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Koo CW, Frota Lima LM, Kerper A, Lo YC. Anatomic Approach to Common and Uncommon Manifestations of Thoracic Leukemias with Radiologic-Pathologic Correlation. Radiol Cardiothorac Imaging 2023; 5:e230151. [PMID: 38166347 DOI: 10.1148/ryct.230151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Leukemias are hematopoietic malignancies characterized by the production of abnormal leukocytes in the bone marrow. Clinical manifestations arise from either bone marrow suppression or leukemic organ infiltration. Lymphadenopathy is the most common direct manifestation of intrathoracic leukemia. However, leukemic cells may also infiltrate the lungs, pleura, heart, bones, and soft tissues. Pulmonary complications in patients with leukemia typically include pneumonia, hemorrhage, pulmonary edema, and sequelae of leukemia treatment. However, pulmonary abnormalities can also be related directly to leukemia, including leukemic pulmonary infiltration. The direct, non-treatment-related effects of leukemia on intrathoracic structures will be the focus of this imaging essay. Given the typical anatomic approach for image interpretation, an organ-based depiction of common and less common intrathoracic findings directly caused by leukemic involvement is presented, emphasizing imaging findings with pathologic correlations. Keywords: Leukemia, Pulmonary, Thorax, Soft Tissues/Skin, Hematologic, Bone Marrow © RSNA, 2023.
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Affiliation(s)
- Chi Wan Koo
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Livia Maria Frota Lima
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Allison Kerper
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ying-Chun Lo
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Yue P, Xu Z, Wan K, Tan Y, Xu Y, Xie X, Mui D, Yi C, Han Y, Chen Y. Multiparametric mapping by cardiovascular magnetic resonance imaging in cardiac tumors. J Cardiovasc Magn Reson 2023; 25:37. [PMID: 37349765 PMCID: PMC10286406 DOI: 10.1186/s12968-023-00938-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/11/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND There is a paucity of quantitative measurements of cardiac tumors and myocardium using parametric mapping techniques. This study aims to explore quantitative characteristics and diagnostic performance of native T1, T2, and extracellular volume (ECV) values of cardiac tumors and left ventricular (LV) myocardium. METHODS Patients with suspected cardiac tumors who underwent cardiovascular magnetic resonance (CMR) between November 2013 and March 2021 were prospectively enrolled. The diagnoses of primary benign or malignant tumors were based on pathologic findings if available, comprehensive medical history evaluations, imaging, and long-term follow-up data. Patients with pseudo-tumors, cardiac metastasis, primary cardiac diseases, and prior radiotherapy or chemotherapy were excluded. Multiparametric mapping values were measured on both cardiac tumors and the LV myocardium. Statistical analyses were performed using independent-samples t-test, receiver operating characteristic, and Bland-Altman analyses. RESULTS A total of 80 patients diagnosed with benign (n = 54), or primary malignant cardiac tumors (n = 26), and 50 age and sex-matched healthy volunteers were included. Intergroup differences in the T1 and T2 values of cardiac tumors were not significant, however, patients with primary malignant cardiac tumors showed significantly higher mean myocardial T1 values (1360 ± 61.4 ms) compared with patients with benign tumors (1259.7 ± 46.2 ms), and normal controls (1206 ± 44.0 ms, all P < 0.05) at 3 T. Patients with primary malignant cardiac tumors also showed significantly higher mean ECV (34.6 ± 5.2%) compared with patients with benign (30.0 ± 2.5%) tumors, and normal controls (27.3 ± 3.0%, all P < 0.05). For the differentiation between primary malignant and benign cardiac tumors, the mean myocardial native T1 value showed the highest efficacy (AUC: 0.919, cutoff value: 1300 ms) compared with mean ECV (AUC: 0.817) and T2 (AUC: 0.619) values. CONCLUSION Native T1 and T2 of cardiac tumors showed high heterogeneity, while myocardial native T1 values in primary malignant cardiac tumors were elevated compared to patients with benign cardiac tumors, which may serve as a new imaging marker for primary malignant cardiac tumors.
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Affiliation(s)
- Pengfei Yue
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Ziqian Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yinxi Tan
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Xiaotong Xie
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - David Mui
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Cheng Yi
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus, OH USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
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Luo Z, Cheng J, Wang Y. Cardiac Infiltration as the First Manifestation of Acute Lymphoblastic Leukemia: A Systematic Review. Front Oncol 2022; 12:805981. [PMID: 35155242 PMCID: PMC8828482 DOI: 10.3389/fonc.2022.805981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiac symptoms or signs as the first manifestations in acute lymphoblastic leukemia patients are sporadically reported which lead to misdiagnosis or delayed diagnosis due to lack of clinical experience and improper diagnosis procedures. Here, we documented the clinical features, procedures of diagnosis, treatments, and outcomes from the so-far reported 30 lymphoblastic leukemia cases that initially presented as cardiac problems and provided management recommendations based on the experiences and lessons learned from these patients to help physicians avoid misdiagnosis and improper treatment.
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Affiliation(s)
- Zhi Luo
- Department of Internal Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Cheng
- Medical Research Institute of Wuhan University, Wuhan, China
| | - Yanggan Wang
- Department of Internal Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Medical Research Institute of Wuhan University, Wuhan, China
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Kawamura I, Fukamizu S, Miyazawa S, Hojo R. Multiple peritricuspidal reentry tachycardias after cardiac infiltration by leukaemia: a case report. Eur Heart J Case Rep 2019; 3:5476577. [PMID: 31449600 PMCID: PMC6601183 DOI: 10.1093/ehjcr/ytz046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 04/02/2019] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Cardiac involvement by malignant lymphocytic neoplasms is a rare phenomenon. Little is known concerning cardiotoxicity in the chronic phase after completion of treatment.
Case summary
A 50-year-old woman with a past history of cardiac involvement of acute lymphoblastic leukaemia (ALL) underwent electrophysiologic study and catheter ablation for symptomatic atrial tachycardia (AT). She was diagnosed with ALL when she was 8 years old and treated with systematic chemotherapy with prednisolone and vincristine. After complete remission, she suffered from repeated palpitations beginning at the age of 16 years. Electrophysiologic study using high-density (HD) mapping showed two types of peritricuspid AT in addition to low voltage in the right atrium with conduction delay.
Discussion
Cardiac involvement by malignant lymphocytic neoplasms is a rare phenomenon, and cardiac infiltration often disappears after remission of ALL. Thus, little is known about cardiac electrophysiological characteristics in the chronic phase of complete remission of ALL. We describe a rare case of a patient with multiple peritricuspidal reentry tachycardias after cardiac infiltration by leukaemia using a HD mapping system.
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Affiliation(s)
- Iwanari Kawamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Satoshi Miyazawa
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
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Assuncao BMBL, Handschumacher MD, Brunner AM, Yucel E, Bartko PE, Cheng KH, Campos O, Fathi AT, Tan TC, Scherrer-Crosbie M. Acute Leukemia is Associated with Cardiac Alterations before Chemotherapy. J Am Soc Echocardiogr 2017; 30:1111-1118. [PMID: 28927558 DOI: 10.1016/j.echo.2017.07.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with acute leukemia (AL) have a higher rate of congestive heart failure than patients with other cancers. AL may predispose to cardiac dysfunction before chemotherapy because of high cytokine release or direct leukemic myocardial infiltration. The aims of this study were to evaluate whether AL is associated with abnormalities of myocardial structure and function before chemotherapy and to identify possible risk factors associated with these myocardial changes. METHODS Using an echocardiographic database, 76 patients with AL and 76 patients without cancer matched for age, gender, hypertension, and the presence of diabetes were retrospectively selected. Subsequently, to assess the effect of a nonhematologic malignancy, 28 women in each group were matched with women with breast cancer. Left ventricular (LV) mass, volumes, ejection fraction, and global longitudinal strain (GLS) were measured before chemotherapy. RESULTS The patients were predominantly male (63%), with a median age of 51 years, and had low prevalence of cardiovascular risk factors. Despite similar LV ejection fractions, patients with AL had higher LV mass and volumes and lower GLS (-19.3 ± 2.7% vs -20.9 ± 1.9%, P < .001) than patients without cancer. Similarly, GLS was lower in women with AL compared with women with breast cancer or without cancer. Among patients with AL, high body mass index, low LV ejection fraction, and a small number of circulating lymphocytes were all independently associated with low GLS. CONCLUSIONS Patients with AL had higher LV volumes and lower GLS than patients without cancer and lower GLS than patients with breast cancer, suggesting that AL by itself may be associated with these cardiac alterations.
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Affiliation(s)
- Bruna Morhy Borges Leal Assuncao
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Internal Medicine, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, Brazil
| | - Mark D Handschumacher
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew M Brunner
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philipp E Bartko
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kai-Hung Cheng
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Orlando Campos
- Division of Cardiology, Department of Internal Medicine, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, Brazil
| | - Amir T Fathi
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy C Tan
- Blacktown Clinical School, Department of Cardiology, Faculty of Medicine, University of Western Sydney, and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Marielle Scherrer-Crosbie
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiac Ultrasound Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania.
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Leukemic Ischemia: A Case of Myocardial Infarction Secondary to Leukemic Cardiac Involvement. Case Rep Cardiol 2017; 2017:7298347. [PMID: 28848680 PMCID: PMC5564183 DOI: 10.1155/2017/7298347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/09/2017] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 39-year-old male who presented to the emergency department with acute chest pain while being in remission from T-cell acute lymphoblastic leukemia (T-ALL). Cardiac markers were elevated and EKG revealed ischemic changes compatible with acute myocardial ischemia. Coronary computed tomography angiography (CCTA) showed calcium-free coronary arteries and soft tissue myocardial infiltration suggestive of cardiac leukemia. A bone marrow biopsy confirmed recurrence of T-ALL, and patient was successfully treated with chemotherapy. We discuss the prospective diagnosis of myopericardial leukemic involvement and the role of CCTA in diagnosis and perform a literature review.
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Mohanty BD, Mohanty S, Hussain Y, Padmaraju C, Aggarwal S, Gospin R, Yu AF. Management of ischemic coronary disease in patients receiving chemotherapy: an uncharted clinical challenge. Future Cardiol 2017; 13:247-257. [PMID: 28570141 DOI: 10.2217/fca-2017-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acute coronary syndrome (ACS) coinciding with active malignancy presents a unique clinical challenge given intersecting pathophysiology and treatment-related effects. There is little established clinical guidance on management strategies, rendering most treatment approaches anecdotal. We present a case highlighting the complexity of managing a patient being treated for malignancy who concurrently suffers from ACS. We then review the literature on co-management of ACS and malignancy, including reports of specific cancer therapies associated with ACS, unique features of clinical presentation and optimal use of dual antiplatelet therapy to minimize risks of bleeding and thrombosis. We also describe gaps in current literature, challenges in systematically studying the clinical intersection of these disease processes and propose alternative methodologies for further research.
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Affiliation(s)
- Bibhu D Mohanty
- Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Sudipta Mohanty
- Department of Medicine, University of California Riverside, Moreno Valley, CA 92555, USA
| | - Yasin Hussain
- Department of Medicine, Weill Cornell Medical College, NY 10065, USA
| | | | - Sameer Aggarwal
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD 21201, USA
| | | | - Anthony F Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, NY 10065, USA
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Feher A, Kampaktsis PN, Parameswaran R, Stein EM, Steingart R, Gupta D. Aspirin Is Associated with Improved Survival in Severely Thrombocytopenic Cancer Patients with Acute Myocardial Infarction. Oncologist 2017; 22:213-221. [PMID: 28159866 DOI: 10.1634/theoncologist.2016-0110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with hematologic malignancies are at risk for severe thrombocytopenia (sTP). The risk and benefit of aspirin are not known in thrombocytopenic cancer patients experiencing acute myocardial infarction (AMI). MATERIALS AND METHODS Medical records of patients with hematologic malignancies diagnosed with AMI at Memorial Sloan Kettering Cancer Center during 2005-2014 were reviewed. sTP was defined as a platelet count <50,000 cells per µL within 7 days of AMI. RESULTS Of 118 patients with hematologic malignancies who had AMI, 58 (49%) had sTP. Twenty-five patients (43%) with sTP received aspirin as a treatment for AMI. Compared with patients without sTP with AMI, patients with sTP with AMI were less likely to receive aspirin (83% vs. 43%; p = .0001) and thienopyridine treatment (27% vs. 3%; p = .0005). During median follow-up of 3.7 years after AMI, survival was lower in patients with sTP than in those with no sTP (23% vs. 50% at 1 year; log rank p = .003). Patients with sTP who received aspirin for AMI had improved survival compared with those who did not (92% vs. 70% at 7 days, 72% vs. 33% at 30 days, and 32% vs. 13% at 1 year; log rank p = .008). In multivariate regression models, aspirin use was associated with improved 30-day survival both in the overall patient cohort and in sTP patients. No fatal bleeding events occurred. Major bleeding was not associated with sTP or aspirin use. CONCLUSION Treatment of AMI with aspirin in patients with hematologic malignancies and sTP is associated with improved survival without increase in major bleeding. The Oncologist 2017;22:213-221Implications for Practice: In patients with hematologic malignancies and acute myocardial infarction with severe thrombocytopenia (platelet count < 50,000 cells/µL), guideline-recommended medical therapy is often withheld because of the fear of major bleeding. In this study, aspirin therapy was associated with improved survival without an increase in major bleeding in this high-risk patient cohort.
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Affiliation(s)
- Attila Feher
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Polydoros N Kampaktsis
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rekha Parameswaran
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eytan M Stein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Steingart
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dipti Gupta
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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