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Bryant JM, Weygand J, Keit E, Cruz-Chamorro R, Sandoval ML, Oraiqat IM, Andreozzi J, Redler G, Latifi K, Feygelman V, Rosenberg SA. Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions. Cancers (Basel) 2023; 15:2081. [PMID: 37046741 PMCID: PMC10093051 DOI: 10.3390/cancers15072081] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) offers improved soft-tissue visualization, allowing for better tumor and normal tissue delineation. MR-guided RT (MRgRT) has traditionally been defined by the use of offline MRI to aid in defining the RT volumes during the initial planning stages in order to ensure accurate tumor targeting while sparing critical normal tissues. However, the ViewRay MRIdian and Elekta Unity have improved upon and revolutionized the MRgRT by creating a combined MRI and linear accelerator (MRL), allowing MRgRT to incorporate online MRI in RT. MRL-based MR-guided SBRT (MRgSBRT) represents a novel solution to deliver higher doses to larger volumes of gross disease, regardless of the proximity of at-risk organs due to the (1) superior soft-tissue visualization for patient positioning, (2) real-time continuous intrafraction assessment of internal structures, and (3) daily online adaptive replanning. Stereotactic MR-guided adaptive radiation therapy (SMART) has enabled the safe delivery of ablative doses to tumors adjacent to radiosensitive tissues throughout the body. Although it is still a relatively new RT technique, SMART has demonstrated significant opportunities to improve disease control and reduce toxicity. In this review, we included the current clinical applications and the active prospective trials related to SMART. We highlighted the most impactful clinical studies at various tumor sites. In addition, we explored how MRL-based multiparametric MRI could potentially synergize with SMART to significantly change the current treatment paradigm and to improve personalized cancer care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Stephen A. Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (J.M.B.)
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Restivo L, De Luca A, Fabris E, Pagura L, Pierri A, Korcova R, Franzese I, Fiocco A, Rauber E, Mazzaro E, Bussani R, Belgrano M, Pappalardo A, Sinagra G. A 20-year experience in cardiac tumors: a single center surgical experience and a review of literature. J Cardiovasc Med (Hagerstown) 2022; 23:722-727. [PMID: 36166324 DOI: 10.2459/jcm.0000000000001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cardiac tumors are rare and heterogeneous entities which still remain a diagnostic and therapeutic challenge. The treatment for most cardiac tumors is prompt surgical resection. We sought to provide an overview of surgical results from a series of consecutive patients treated at our tertiary care center during almost a 20-year experience. METHODS AND RESULTS In this single center study, 55 consecutive patients with diagnosis of cardiac tumor underwent surgical treatment from January 2002 to April 2021. Of these, 23 (42%) were male and the mean age was 62 ± 12 years. Fifteen (27%) patients were symptomatic at the time of the diagnosis, mostly for dyspnea and palpitations. The most frequent benign cardiac tumor was myxoma (32; 58%), occurring mainly in the left atrium (31; 97%). Pleomorphic sarcoma was the most frequent primary malignant cardiac tumor (4; 7%), mainly located in the ventricles (1; 25% in the left ventricle; 2; 50% in the right ventricle). In all cases of benign tumors surgery was successful with no relapses. Two (50%) pleomorphic sarcomas showed subsequent relapses. After a median follow-up of 44 months, 15 (27%) patients died. Although malignant tumors presented a limited survival, benign tumors showed a very good prognosis. CONCLUSION Cardiac tumors require a multidisciplinary approach to guarantee a prompt diagnosis and appropriate treatment. In our surgical experience, outcome after surgery of benign tumors was excellent, while malignant tumors had poor prognosis despite radical surgery.
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Affiliation(s)
- Luca Restivo
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Enrico Fabris
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Linda Pagura
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Alessandro Pierri
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Renata Korcova
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Ilaria Franzese
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Alessandro Fiocco
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste.,Department of Surgical, Medical and Molecular Pathology and Critical Care, Division of Cardiac Surgery, University of Pisa, Pisa
| | - Elisabetta Rauber
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Enzo Mazzaro
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Rossana Bussani
- Pathology Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
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Tumors of the cardiovascular system: heart and blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Restivo L, De Luca A, Pinamonti B, Grilli G, Bussani R, Cominotto F, Crisafulli C, Dore F, Sinagra G, Pappalardo A. A case of primary cardiac sarcoma with an acute presentation: The role of multimodality imaging. Clin Case Rep 2021; 9:e04219. [PMID: 34178334 PMCID: PMC8212016 DOI: 10.1002/ccr3.4219] [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: 03/16/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
The case highlights the value of contrast echocardiography in raising clinical suspicion of malignancy, allowing a diagnostic work-up and the treatment of the primitive heart tumors.
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Affiliation(s)
- Luca Restivo
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Antonio De Luca
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Bruno Pinamonti
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Giulia Grilli
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Rossana Bussani
- Pathology DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Franco Cominotto
- Emergency Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Carmelo Crisafulli
- Nuclear Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Franca Dore
- Nuclear Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Gianfranco Sinagra
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Aniello Pappalardo
- Division of Cardiac SurgeryCardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
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Alrehaili M, Tashkandi E. Diagnostic and Therapeutic Challenges Associated with the Rare Cardiac Metastasis Complicating Rectal Adenocarcinoma. Case Rep Oncol 2021; 13:1441-1445. [PMID: 33442368 PMCID: PMC7772863 DOI: 10.1159/000511600] [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: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in the world. It typically metastasizes to the lymph nodes, liver or lungs. Cardiac involvement is considered the least likely metastatic complication of malignant tumors including CRC. We report a rare case of metastatic rectal cancer to the liver, ovaries, lungs and peritoneum that presented initially with a 1-week history of rectal bleeding. Her hospital course was complicated by progressive dyspnea and palpitations secondary to right atrial metastasis based on imaging studies including cardiac MRI with contrast. The patient was not fit for chemotherapy or any surgical intervention given her poor prognosis and functional status in the setting of advanced stage of her disease. After discussion with the patient and her family, a decision was made to change her code status to DNR (do not resuscitate) and focus on palliative treatment of her disease. She expired about 2 weeks following her discharge date. Based on this case report, we recommend a high index of suspicion for cardiac metastasis when dealing with cardiac or respiratory complaints in cases of CRC that need careful evaluation with echocardiography and MRI.
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Affiliation(s)
- Mohammad Alrehaili
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Emad Tashkandi
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia.,College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Sim AJ, Palm RF, DeLozier KB, Feygelman V, Latifi K, Redler G, Washington IR, Wuthrick EJ, Rosenberg SA. MR-guided stereotactic body radiation therapy for intracardiac and pericardial metastases. Clin Transl Radiat Oncol 2020; 25:102-106. [PMID: 33204858 PMCID: PMC7653008 DOI: 10.1016/j.ctro.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023] Open
Abstract
Radiation is not typical in the standard of care for cardiac metastases. MR-guided radiation uses real-time imaging and offers better soft tissue contrast. Real-time MR-guidance allows for safe high dose radiation to cardiac metastases. MR-guided stereotactic radiation can improve symptoms without acute toxicity.
Aims To assess the safety and efficacy of MR-guided stereotactic body radiation therapy (MRgSBRT) for cardiac metastases. Materials/methods This single institution retrospective analysis evaluated our experience with MRgSBRT for cardiac metastases. Response rate was compared between pre-RT and post-RT imaging. Symptomatic changes were also tracked and documented. Results Between 4/2019 and 3/2020, five patients with cardiac metastases (4 intracardiac and 1 pericardial) were treated with MRgSBRT. Median age at treatment was 73 years (range 64–80) and two patients had pre-existing cardiac disease. Histologies included melanoma and breast adenocarcinoma. Median lesion diameter was 2 cm (range 1.96–5.8 cm). Three patients were symptomatic, one of whom had pulmonary hypertension and RV enlargement. Another patient had an asymptomatic arrythmia. Median PTV prescribed dose was 40 Gy (range 40–50 Gy) and delivered in five fractions on nonconsecutive days. Median PTV volume was 53.4 cc (range 8.7–116.6 cc) and median coverage was 95% (range 84.1–100%). A uniform 3 mm margin was used for real-time gating, allowing a median 7% (range 5–10%) pixel excursion tolerance. Median follow-up was 4.7 months (range 0.9–12.3). Two patients exhibited stable disease, two had a partial response and one exhibited a complete response. All symptomatic patients experienced some relief. There were no acute adverse events, however, one patient without prior cardiac disease developed atrial fibrillation 6 months after treatment. Two patients died of causes unrelated to cardiac MRgSBRT. Conclusion In this largest known series of cardiac metastasis MRgSBRT, real-time image guidance enables safe treatment resulting in good response with improving presenting symptoms without acute adverse events.
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Affiliation(s)
- Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Russell F Palm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Kirby B DeLozier
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Vladimir Feygelman
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Gage Redler
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Iman R Washington
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Evan J Wuthrick
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Stephen A Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
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Rahouma M, Arisha MJ, Elmously A, El-Sayed Ahmed MM, Spadaccio C, Mehta K, Baudo M, Kamel M, Mansor E, Ruan Y, Morsi M, Shmushkevich S, Eldessouki I, Rahouma M, Mohamed A, Gambardella I, Girardi L, Gaudino M. Cardiac tumors prevalence and mortality: A systematic review and meta-analysis. Int J Surg 2020; 76:178-189. [PMID: 32169566 DOI: 10.1016/j.ijsu.2020.02.039] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Cardiac tumors and their associated outcomes are poorly characterized. This study sought to comprehensively assess the epidemiology and natural history of primary and secondary malignant cardiac tumors (PMCT and SMCT), a well as establish predictors of mortality. METHODS A comprehensive literature review was performed to identify articles reporting on PMCTs and SMCTs. The prevalence of important cardiac tumor (CT) subtypes was evaluated and further stratified based on the continental region. Outcomes of interest included short- and long-term mortality and utilization of heart transplantation (HTX). A random effect model was adopted, and a meta-regression was performed to determine predictors of the prevalence of CTs as well as predictors of operative mortality. RESULTS Of the 1,226 retrieved articles, 74 were included in our study (n = 8,849 patients). The mean follow-up was 2.27 years, mean age was 42.9 years, and 55% of the patients were females. There was a total number of 7,484 benign primary cardiac tumors (PCTs) (5,140 were myxoma), 862 (9.7%) malignant PCTs, and 355 secondary cardiac tumors. The prevalence of PMCTs among PCTs was 10.83% [95%CI = 09.11; 12.83%] with a trend towards being lower in South America compared to other continents (Prevalence = 5.80%). The prevalence of HTX among all patients was 2.45% [1.36; 4.38%]. The pooled short-term mortality was 5.90% [4.70; 7.39%] and the incidence of late mortality in all CTs, benign CT and PMCTs was 2.55% [1.76; 3.72%], 0.79% [0.46; 1.37%] and 14.77% [9.32; 23.40%], respectively. On meta-regression, the annual volume of cardiac tumor cases per center was the only predictor of lower early mortality (Beta = -0.14 ± 0.03, P < 0.0001). CONCLUSIONS PMCTs represent the minority of PCT (~10%) and have a higher prevalence in Europe and North America. Survival is higher in benign pathology and is significantly improved by treatment in specialized high-volume centers. Approximately 2% of patients with CTs undergo heart transplantation.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt.
| | - Mohammed J Arisha
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Adham Elmously
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | | | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, G814DY, UK; Institute of Cardiovascular and Medical Sciences, Veterinary and Life Sciences, College of Medical, University of Glasgow, Glasgow, G128QQ, UK
| | - Kritika Mehta
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Massimo Baudo
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mohamed Kamel
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Esraa Mansor
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Yongle Ruan
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mahmoud Morsi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Shon Shmushkevich
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Ihab Eldessouki
- Medical Oncology Department, University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - Mostafa Rahouma
- Information Technology Department, National Cancer Institute, Cairo University, Egypt
| | - Abdelrahamn Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Ivancarmine Gambardella
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Leonard Girardi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mario Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
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8
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Tripathy S, Parida GK, Naswa N, Jha P, Reddy S, Arun Raj ST. Right Ventricle Metastasis from Carcinoma Rectum: Findings on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography. Indian J Nucl Med 2019; 35:78-79. [PMID: 31949380 PMCID: PMC6958966 DOI: 10.4103/ijnm.ijnm_15_19] [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: 01/15/2019] [Accepted: 02/03/2019] [Indexed: 12/16/2022] Open
Abstract
Rectal adenocarcinoma metastasizes most commonly to the lungs and liver. Metastasis to heart, although described in literature, is a very rare phenomenon. We describe the 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET-CT) findings of a 45-year-old male who was a biopsy-proven case of adenocarcinoma rectum. Apart from metastatic disease involving liver, lungs, bone marrow, and lymph nodes, metastasis to right ventricle was also seen on PET-CT scan.
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Affiliation(s)
- Sarthak Tripathy
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine and PET-CT, Delhi Institute of Functional Imaging, New Delhi, India
| | - Niraj Naswa
- Department of Nuclear Medicine and PET-CT, Delhi Institute of Functional Imaging, New Delhi, India
| | - Pragati Jha
- Department of Nuclear Medicine and PET-CT, Delhi Institute of Functional Imaging, New Delhi, India
| | - Sreenivas Reddy
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
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Hendriksen BS, Stahl KA, Hollenbeak CS, Taylor MD, Vasekar MK, Drabick JJ, Conte JV, Soleimani B, Reed MF. Postoperative chemotherapy and radiation improve survival following cardiac sarcoma resection. J Thorac Cardiovasc Surg 2019; 161:110-119.e4. [PMID: 31928808 DOI: 10.1016/j.jtcvs.2019.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cardiac sarcoma represents a rare and aggressive form of cancer with a paucity of data to produce outcome-driven evidence-based guidelines. Current surgical management consists of resection with postoperative therapy (chemotherapy, radiation, or both) offered on a selective, individualized basis. This study was designed to determine whether postoperative therapy was associated with improved overall survival after resection. METHODS The National Cancer Database was used to identify patients with cardiac sarcoma between 2004 and 2015. Patient characteristics were stratified by treatment (surgical, nonsurgical, and none), and treatment was analyzed by stage. Overall survival, assessed with Kaplan-Meier methodology, was compared between patients who received postoperative therapy and those who did not following resection. Multivariable survival modeling using a Weibull model identified risk factors associated with survival while controlling for confounders. RESULTS The study included 617 patients diagnosed with cardiac sarcoma. Only 24% (149/617) of patients were diagnosed with early-stage disease. Angiosarcoma represented 48% (298/617) of cases and was the most commonly identified histologic subtype. 60% (372/617) underwent surgical resection and 58% (216/372) of those patients were treated with postoperative therapy. Following surgery, median survival was more than doubled for patients treated with postoperative therapy (19 months vs 8 months, P = .026). However, 5-year overall survival was similar between the groups. Multivariable analysis confirmed an improvement in survival with postoperative therapy (hazard ratio, 0.68; 95% confidence interval, 0.51-0.91, P = .009). CONCLUSIONS Postoperative therapy is associated with better median survival following resection of cardiac sarcoma. However, at 5 years, the difference in overall survival is not statistically significant.
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Affiliation(s)
- Brandon S Hendriksen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa.
| | - Kelly A Stahl
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Christopher S Hollenbeak
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa; Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, Pa; Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Matthew D Taylor
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Monali K Vasekar
- Department of Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Joseph J Drabick
- Department of Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - John V Conte
- Penn State Heart and Vascular Institute, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Behzad Soleimani
- Penn State Heart and Vascular Institute, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Michael F Reed
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa
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10
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Pichler Sekulic S, Glasgow A, Wasman J, Sabik JF, Fitzsimons B, Sekulic M. Cardiac varix: an example via a case report of a radiological mimicker of cardiac myxoma. Cardiovasc Pathol 2019; 45:107183. [PMID: 31865270 DOI: 10.1016/j.carpath.2019.107183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022] Open
Abstract
Cardiac myxoma is the most frequently encountered primary neoplasm of the heart; however, other tumefactive lesions can share similar radiologic features. We present briefly the case of a 69-year-old man incidentally found to have a mobile right atrial mass that based on initial radiologic findings was considered to represent a myxoma. After pathologic examination, the lesion was determined instead to be a cardiac varix: an endocardial, blood filled cystic space lined by endothelium and considered to represent a dilated vein.
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Affiliation(s)
- Simona Pichler Sekulic
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Akisha Glasgow
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jay Wasman
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joseph F Sabik
- Department of Surgery, Cardiac Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Fitzsimons
- Department of Anesthesiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Miroslav Sekulic
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Ahumada-Zakzuk SJ, Ruiz-Pla FA. Uso de ecocardiografía en la evaluación de masas cardíacas. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2019.04.009] [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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Abstract
Surgeons typically rely on their past training and experiences as well as visual aids from medical imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) for the planning of surgical processes. Often, due to the anatomical complexity of the surgery site, two dimensional or virtual images are not sufficient to successfully convey the structural details. For such scenarios, a 3D printed model of the patient's anatomy enables personalized preoperative planning. This paper reviews critical aspects of 3D printing for preoperative planning and surgical training, starting with an overview of the process-flow and 3D printing techniques, followed by their applications spanning across multiple organ systems in the human body. State of the art in these technologies are described along with a discussion of current limitations and future opportunities.
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13
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He S, Cao Y, Qin W, Chen W, Yin L, Chai H, Tao Z, Tang S, Qiu Z, Chen X. Prevalence of primary cardiac tumor malignancies in retrospective studies over six decades: a systematic review and meta-analysis. Oncotarget 2018; 8:43284-43294. [PMID: 28489604 PMCID: PMC5522145 DOI: 10.18632/oncotarget.17378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/30/2017] [Indexed: 12/21/2022] Open
Abstract
The incidence of patients diagnosed with primary malignant cardiac tumors (PMCTs) has increased greatly in the past few decades. Whether this rising prevalence is due to overdiagnosis or an increased malignancy rate of primary cardiac tumors (PCTs) remains unclear. Therefore, we performed a systematic review and meta-analysis of published retrospective studies to determine whether the malignancy rate has been increasing over time. Published studies containing relevant data between 1956 and 2014 were evaluated. Two authors searched for all retrospective studies that included patients diagnosed with PCT and PMCT. Two other investigators independently extracted the data, and discrepancies were resolved by consensus. A random-effects meta-analysis model and cumulative meta-analysis model were used to evaluate the pooled prevalence and trend of dynamic change in PCT malignancies. The effects of time, study period and sample size were studied using a logit-linear regression model with robust error variance and a time variable. Thirty-eight studies involving 5,586 patients were analyzed. The pooled prevalence of PMCT among the patients diagnosed with PCT was 9.9% (95% CI, 8.4% to 11.4%) (I2=70%; P< 0.001), and this prevalence has been stable since around 2003. In the regression model, the malignancy odds ratio remained stable from 1975 onward, and no time effect was observed. Our study confirms that PMCT is uncommon, and the prevalence of PCT malignancies remained stable in the past few decades. The clinically observed increase in incidence is unlikely to reflect a true population-level increase in tumorigenesis. This result strongly suggests that the observed increase in incidence of PMCT most likely reflects increased diagnostic detection over time.
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Affiliation(s)
- Shuai He
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yide Cao
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wen Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li Yin
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hao Chai
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhonghao Tao
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shaowen Tang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhibing Qiu
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Veroux P, Mignosa C, Veroux M, Bartoloni G, Bonanno MG, Tumminelli MG. Acute Occlusion of Abdominal Aorta: Unusual Embolization Site for a Cardiac Tumor Mass. TUMORI JOURNAL 2018; 88:417-9. [PMID: 12487563 DOI: 10.1177/030089160208800514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a rare case of complete embolization of a left atrial myxoma resulting in total occlusion of the suprarenal abdominal aorta. A 54-year-old man was admitted to hospital because of acute thoracic pain with paraplegia and acute renal failure. Abdominal computed tomography and angiography showed evidence of total occlusion of the suprarenal aorta. Intraoperatively, the aorta was found to be occluded by a hard neoformation, histologically defined as atrial myxoma. A diagnosis of atrial myxoma should be suspected in young patients suffering from acute thoracic pain and affected by paraplegia and acute renal failure. Early diagnosis may significantly abate the morbidity and mortality rates associated with this condition.
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Affiliation(s)
- Pierfrancesco Veroux
- Department of Surgery and Transplantation, University Hospital of Catania, Italy.
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15
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Reddy G, Maor E, Bois M, Chandrasekharan K, Rihal C, Nishimura R, Holmes D, Reeder G, Maleszewski J, Klarich K. Percutaneous transcatheter biopsy for intracardiac mass diagnosis. EUROINTERVENTION 2017; 13:e1436-e1443. [DOI: 10.4244/eij-d-17-00707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Randhawa JS, Budd GT, Randhawa M, Ahluwalia M, Jia X, Daw H, Spiro T, Haddad A. Primary Cardiac Sarcoma: 25-Year Cleveland Clinic Experience. Am J Clin Oncol 2017; 39:593-599. [PMID: 25036471 DOI: 10.1097/coc.0000000000000106] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac sarcomas are rare and have a poor prognosis. The median overall survival remains dismal and has been reported ranging from 6 months to a few years. Primary cardiac sarcoma is the most common malignant tumor comprising approximately 95% of all malignant tumors of the heart. METHODS We conducted a retrospective chart review in a single institution of patients diagnosed between March 1988 and April 2013. A total of 42 patients were identified. The following variables were studied: age at diagnosis, year of diagnosis, sex, stage, site of tumor involvement, tumor histology, grade, treatment modality, type of chemotherapy, and survival outcome. The overall median follow-up time was 49.5 months. RESULTS The most common histologic type was angiosarcoma. Overall estimated median survival (EMS) was 25 months. Tumors involving the left side of the heart and pericardium demonstrated better survival. Patients who received multimodality treatment (any combination of surgery, radiation therapy, and chemotherapy) had an EMS of 36.5 months compared with 14.1 months for patients treated with surgery, radiation therapy, or chemotherapy only (P=0.05). CONCLUSIONS Cardiac sarcoma is a lethal tumor with an EMS of 25 months. The tumor histology could be a possible predictor of better survival. Although selection bias may have been present, multimodality therapy (surgery, radiation therapy, and chemotherapy) was associated with improved survival.
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17
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Soylu E, Kidher E, Ashrafian H, Stavridis G, Harling L, Athanasiou T. A systematic review of left ventricular cardio-endoscopic surgery. J Cardiothorac Surg 2017; 12:41. [PMID: 28545585 PMCID: PMC5445499 DOI: 10.1186/s13019-017-0599-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 05/10/2017] [Indexed: 11/24/2022] Open
Abstract
Better visualisation, accurate resection and avoidance of ventriculotomy associated with use of endoscopic devices during intracardiac surgery has led to increasing interest in their use. The possibility of combining a cardio-endoscopic technique with either minimally invasive or totally endoscopic cardiac surgery provides an incentive for its further development. Several devices have been used, however their uptake has been limited due to uncertainty around their impact on patient outcomes. A systematic review of the literature identified 34 studies, incorporating 54 subjects undergoing treatment of left ventricular tumours, thrombus or hypertrophic myocardium using a cardio-endoscopic technique. There were no mortalities (0%; 0/47). In 12 studies, the follow-up period was longer than 30 days. There were no post-operative complications apart from one case of atrial fibrillation (2.2%; 1/46). Complete resection of left ventricular lesion was achieved in all cases (100%; 50/50). These successful results demonstrate that the cardio-endoscopic technique is a useful adjunct in resection of left ventricular tumours, thrombus and hypertrophic myocardium. This approach facilitates accurate resection of pathological tissue from left ventricle whilst avoiding exposure related valvular damage and adverse effects associated with ventriculotomy. Future research should focus on designing adequately powered comparative randomised trials focusing on major cardiac and cerebrovascular morbidity outcomes in both the short and long-term. In this way, we may have a more comprehensive picture of both the safety and efficacy of this technique and determine whether such devices could be safely adopted for routine use in minimal access or robotic intra-cardiac surgery.
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Affiliation(s)
- Erdinc Soylu
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - Emaddin Kidher
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - George Stavridis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK.
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18
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Reisenauer JS, Said SM, Allen MS. Metastatic Rectal Adenocarcinoma Presenting as a Giant Left Atrial Mass: Resection Combined With Right Lower Lobectomy. Ann Thorac Surg 2017; 102:e19-21. [PMID: 27343521 DOI: 10.1016/j.athoracsur.2015.11.064] [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: 10/20/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 12/20/2022]
Abstract
Pulmonary metastasis due to rectal adenocarcinoma is common, noted to be 5.8% in 5 years in patients presenting with rectal adenocarcinoma. However, direct extension into the cardiac chambers is rare. Here we describe an unusual presentation of metastatic rectal adenocarcinoma.
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Affiliation(s)
- Janani S Reisenauer
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
| | - Mark S Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Tsujii Y, Hayashi Y, Maekawa A, Fujinaga T, Nagai K, Yoshii S, Sakatani A, Hiyama S, Shinzaki S, Iijima H, Takehara T. Cardiac metastasis from colon cancer effectively treated with 5-fluorouracil, leucovorin, and oxaliplatin (modified FOLFOX6) plus panitumumab: a case report. BMC Cancer 2017; 17:152. [PMID: 28228152 PMCID: PMC5322603 DOI: 10.1186/s12885-017-3147-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiac metastasis from colorectal cancer is rare. There is little evidence supporting the effectiveness of chemotherapy, and standard therapy for metastatic cardiac tumors has not been established. CASE PRESENTATION A 76-year-old woman presented with a right ventricle tumor that was detected incidentally on screening cardiac ultrasonography. The initial computed tomography (CT) scan showed the cardiac tumor, which was approximately 40 mm in size, and multiple pulmonary nodules. Serum levels of tumor markers CEA and CA19-9 were elevated aberrantly. The suspected primary tumor, a well-differentiated adenocarcinoma of the transverse colon with wild-type KRAS was found by colonoscopy, and treatment with 5-fluorouracil, leucovorin, and oxaliplatin (modified FOLFOX6) plus panitumumab was initiated. After 4 courses of the therapy, a CT scan showed that the cardiac tumor size had markedly decreased and the pulmonary nodules had diminished. The serum levels of CEA and CA19-9 were also markedly decreased. After 12 courses of chemotherapy during 10 months of treatment, the patient continued to show a partial response, and she remained asymptomatic with continuation of the treatment through 15 courses. CONCLUSION To the best of our knowledge, this is the first report of the efficacy of combination therapy using cytotoxic and molecular targeted agents against cardiac metastasis from colon cancer.
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Affiliation(s)
- Yoshiki Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Akira Maekawa
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Tetsuji Fujinaga
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Kengo Nagai
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Shunsuke Yoshii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Akihiko Sakatani
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Satoshi Hiyama
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
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20
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Shi L, Wu L, Fang H, Han B, Yang J, Ma X, Liu F, Zhang Y, Xiao T, Huang M, Huang M. Identification and clinical course of 166 pediatric cardiac tumors. Eur J Pediatr 2017; 176:253-260. [PMID: 28074279 DOI: 10.1007/s00431-016-2833-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of this study was to investigate the pathological classifications, clinical features, and natural history of pediatric cardiac tumors to provide a basis for the selection of an appropriate therapeutic method. The medical records of in- or outpatients with cardiac tumors at four hospitals were classified to analyze various types of tumor growth locations, clinical manifestations, surgical indications, and long-term follow-up results. There were 166 patients, including 158 with primary cardiac tumors, six with metastatic cardiac tumors, and two with unclassified cardiac tumors. Among the 158 cases of primary cardiac tumor, 150 were benign and eight were malignant. The rhabdomyoma, fibroma, and myxoma are the most common types of benign cardiac tumors. The major clinical manifestations of cardiac tumors include outflow tract obstruction, arrhythmia, dyspnea, pericardial effusion, heart failure, and seizures. Among the 59 patients who underwent surgery, 49 had primary benign cardiac tumors, eight had primary malignant tumors, and two had malignant metastatic tumors. Post-surgery, nine of the patients had residual tumor tissues that did not significantly affect their hemodynamics. Following surgery, there were two cases of recurrence and nine deaths, including four of benign and five of malignant tumors with mortality rates of 8.2 and 50.0 %, respectively. Of the remaining 107 cases of patients who did not undergo surgery, five (4.7 %) died. CONCLUSION The primary benign cardiac tumors are the predominant pediatric cardiac tumors, of which rhabdomyoma, fibroma, and myxoma are the most common types. If severe symptoms are nonexistent and the hemodynamics is unaffected, most of the patients can survive in the long term despite the tumors. What is known: • Pediatric cardiac tumors are rare and are predominantly primary and benign. • The symptoms of heart failure, arrhythmia, and outflow obstruction are the most severe complications of cardiac tumors. What is new: • The rhabdomyoma, fibroma, and myxoma are the most common types of primary benign cardiac tumors. • If severe symptoms are not present and the hemodynamics are unaffected, most of the patients can survive in the long term despite the tumors.
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Affiliation(s)
- Lin Shi
- Shanghai Children's Medical Center, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Lanping Wu
- Shanghai Children's Medical Center, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Huijuan Fang
- , Shandong Provincial Hospital, Jinan, People's Republic of China
| | - Bo Han
- , Shandong Provincial Hospital, Jinan, People's Republic of China
| | - Jialun Yang
- Children's Hospital, Fudan University, Shanghai, China
| | - Xiaojin Ma
- Children's Hospital, Fudan University, Shanghai, China
| | - Fang Liu
- Children's Hospital, Fudan University, Shanghai, China
| | - Yongwei Zhang
- Shanghai Children's Hospital, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Tingting Xiao
- Shanghai Children's Hospital, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Min Huang
- Shanghai Children's Hospital, Medical Institute, Shanghai Jiaotong University, Shanghai, China
| | - Meirong Huang
- Shanghai Children's Medical Center, Medical Institute, Shanghai Jiaotong University, Shanghai, China. .,Department of Pediatric Cardiology, Shanghai Children's Medical Center, Medical Institute, Shanghai Jiao Tong University, 1678, Dongfang Road, Shanghai, 200127, China.
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21
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Sudden death following endomyocardial biopsy of cardiac metastasis from malignant melanoma. Forensic Sci Med Pathol 2016; 12:217-9. [DOI: 10.1007/s12024-016-9755-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 02/06/2023]
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22
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23
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Ramlawi B, Leja MJ, Abu Saleh WK, Al Jabbari O, Benjamin R, Ravi V, Shapira OM, Blackmon SH, Bruckner BA, Reardon MJ. Surgical Treatment of Primary Cardiac Sarcomas: Review of a Single-Institution Experience. Ann Thorac Surg 2015; 101:698-702. [PMID: 26476808 DOI: 10.1016/j.athoracsur.2015.07.087] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary cardiac sarcomas are rare, aggressive, and usually lethal. Surgical management protocols are not defined because of the lack of extensive experience in treating these patients. In this study, we reviewed our outcomes with primary cardiac sarcoma, and we make recommendations regarding management. METHODS Review of the Houston Methodist Hospital cardiac tumor database from 1990 to 2015 (25 years) yielded 131 primary cardiac evaluations of possible cardiac sarcoma. From these we identified 95 patients who underwent surgical excision. A computer search of cardiac sarcomas yielded 131 tumors that were coded as primary cardiac sarcoma or possible primary cardiac sarcoma. Retrospective data collection and clinical outcomes were evaluated for all 95 patients. Medical records and follow-up material were requested for all patients through clinic visits and contacting the physician of the patient, the hospital record department, and the cardiac tumor board after previous approval. The procedures were performed using an institutional review board-approved cardiac tumor protocol, and the patients gave full consent. RESULTS All 95 patients were diagnosed as having primary cardiac sarcoma by histologic appearance. Age ranged from 15 to 84 years at the time of presentation (mean, 44 years). Male patients made up 57% of the sample. The most common site for the cardiac sarcoma was the right atrium (37 patients) followed by the left atrium (31 patients). Postoperative 1-year mortality was 35% (33 patients). The most common tumor histologic type was angiosarcoma (40%) followed by spindle cell sarcoma (11%). CONCLUSIONS Primary cardiac sarcoma is a rare but lethal disease. Surgical intervention is associated with acceptable surgical mortality in this high-risk group of patients.
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Affiliation(s)
- Basel Ramlawi
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Monika J Leja
- Department of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Walid K Abu Saleh
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Odeaa Al Jabbari
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Robert Benjamin
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Haddasah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Brian A Bruckner
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
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24
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Tang QY, Guo LD, Wang WX, Zhou W, Liu YN, Liu HY, Li L, Deng YB. Usefulness of contrast perfusion echocardiography for differential diagnosis of cardiac masses. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2382-2390. [PMID: 26087885 DOI: 10.1016/j.ultrasmedbio.2015.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/08/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to assess the usefulness of contrast perfusion echocardiography in the differential diagnosis of different types of cardiac masses. Conventional echocardiography and contrast perfusion echocardiography were performed in 72 patients with cardiac masses. The degree of contrast enhancement of the mass and an adjacent section of myocardium after injection of contrast agent was determined by visual inspection and quantitative time-signal intensity curve analysis. The difference in maximal steady-state pixel intensity between the mass and the adjacent myocardium (ΔAmass-myocardium) was calculated. All masses had a pathologic diagnosis or resolved after anticoagulation. All 16 cardiac masses without enhancement on visual inspection were confirmed to be cardiac thrombi. Twenty-four masses with incomplete enhancement on visual inspection were recognized as benign tumors with validation methods. Of the 32 cardiac masses with complete enhancement, 30 were confirmed as malignant tumors and two as benign tumors with validation methods. The sensitivity and specificity of ΔAmass-myocardium in differentiating thrombi from tumors were 93% and 100%, respectively, and 100% and 97% in differentiating malignant tumors from benign tumors and thrombi. Both visual and quantitative assessment of degree of enhancement of cardiac masses in relation to the adjacent myocardium during contrast perfusion echocardiography had high diagnostic accuracy for differentiation of a thrombus from a tumor or a benign tumor from a malignant tumor.
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Affiliation(s)
- Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Xuan Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Ni Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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25
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Vroomen M, Houthuizen P, Khamooshian A, Soliman Hamad MA, van Straten AHM. Long-term follow-up of 82 patients after surgical excision of atrial myxomas. Interact Cardiovasc Thorac Surg 2015; 21:183-8. [PMID: 25972592 DOI: 10.1093/icvts/ivv125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/17/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Literature reporting on large patient groups with the long-term follow-up is limited due to the low incidence of myxomas. This single-centre, retrospective study reports on the long-term follow-up (e.g. complications, recurrence and survival) of a substantial patient group operated for cardiac myxomas. METHODS Patients were retrospectively selected from a prospectively obtained database comprising patients who had undergone cardiac surgery in the Catharina Hospital from 1990 onwards. Baseline characteristics and perioperative data were obtained from the database. In case of insufficient information, medical reports were analysed. The echocardiogram and clinical follow-up data were collected at outpatient clinics. RESULTS Eighty-two patients were included, of which 48 were females with a mean age of 61.3 years (±13.8). The main presenting symptom was dyspnoea (29.3%), followed by chest pain (24.4%), palpitations (19.5%) and embolism (15.9%). Atrial fibrillation was the most frequent complication; directly postoperative (22%) and at the long-term follow-up (26.3%). The follow-up was completed in 95.1%, with a mean echocardiographic follow-up time of 72 months and with a longest follow-up of almost 23 years. There were no myxoma recurrences. Thirteen patients (16.5%) deceased during the follow-up, with a mean time of 9 years after surgery. CONCLUSIONS Myxomas carry the risk of severe complications. Surgical excision is the only option of treatment and gives excellent early and long-term results. Recurrence rates are low in case of non-hereditary myxomas, even in case of irradical excision. The echocardiographic follow-up therefore could be called into question.
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Affiliation(s)
- Mindy Vroomen
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Patrick Houthuizen
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Arash Khamooshian
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
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Intrapericardial bronchogenic cyst: an unusual clinical entity. Case Rep Med 2014; 2014:651683. [PMID: 25580130 PMCID: PMC4279424 DOI: 10.1155/2014/651683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/12/2014] [Accepted: 11/19/2014] [Indexed: 12/04/2022] Open
Abstract
Mediastinal cysts are extremely rare clinical disorders. They usually have a pericardial origin. In this report, we present a 27-year-old male patient with a mediastinal bronchogenic cyst together with clinical presentation and management of the pathology.
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27
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A butterfly shaped mobile biatrial cardiac mass: myxoma or something else. Indian Heart J 2014; 66:372-4. [PMID: 24973849 DOI: 10.1016/j.ihj.2013.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/25/2013] [Accepted: 11/04/2013] [Indexed: 11/21/2022] Open
Abstract
Primary cardiac tumors are rare with a reported prevalence of 0.01-0.02% based on pooled autopsy series. Although most mobile cardiac tumors arising from the interatrial septum and extending into the atria are thought to be benign myxomas, this may often not be true. Myxoid fibrosarcomas which in contrast to myxomas are malignant cardiac tumors often mimic the clinical and echocardiographic picture of atrial myxomas. We describe a rare entity of biatrial low-grade myxoid fibrosarcoma presenting in an adult patient as a butterfly shaped mass, with progressive shortness of breath and prolonged PR interval on the ECG that was pre-operatively thought to be a cardiac myxoma. The distinguishing echocardiographic features of the two entities are discussed.
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Xu J, Zheng Y, Wang L, Feng Q, Yu C, Zhu S. Anesthetic management of the removal of a giant metastatic cardiac liposarcoma occupying right ventricle and pulmonary artery. J Cardiothorac Surg 2014; 9:56. [PMID: 24655329 PMCID: PMC3974594 DOI: 10.1186/1749-8090-9-56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 03/17/2014] [Indexed: 11/10/2022] Open
Abstract
A 60 years old chinese male scheduled for a removal of an intracardiac mass occupying majority of right ventricular space, right ventricular outflow tract and pulmonary artery. The giant cardiac mass was later diagnosed pathologically as metastatic liposarcoma. The patient had a history of surgical removal of myxoid liposarcoma from his left thigh many years ago. It is extremely rare for liposarcoma to metastatize to right ventricle and pulmonary artery. The anesthetic management of the surgical procedure to remove this kind of intracardiac mass poses significant challenges to anesthesia providers. Our patient developed refractory hypotension after induction of general anesthesia which necessitated urgent cardiopulmonary bypass. The surgical procedure was successful and the patient recovered from the surgery and was discharged home without significant complication. Accurate preoperative diagnosis and assessment of patient's functional status, appropriate preoperative volume status, emergency cardiopulmonary bypass readiness, smooth and gentle induction of general anesthesia with less myocardial depressing agent, and closely monitoring patient's vitals and hemodynamic parameters are imperative in managing this kind of patients.
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Affiliation(s)
| | | | | | | | | | - Shengmei Zhu
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China.
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Prognostic analysis for survival after resections of localized primary cardiac sarcomas: a single-institution experience. Ann Thorac Surg 2014; 97:1379-85. [PMID: 24565404 DOI: 10.1016/j.athoracsur.2013.12.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/22/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary cardiac sarcomas are rare diseases with a poor prognosis. This study aims to provide a prognostic analysis after different levels of resections of cardiac sarcomas. METHODS Twenty-nine patients undergoing resections of primary cardiac sarcomas at the Zhongshan Hospital from September 1995 to July 2012 were retrospectively reviewed. RESULTS There were 15 women and 14 men. The mean age was 41.0 years. The most common histologic type was angiosarcoma (28%). The median survival for the entire cohort was 17 months (range, 5 to 216 months). Patients with microscopically negative margin (R0) resections had a better median survival than those with microscopically positive margin (R1) resections (58 months versus 11 months; p<0.001). The median survival after an R1 resection was not different from that after a partial resection (12 months; p=0.81). The median local recurrence-free survival after an R0 resection was longer than that after an R1 resection (36 months versus 6 months; p<0.001). Five patients who underwent R0 resections and repeated resections of local recurrences or metastases had the longest median survival of 72 months. None of the patients with R0 resections received adjuvant therapy. Multimodality treatment after R1 and partial resections slightly increased the survival. CONCLUSIONS For nonmetastatic and localized primary cardiac sarcoma, an R0 surgical resection of cardiac sarcomas should be performed. Aggressive surgical treatment or radiation therapy for local recurrence or metastasis prolongs the survival. Multimodality treatment is recommended after incomplete resections of cardiac sarcomas. The role of adjuvant chemotherapy after R0 resections is unclear.
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Aydemir B, Celik S, Okay T, Doğusoy I. Intrathoracic giant solitary fibrous tumor. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:91-3. [PMID: 23826442 PMCID: PMC3700483 DOI: 10.12659/ajcr.883867] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/21/2012] [Indexed: 11/16/2022]
Abstract
Background Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Complete surgical resection for giant tumor of the pleura is challenging because of poor exposure and a large blood supply. We report the case of a giant hypervascular fibrous tumor that filled nearly the entire left hemithorax and anterior mediastinum, and its preoperative management. Case Report: A 59-year-old woman presented to us with exertional dyspnea and chest pain. A chest radiograph showed the right hemithorax completely opaque and a mediastinal shift to the left hemithorax. A tomography scan of the thorax showed a giant mass that almost completely filled the right hemithorax and compressed the mediastinum to the left. Because of excessive bleeding during dissection, the operation was terminated after a biopsy specimen was obtained. The biopsy was diagnosed as a benign fibrous tumour. A thoracic computed tomography angiogram showed that the mass was supplied by multiple intercostal arteries as well as an aberrant artery that branches off the celiac trunk in the subdiaphragmatic region. Due to the many arteries that needed to be embolized, the final decision was to control the bleeding following resection by inducing total circulatory arrest with the help of cardiopulmonary bypass. The bleeding could not be controlled under cardiopulmonary bypass and the patient’s death was confirmed. Conclusions: We report this case to emphasize the necessity of preoperative embolization; the use of cardiopulmonary bypass and total circulatory arrest is not a valid alternative method to control the bleeding.
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Affiliation(s)
- Bülent Aydemir
- Siyami Ersek Cardiothoracic Surgery Training Hospital, Istanbul, Turkey
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31
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Carvalho MS, Andrade MJ, Abecasis J, Gouveia R, Branco L, Neves JP, Mendes M. Understanding cardiac myxoma recurrence: A case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.04.002] [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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32
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Understanding cardiac myxoma recurrence: A case report. Rev Port Cardiol 2013; 32:239-42. [DOI: 10.1016/j.repc.2012.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/27/2012] [Indexed: 12/15/2022] Open
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Abstract
Cardiac tumours in infancy are rare and are mostly benign with rhabdomyomas, fibromas and teratomas accounting for the majority. The presentation depends on size and location of the mass as they tend to cause cavity obstruction or arrhythmias. Most rhabdomyomas tend to regress spontaneously but fibromas and teratomas generally require surgical intervention for severe haemodynamic or arrhythmic complications. Other relatively rare cardiac tumours too are discussed along with an Indian perspective.
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Affiliation(s)
- O P Yadava
- National Heart Institute, New Delhi, India.
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34
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Yohannan TM, Goldberg SP, Stamps JK, Mathis CA, Anthony CL, Lasater OE, Knott-Craig CJ. Cardiac myxolipoma in a child: diagnosis and surgical management. CONGENIT HEART DIS 2012; 7:E113-6. [PMID: 22613181 DOI: 10.1111/j.1747-0803.2012.00665.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of a rare tumor, a myxolipoma, appearing in a 5-year-old child, along with the imaging evaluation and surgical management. The natural history is expected to be that of a benign lesion, but the rarity precludes large studies.
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Affiliation(s)
- Thomas M Yohannan
- Department of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN 38103, USA
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Abstract
Cardiac neoplasms and other mass-forming lesions are not commonly encountered in surgical pathology practice. Fortunately, for the most part, these fall into a small group of well characterized and readily-recognized entities, although they are not without diagnostic dilemmas. A brief and practical synopsis of cardiac tumors is presented in this section with attention to more frequently encountered and clinically significant diagnostic challenges as well as pertinent clinical associations and prognostic information.
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Affiliation(s)
- Dylan V Miller
- Intermountain Central Laboratory, Immunostains and Electron Microscopy, University of Utah, 5252 South Intermountain Drive, Salt Lake City, UT 84157, USA
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36
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Isolated cardiac metastasis from colorectal cancer in a 35-year-old man. Case Rep Med 2012; 2012:751761. [PMID: 22481955 PMCID: PMC3303752 DOI: 10.1155/2012/751761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/24/2012] [Accepted: 01/25/2012] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 35-year-old patient who was found to be affected by an isolated clinically silent cardiac metastasis despite a negative CT follow-up at one year from abdominal surgery for colorectal cancer. CT/PET and tumor marker GICA were fundamental in suggesting the diagnosis, which was then confirmed by cardiac magnetic resonance and surgical biopsy. This is a very rare modality of presentation of cardiac metastasis because of the young age of our patient and the absence of disease in other sites.
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37
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Renilla González A, Barreiro Pérez M, Flórez Muñoz JP, García Pérez L. [Primary cardiac tumours: clinical presentation and prognosis in the elderly]. Rev Esp Geriatr Gerontol 2012; 47:88. [PMID: 22385582 DOI: 10.1016/j.regg.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
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38
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Dogan U, Zamani A, Gormus N, Paksoy Y, Avunduk MC, Demirbas S. The first case report of a metastatic myxoid liposarcoma invading the left atrial cavity and pulmonary vein. Heart Surg Forum 2012; 14:E261-3. [PMID: 21859649 DOI: 10.1532/hsf98.20111021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myxoid liposarcoma (MLS) is the most commonly encountered liposarcoma subgroup, accounting for about 50% of all cases. Metastatic MLS of the heart is extremely rare. Herein we describe for the first time metastasis of MLS to the left atrium and left upper pulmonary vein in a 54-year-old woman who was admitted with shortness of breath and cough persisting for 2 weeks. The patient reported that a total surgical excision of MLS of the left thigh followed by radiotherapy was performed 4 years ago. An emergency operation was performed due to rapidly progressive worsening of clinical condition and echocardiographic determination of left atrial mass protruding into the left ventricle and obstructing the mitral inflow throughout the diastole. The mass could not be totally excised because it was tightly adhered to the surrounding tissue. Postoperative magnetic resonance imaging (MRI) showed a 5 × 3 cm residual tumor deforming the posterior wall of the left atrium entirely and extending into the left upper pulmonary vein. Histopathological examination was consistent with MLS. In conclusion, considering probable cardiac metastasis in patients presenting with respiratory symptoms with medical history of soft tissue sarcomas would be life saving. The case is discussed, and a review of the literature in relation to the metastatic involvement of the heart by MLS is presented.
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Affiliation(s)
- Umuttan Dogan
- Department of Cardiology, Selcuk University, Meram School of Medicine, Konya, Turkey.
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39
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Kumar N, Agarwal S, Ahuja A, Das P, Airon B, Ray R. Spectrum of cardiac tumors excluding myxoma: Experience of a tertiary center with review of the literature. Pathol Res Pract 2011; 207:769-74. [DOI: 10.1016/j.prp.2011.09.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 09/07/2011] [Accepted: 09/24/2011] [Indexed: 11/27/2022]
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Abstract
Cardiac tumors are rare in neonates, most are benign hamartomas (rhabdomyomas) of the muscle cells. Due of large size, they may cause homodynamic instability and even death in neonatal period. They are rarely diagnosed prenatally and are found in multiple forms. In ∼50% of the cases, rhabdomyoma is associated with tuberous sclerosis.
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Affiliation(s)
- Mukul Aggarwal
- Neonatal Division, Department of Pediatrics, Safdarjang Hospital, New Delhi, India
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43
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Wu JT, Frazier OH, Nasser MM, Reul RM. A Novel Surgical Approach to Cardiac Autotransplantation in Complex Cardiac Sarcoma Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - O. H. Frazier
- Cardiopulmonary Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas USA
| | - Maher M. Nasser
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas USA
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A novel surgical approach to cardiac autotransplantation in complex cardiac sarcoma resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:364-8. [PMID: 22437523 DOI: 10.1097/imi.0b013e3181f5e77c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 28-year-old woman was admitted to our institution, reporting progressive dyspnea, cough, and weight loss of 14 kg. Two-dimensional echocardiography revealed a left atrial mass, and cardiac magnetic resonance imaging showed localized involvement of the mass with adjacent structures. These clinical signs and radiographic images were highly suggestive of cardiac sarcoma. The patient underwent emergent mediastinal exploration, and an incisional biopsy of the mass showed high-grade sarcoma. Removing the tumor required radical en bloc resection of the left atrium, including the mitral valve, the left pulmonary vein, and the left lower lobe of the lung. Autotransplantation was necessary for the resection and reconstruction. We report a unique method of handling the right atrium to avoid the potential complications associated with bicaval anastomoses after autotransplantation.
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45
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Bang JH, Woo JS, Choi PJ, Cho GJ, Kim SH, Park KJ. Clinical Experience of the Surgical Treatment of Cardiac Tumor. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.4.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jung Hee Bang
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Jong Soo Woo
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Pill Jo Choi
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Gwang Jo Cho
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
| | - Si-Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital
| | - Kwon-Jae Park
- Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital
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46
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Jang JY, Chang BC, Shim CY. Multiple calcified right ventricular masses presenting with pulmonary embolism and severe pulmonary hypertension. J Thorac Cardiovasc Surg 2010; 140:e64-5. [PMID: 20554293 DOI: 10.1016/j.jtcvs.2010.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 05/03/2010] [Accepted: 05/14/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Ji-Yong Jang
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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47
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Inoue H, Iguro Y, Matsumoto H, Ueno M, Higashi A, Sakata R. Right hemi-reconstruction of the left atrium using two equine pericardial patches for recurrent malignant fibrous histiocytoma: report of a case. Surg Today 2009; 39:710-2. [PMID: 19639440 DOI: 10.1007/s00595-008-3920-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 08/06/2008] [Indexed: 11/25/2022]
Abstract
We report a case of recurrent malignant fibrous histiocytoma (MFH) in the left atrium, treated by removal of the tumor and the right half of the left atrium, which was reconstructed with two equine pericardial patches. Postoperative echocardiography showed patent right pulmonary veins and a properly shaped left atrium. The patient survived for 3 years after the operation with no cardiac symptoms.
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Affiliation(s)
- Hironori Inoue
- Department of Thoracic, Cardiovascular and Hepatobiliary-Pancreatic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
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Zhang F, Yin N, Yin B, Xu S, Yang Y. Giant right atrial cystic hamartoma: a case report and literature review. BMJ Case Rep 2009; 2009:bcr02.2009.1587. [PMID: 21686985 DOI: 10.1136/bcr.02.2009.1587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED An 11-year-old boy presenting with palpitation and chest distress was found to have gross cardiomegaly on chest radiography. Subsequent echocardiography revealed an intramural giant cystic mass in the right atrium. An operative measure was planned to prevent acute cardiac tamponade and right coronary artery obstruction. The patient successfully underwent open cystectomy to remove the mass, which was located on the front wall of the right atrium and extended to the atrioventricular appendage. Histopathological examination confirmed a cystic hamartoma. To the best of our knowledge, this is the first reported case of a giant cystic hamartoma located on the right atrium. TRIAL REGISTRATION NUMBER 704640.
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Affiliation(s)
- Fei Zhang
- Department of Thoracic and Cardiovascular, the 2nd Xiangya Hospital, Center South University, Changsha, Hunan, P.R. China, 410011
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Bakaeen FG, Jaroszewski DE, Rice DC, Walsh GL, Vaporciyan AA, Swisher SS, Benjamin R, Blackmon S, Reardon MJ. Outcomes after surgical resection of cardiac sarcoma in the multimodality treatment era. J Thorac Cardiovasc Surg 2009; 137:1454-60. [PMID: 19464464 DOI: 10.1016/j.jtcvs.2008.11.026] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 10/28/2008] [Accepted: 11/18/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Primary cardiac sarcomas are rare tumors carrying poor prognosis. Resection remains the primary therapy. Especially in recent years, chemotherapy and radiation have been used adjunctively. METHODS All patients (n = 27) surgically treated for primary cardiac sarcoma at two tertiary referral centers from January 1990 to January 2006 were retrospectively reviewed. RESULTS There were 13 women and 14 men, with 26 resections and 1 palliative debulking performed. Cardiac explantation was necessary in 8 cases because of tumor location. Concomitant valve surgery (repair or replacement) or coronary artery bypass grafting was performed in 9 and 3 patients, respectively. Synchronous or staged resections of associated pulmonary metastases were performed in 6 and 2 patients, respectively. Operative mortality was 7.4% (2/27). Preoperative or postoperative chemotherapy was administered to 16 and 19 patients, respectively. At follow-up (median 22 months, range, 2-119 months), 12 patients were alive, with 7 tumor free. Among patients who underwent resection with curative intent and survived surgery (n = 24), median survival was 23.5 months (range 4-119 months). Patients who underwent surgical resection, radiofrequency ablation, or radiation treatment for tumor recurrence (local or metastatic, n = 7) had median survival of 47 months (range 16-119 months), whereas patients with no further intervention for recurrent disease (n = 7) had median survival of 25 months (range 8-34 months). CONCLUSIONS Multimodal therapy can achieve reasonable survival for patients with resected cardiac sarcomas. Patients with local tumor recurrence or metastatic disease may still benefit from aggressive treatment.
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Affiliation(s)
- Faisal G Bakaeen
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex 77030, USA.
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Abstract
Cardiac sarcomas are rare entities. The biological behavior of cardiac sarcomas is similar to all soft-tissue sarcomas. Aggressive local growth and metastatic spread are common. Although histologic type affects behavior, survival is dependent on the histologic grade. Chemotherapy and radiation therapy are not adequate for long-term survival. Although surgery provides the best modality for local control it is limited by its inability to control distant metastatic disease. Right heart sarcomas tend to be bulky, infiltrative, cause heart failure late and metastasize early. Based on the surgical approach and clinical behavior, cardiac sarcomas can be classified as right heart sarcomas, left heart sarcomas and pulmonary artery sarcomas. Our limited - albeit the most extensive - experience with cardiac sarcomas has helped improve survival compared with chemotherapy alone. They are usually treated with chemotherapy prior to extensive resection. Left heart sarcomas tend to be more circumscribed, less infiltrative, cause heart failure early and metastasize later. They are usually treated with surgery first, given the possibility of cardiac failure. Pulmonary artery sarcomas tend to be confined to the pulmonary artery, often causing severe right heart failure and metastasize later than right heart sarcomas. They are usually treated with complete resection. Adjuvant therapy is recommended for all patients given that excellent local control is often achieved with surgery, yet long-term survival is often poor due to metastatic recurrence. Cardiac autotransplantation is an excellent technique for resection of posterior or left heart cardiac sarcomas. Surgical outcomes with cardiac autotransplantation are excellent in patients who do not require concurrent pneumonectomy. Pulmonary artery sarcomas allow for radiation therapy in addition to chemotherapy for neoadjuvant control, as the myocardium can be avoided. However, overall, long-term survival after cardiac sarcoma requires improved systemic control. This progress awaits the development of novel chemotherapeutics.
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