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Stergioula A, Kokkali S, Pantelis E. Multimodality treatment of primary cardiac angiosarcoma: A systematic literature review. Cancer Treat Rev 2023; 120:102617. [PMID: 37603906 DOI: 10.1016/j.ctrv.2023.102617] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Primary cardiac angiosarcoma (PCA) is the most prevalent histological type of cardiac sarcoma but its rarity poses a challenge for standardizing treatment protocols. Moreover, published studies are limited by small patient numbers and lack of randomization, making it challenging to establish evidence-based treatment strategies. This systematic review aims to consolidate the heterogeneous published data and identify factors related to the treatment outcome of PCA patients. METHODS The PubMed and Scopus bibliographic databases were systematically searched for original articles reporting clinical, treatment and outcome data for PCA patients. Kaplan-Meier analysis was used to calculate the time to progression and survival. The Log-Rank test was used to compare progression-free and overall survival data. The Cox proportional hazards regression model was used for univariate and multivariate analysis of survival data. RESULTS A total of 127 studies containing data for 162 patients were analyzed. The median age of the patient cohort was 45 years, with males being 1.5 times more frequently affected than females. Tumors were primarily located on the right side of the heart, with a median size of 6 cm. Median progression-free and overall survival of 5 months and 12 months, respectively, were calculated. Age, sex, and resection margins did not have a significant impact on PCA survival, as determined by both univariate and multivariate analyses. The presence of metastases at diagnosis was associated with lower overall survival in univariate analysis, although this effect was not significant in multivariate analysis. Multimodality treatment that incorporated surgery and adjuvant chemo-radiotherapy was associated with a statistically significant survival benefit. Median overall survival increased from 6 months with surgery alone to 13 months and 27 months with adjuvant chemotherapy and chemo-radiotherapy, respectively. CONCLUSION Multimodality treatment including surgery and chemo-radiotherapy was found to offer the greatest survival benefit for PCA patients.
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Affiliation(s)
- Anastasia Stergioula
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Center of Radiotherapy, IASO General Hospital, Athens, Greece.
| | - Stefania Kokkali
- Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Junze Z, Yuxi L, Jiande T, Xuezhe W, Yequan S. A cardiac malignant primary tumor: Left atrium myxosarcoma-A case report. J Clin Ultrasound 2022; 50:1262-1267. [PMID: 35899966 DOI: 10.1002/jcu.23275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/18/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Myxosarcoma only accounts for a very small proportion of primary malignant tumors of the heart. The disease has no specificity in clinical manifestations or features on medical images. In this case study, we report about a middle-aged female patient afflicted with cardiac myxosarcoma. The initial transthoracic echocardiography of the patient revealed a cardiac myxoma. However, the postoperative histopathology confirmed the presence of a malignant cardiac myxosarcoma. Post-surgery follow-up imaging examinations revealed local recurrence in the left atrium as well as soft-tissue and bone metastases. The recurrent tumor and metastases were subsequently treated with chemotherapy and radiotherapy. However, the tumor did not respond to treatment and the disease progressed.
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Affiliation(s)
- Zheng Junze
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Image Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Liu Yuxi
- Department of Ultrasonic, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Tang Jiande
- Department of Ultrasonic, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Wei Xuezhe
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Image Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Sun Yequan
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Image Center, Affiliated Hospital of Weifang Medical University, Weifang, China
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Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. J Clin Ultrasound 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
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Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
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L'Acqua C, Piazzoni N, Muratori M, Mazzanti V. Intraoperative 3D TrueVue transesophageal echo imaging in cardiac mass: Bridge between cardiac anesthesiologist and surgeon. Ann Card Anaesth 2022; 25:241-243. [PMID: 35417982 PMCID: PMC9244262 DOI: 10.4103/aca.aca_213_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Xu C, Sun W, Fang L, He L, Yang F, Zhang J, Xie M. The value of multimodal imaging in the diagnosis of primary cardiac angiosarcoma. Echocardiography 2021; 38:1474-1477. [PMID: 34286882 DOI: 10.1111/echo.15156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/10/2021] [Accepted: 07/06/2021] [Indexed: 01/19/2023] Open
Abstract
A primary cardiac angiosarcoma (PCA) is very rare, highly aggressive, and metastatic in nature. The manifestations are often nonspecific, and the overall prognosis is extremely poor. The diagnosis of PCA can be complex and remains challenging. The key for diagnosis is echocardiography, and multimodality imaging is a more advantageous modality. Here, we present a rare case of a 41-year-old man who was diagnosed with PCA with multiple lung and bone metastases using multimodal imaging technology. Our case emphasizes the value of multimodality imaging in diagnosing PCA and suggests that patients showing intra-cardiac thrombus and hemorrhagic effusion on echocardiography without a clear explanation should be further investigated or closely followed.
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Affiliation(s)
- ChunYan Xu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - WenGang Sun
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - LingYun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lin He
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fan Yang
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Abstract
In this study, we present the case of a 34-year-old man who was diagnosed with primary cardiac angiosarcoma 1 month after hospital admission. Cardiac angiosarcoma is a relatively rare disease that can be easily misdiagnosed as pneumonia or other diseases. Although surgery is the preferred treatment to prolong survival time, highly malignant tumors with local infiltration and systemic metastasis can lead to poor prognosis.
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Affiliation(s)
- Shiqi Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University.,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University
| | - Qiang Guo
- Department of Critical Care Medicine, Dushu Lake District of The First Affiliated Hospital of Soochow University (Medical Center of Soochow University, Dushu Lake Hospital Affiliated to Soochow University)
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Medhora J, Wilson G, Ronald A, Allen L. Use of focused intensive care echo in the diagnosis of primary cardiac angiosarcoma. Clin Case Rep 2020; 8:3058-3061. [PMID: 33363879 PMCID: PMC7752425 DOI: 10.1002/ccr3.3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 11/07/2022] Open
Abstract
Focused Intensive Care Echo can aid diagnosis in complex patients where initial investigations are non-diagnostic. FICE is an essential skill for critical care physicians, and bedside echocardiography should be a standard investigation for all critical care patients.
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Affiliation(s)
| | - Graham Wilson
- Intensive Care DepartmentAberdeen Royal InfirmaryAberdeenUK
| | - Andrew Ronald
- Anaesthetics DepartmentAberdeen Royal InfirmaryAberdeenUK
| | - Lee Allen
- Intensive Care DepartmentAberdeen Royal InfirmaryAberdeenUK
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Cunha-Silva M, Mazo DFDC, Gomes ILC, Imbrizi MR, Sevá-Pereira T, Vaz NF, Lourenço MS, Eloy da Costa LB, Escanhoela CAF, Almeida JRDS. Multiple hepatic metastases of cardiac angiosarcoma. Autops Case Rep 2019; 8:e2018048. [PMID: 30775323 PMCID: PMC6360823 DOI: 10.4322/acr.2018.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/02/2018] [Indexed: 11/23/2022] Open
Abstract
The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson's capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome.
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Affiliation(s)
- Marlone Cunha-Silva
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Daniel Ferraz de Campos Mazo
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Igor Logetto Caetité Gomes
- University of Campinas (Unicamp), School of Medical Sciences, Department of Internal Medicine. Campinas, SP, Brazil
| | - Marcello Rabello Imbrizi
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Tiago Sevá-Pereira
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Nayana Fonseca Vaz
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | - Mariana Sandoval Lourenço
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
| | | | | | - Jazon Romilson de Souza Almeida
- University of Campinas (Unicamp), School of Medical Sciences, Department of Gastroenterology (Gastrocentro). Campinas, SP, Brazil
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