremely rare occurrence especially from a rare malignant sarcoma of cardiac origin. The dismal prognosis of cardiac sarcomas results from extensive local invasion at presentation or distant metastasis. Metastasis to the small bowel may cause obstruction, bleeding, or intussusception in which the diagnosis may be delayed because of rarity of the condition and mild and vague abdominal symptoms at early presentation. In this report, a 35 year old woman a known case of cardiac fibrosarcoma was admitted to the emergency ward with abdominal pain and distention, bloody diarrhea, and recurrent nausea and vomiting. Jejuno-jejunal invagination was diagnosed at laparotomy along with tumoral involvement of the left ovary. Histopathological study showed that there was a fibrosarcoma compatible with the earlier diagnosis of primary cardiac tumor. We have described some aspects of diagnosis and treatment of this rare cause of intestinal intussusception.
Collapse
Affiliation(s)
- Maryam Hassan Esfehani
- Department of Surgery, Iranian National Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Habibollah Mahmoodzadeh
- Department of Surgery, Iranian National Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramesh Omranipour
- Department of Surgery, Iranian National Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|