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Bandyopadhyay D, Panchabhai TS, Bajaj NS, Patil PD, Bunte MC. Primary pulmonary artery sarcoma: a close associate of pulmonary embolism-20-year observational analysis. J Thorac Dis 2016; 8:2592-2601. [PMID: 27747013 DOI: 10.21037/jtd.2016.08.89] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary pulmonary artery sarcoma (PPAS) is a rare tumor that mimics pulmonary thromboembolism (PE). Similarities to PE can delay the diagnosis and misguide the treatment of PPAS. This study aimed to evaluate tumor characteristics and outcome predictors among those diagnosed with PPAS and misdiagnosed as PE. METHODS From 1991-2010, 10 PPAS cases were available from the Cleveland Clinic (CC) institutional database and another 381 cases were reported in the literature. Patient characteristics, tumor subtypes, diagnostic testing & timing, interventions and clinical outcomes were analyzed. We also noted effects of misdiagnosis as PE and clinical outcome as a result of inappropriate intervention. RESULTS Among 391 confirmed cases of PPAS, the mean age at diagnosis was 52±14 years; 55% were male. The median duration of symptoms prior to diagnosis was 100 [interquartile range (IQR), 30-210] days. Nearly half (47%) of PPAS were originally misdiagnosed as PE including 39% that received thrombolytic and/or anticoagulation therapy. For every doubling of time from symptom onset to diagnosis, the odds of death increased by 46% (OR: 1.46, 95% CI: 1.21-1.82; P<0.001). The odds of death (OR: 2.66, 95% CI: 1.58-4.54; P=0.0003) and occurrence of distant metastasis (OR: 2.30, 95% CI: 1.30-4.15; P=0.049) were increased among those who did not receive chemotherapy but chemotherapy did not impact local recurrence. Those with complete resection had a better survival. CONCLUSIONS PPAS has a radiological appearance similar to PE, which makes accurate and timely diagnosis challenging. More rapid diagnosis may lead to earlier, appropriate surgical treatment and improved outcomes, when combined with adjuvant treatment.
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Affiliation(s)
| | | | | | - Pradnya D Patil
- Department of Internal medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew C Bunte
- Department of Cardiovascular Medicine, St Luke's Health System, Kansas, MO, USA
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Reyes G, Rodriguez-Serrano D, Chicot-Llano M, Leal O, Figueroa C, Mingo A. Leiomiosarcoma de arteria pulmonar: una enfermedad infrecuente y de difícil diagnóstico. Med Intensiva 2016; 40:64-5. [DOI: 10.1016/j.medin.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 03/24/2015] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
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Lv Y, Wang F, Qian W, Sun G. Treatment of a recurrent pulmonary artery leiomyosarcoma with a combination of surgery, chemotherapy, and radiotherapy: A case report and literature review. Oncol Lett 2015; 9:1545-1548. [PMID: 25788998 PMCID: PMC4356380 DOI: 10.3892/ol.2015.2957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 12/12/2014] [Indexed: 11/06/2022] Open
Abstract
Pulmonary artery (PA) leiomyosarcoma (PAL) is a rare but extremely malignant tumor of the cardiovascular system, which is often misdiagnosed as pulmonary thromboembolism. Although the early detection and surgical resection improves patient survival, the benefits of adjuvant therapy are not well understood. The current study presents the case of a patient with primary PAL who underwent surgical resection along with three courses of chemotherapy. Despite these interventions, the patient experienced recurrence of the PAL within four months following treatment. The patient received localized radiotherapy and subsequently achieved a stable disease state. This case indicates that radiotherapy may offer a benefit to PAL patients, particularly those who do not respond to chemotherapy.
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Affiliation(s)
- Yin Lv
- Department of Radiotherapy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Fan Wang
- Department of Radiotherapy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Wenchuan Qian
- Department of Radiotherapy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Guoping Sun
- Department of Radiotherapy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Pulmonary Hypertension due to a Pulmonary Artery Leiomyosarcoma: A Case Report. Case Rep Pulmonol 2013; 2013:160619. [PMID: 23607029 PMCID: PMC3626391 DOI: 10.1155/2013/160619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 02/19/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Primary pulmonary artery sarcomas are very rare and their histologic type, called leiomyosarcoma, is even rarer. Case Report. A 64-year-old woman presented with progressive weakness, fatigue, malaise, and dyspnea, and a marked elevation of pulmonary artery pressure was admitted. She was initially diagnosed with chronic pulmonary thromboembolism and chest computed tomography (CT) scan revealed that lobulated heterogeneous left hilar mass extended to precarinal and subcarinal space. MRI demonstrated a polypoid lesion at trunk with extension to left main pulmonary artery and its first branch. She was operated, a yellowish-shiny solid mass in pulmonary trunk was seen intraoperatively, and pulmonary endarterectomy was performed. Her tumor was pathologically diagnosed as pulmonary artery leiomyosarcoma. She died 3 months later after one chemotherapy course. Conclusion. Initially, the patient underwent surgery due to pulmonary embolism but, during the operation, the observed mass increased the probability of pulmonary artery neoplasm. Clinicians must consider pulmonary artery sarcoma when making the differential diagnosis for patients with pulmonary arteries masses. In addition to clinical prediction scores and CT and MRI findings to identify the patients with pulmonary artery sarcoma, PET scanning is the diagnosis of choice in differentiating embolism and neoplasm and is strongly recommended in these patients.
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Primary sarcoma of the right ventricle: surgical and adjuvant therapy. Gen Thorac Cardiovasc Surg 2009; 57:421-5. [PMID: 19779791 DOI: 10.1007/s11748-009-0403-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 01/04/2009] [Indexed: 10/20/2022]
Abstract
We describe surgical and adjuvant therapeutic management of a right ventricular (RV) sarcoma and pulmonary artery occlusion. Echocardiographic evaluation of a 39-year-old man with exertional dyspnea revealed a tumor mass in the right ventricle, pulmonary trunk, and bilateral pulmonary arteries. The tumor was resected with concomitant pulmonary valvotomy, but the resection was incomplete. The RV outflow was reconstructed with an allograft patch, and a stentless valve was implanted for pulmonary valvular function. The pulmonary trunk and arteries were enlarged with allograft patches. The tumor was undifferentiated sarcoma and caused postoperative pulmonary artery restenosis. Radiotherapy improved pulmonary perfusion (reduction of RV pressure), but the patient died of brain metastasis. Undifferentiated cardiac sarcomas associated with pulmonary hypoperfusion should be resected even if incompletely, and radiation therapy could alleviate reduced pulmonary perfusion.
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6
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Athanassiadi K, Grothusen C, Mengel M, Haverich A. Primary leiomyosarcoma of the pulmonary artery: Is aggressive treatment justified for a long survival? J Thorac Cardiovasc Surg 2006; 132:435-6. [PMID: 16872981 DOI: 10.1016/j.jtcvs.2006.02.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Accepted: 02/07/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Kalliopi Athanassiadi
- Department of Thoracic and Cardiovascular Surgery, Medical School of Hannover, Hannover, Germany.
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7
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Neves S, San José J, Velho HV, Oliveira M, Esteves I, Torres S, Magalhães AM. [Pulmonary Artery Sarcoma - diagnostic and treatment difficulties]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2003; 9:41-51. [PMID: 12958667 DOI: 10.1016/s0873-2159(15)30660-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Primary Pulmonary Artery Sarcoma is a rare entity, which shares some clinical features with Thromboembolic Pulmonary Disease (TEPD), complicating differential diagnosis. The authors report a Clinical Case of a Primary Pulmonary Artery Sarcoma in a 59 years old man, admitted with a history of dyspnoea on exertion, chest pain and general symptoms. Chest X-ray, Computed Tomography Scan, Angiographies and Magnetic Resonance Imaging suggested TEPD. Blood Analysis performed before anticoagulation therapy: Lupus Anticoagulant-and Ig M Anticardiolipin +. Our presumptive initial diagnosis was TEPD in a patient with a hypercoagulable state. Intravenous heparin was started, with some clinical improvement but 2 months later he was readmitted, due to clinical and radiological deterioration. Pulmonary Thromboendarterectomy was considered but a right pneumonectomy was necessary because of bleeding. He died of ARDS in a single lung in the 7th day after surgery. Pathology revealed pulmonary artery sarcoma with pulmonary and pleural metastases.
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Tanaka H, Hasegawa S, Egi K, Tachou H, Saitoh F, Sunamori M. Successful radical resection of a leiomyosarcoma of the pulmonary trunk. J Thorac Cardiovasc Surg 2001; 122:1039-40. [PMID: 11689818 DOI: 10.1067/mtc.2001.116196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- H Tanaka
- Department of Thoracic and Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo Kensei Hospital, Tokyo, Japan.
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Hu SS, Sun CC, Zheng Z. Heart Leiomyosarcoma Mimicking Pulmonary Thromboembolism. Asian Cardiovasc Thorac Ann 2001. [DOI: 10.1177/021849230100900120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 34-year-old man was admitted with a putative diagnosis of pulmonary artery trunk thromboembolism. Magnetic resonance imaging and angiography showed a solid mass extending from the pulmonary trunk to the right pulmonary artery. During surgery, a tumor was found arising from the pulmonary valve annulus. The tumor was completely removed and pulmonary valvuloplasty was performed. The result was satisfactory. Histopathology showed the tumor to be a leiomyosarcoma.
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Affiliation(s)
| | - Cheng Chao Sun
- Department of Cardiac and Thoracic Surgery First Affiliated Hospital, Wenzhou Medical College Wenzhou, Zhejiang Province People's Republic of China
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Minakata K, Konishi Y, Matsumoto M, Aota M, Nonaka M, Yamada N. Primary leiomyosarcoma of the pulmonary artery mimicking massive pulmonary thromboembolism. JAPANESE CIRCULATION JOURNAL 2000; 64:783-4. [PMID: 11059620 DOI: 10.1253/jcj.64.783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 57-year-old man with dyspnea and dry cough exhibited pulmonary embolism. Pulmonary arteriography demonstrated absent perfusion of the left main and the right upper and middle lobe pulmonary arteries. A diagnosis of chronic pulmonary thromboembolism was assumed and surgical thromboendarterectomy was attempted under standard cardiopulmonary bypass. At operation, a tumor had invaded far into both the right and left pulmonary arteries and radical resection was impossible. The final pathological diagnosis was primary leiomyosarcoma of the pulmonary artery. The patient refused any adjuvant therapy and died 63 days after the surgery. The clinical presentation of this case was similar to that of pulmonary thromboembolism and its diagnosis and treatment were very difficult.
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Affiliation(s)
- K Minakata
- Department of Cardiovascular Surgery, Japanese Red-Cross Society, Wakayama Medical Center.
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Faul JL, Wahl T, Ihnken K, Berry GJ, Doyle RL, Whyte RI. Superior vena cava syndrome caused by pulmonary artery sarcoma. J Thorac Cardiovasc Surg 1999; 118:749-50. [PMID: 10504645 DOI: 10.1016/s0022-5223(99)70024-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J L Faul
- Division of Pulmonary Medicine, Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
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12
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Abstract
Primary leiomyosarcoma of the pulmonary artery is an extremely rare tumor that is frequently misdiagnosed as chronic pulmonary embolism. In the present case, early diagnosis and location in the left pulmonary artery permitted resection by pneumonectomy with total cardiopulmonary bypass.
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Affiliation(s)
- P Dumont
- Department of Thoracic & Cardiac Surgery, University Hospital, Tours, France
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13
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Kacl GM, Bruder E, Pfammatter T, Follath F, Salomon F, Debatin JF. Primary angiosarcoma of the pulmonary arteries: dynamic contrast-enhanced MRI. J Comput Assist Tomogr 1998; 22:687-91. [PMID: 9754098 DOI: 10.1097/00004728-199809000-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Our goal was to assess the MR appearance and histologic correlation of primary pulmonary artery angiosarcoma. METHOD Four patients with tumorous masses in the pulmonary arteries were evaluated by dynamic contrast-enhanced MRI using T1- and T2-weighted SE images, GE images, as well as coronal 3D MRA in breath-hold technique. The percentage of tumor enhancement was determined by measuring regions of interest before and after Gd-DTPA administration on the 2D multiplanar spoiled GRE images. RESULTS All four masses showed some contrast enhancement on the dynamically acquired GRE images. The degree of contrast enhancement correlated with the degree of tumor differentiation, content of myxoid matrix, and associated thrombus. Contrast-enhanced 3D MRA was useful for preoperative delineation of the peripheral pulmonary arteries to the subsegmental order. CONCLUSION Dynamic contrast-enhanced 3D MRA of the pulmonary arteries can be used to delineate pulmonary arterial angiosarcomas preoperatively. Considerable variability of contrast agent uptake reflects the wide histologic behavior of these masses in differentiation from central pulmonary embolism.
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Affiliation(s)
- G M Kacl
- Department of Radiology, University Hospital Zürich, Switzerland
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Yamada N, Kamei S, Yasuda F, Isaka N, Yada I, Nakano T. Primary leiomyosarcoma of the pulmonary artery confirmed by catheter suction biopsy. Chest 1998; 113:555-6. [PMID: 9498986 DOI: 10.1378/chest.113.2.555] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A patient with clinical features consistent with pulmonary embolism showed no improvement despite therapy with tissue-plasminogen activator and full-dose heparin. Transvenous catheter suction biopsy was successful in establishing an antemortem histologic diagnosis of primary pulmonary artery leiomyosarcoma. Urgent surgical intervention was performed.
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Affiliation(s)
- N Yamada
- First Department of Internal Medicine, Mie University School of Medicine, Japan.
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Giangola G, Migaly J, Crawford B, Moskowitz P, Sebenick M. Leiomyosarcoma of the subclavian artery. J Vasc Surg 1995; 22:496-500. [PMID: 7563412 DOI: 10.1016/s0741-5214(95)70020-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G Giangola
- Department of Vascular Surgery, Tisch Hospital New York, USA
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18
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Raaf HN, Raaf JH. Sarcomas related to the heart and vasculature. SEMINARS IN SURGICAL ONCOLOGY 1994; 10:374-82. [PMID: 7997732 DOI: 10.1002/ssu.2980100511] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Soft tissue sarcoma is the most common malignant neoplasm of the heart, pericardium, and great vessels. Its presentation is infrequent, nonspecific, and subtle. For example, emboli from these tumors to the lungs or peripheral arteries may mimic thrombotic embolic disease. New noninvasive techniques such as echocardiography and magnetic resonance imaging (MRI) aid in diagnosis and preoperative assessment. Angiosarcoma, the most common cardiac sarcoma, is aggressive and usually arises in the right atrium. Kaposi's sarcoma of the heart has been found in patients with AIDS and in immunosuppressed organ transplant recipients. Most primary sarcomas of the aorta and pulmonary artery (the elastic arteries) show minimal differentiation and are classified as "intimal, sarcomas," whereas leiomyosarcomas predominate in the muscular arteries and great veins. Surgical resection of any sarcoma of the vasculature, when feasible, is technically challenging but may result in cure or palliation. Adjuvant chemotherapy and radiation therapy can also relieve symptoms and prolong survival.
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Affiliation(s)
- H N Raaf
- Cuvahoga County Coroner's Office, Cleveland, Ohio 44106
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