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Michalet M, Tétreau R, Pasquié JL, Chabre O, Azria D. Stereotactic magnetic resonance imaging-guided radiotherapy for intra cardiac metastases: A case report. Cancer Radiother 2024; 28:202-205. [PMID: 38341326 DOI: 10.1016/j.canrad.2023.06.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 02/12/2024]
Abstract
Adrenocortical carcinoma is a malignant tumor with a poor prognosis and a frequent metastatic extension. In very rare cases, a cardiac metastatic disease may occur, and surgical resection is essential for its management. MR-guided stereotactic radiotherapy is an attractive radiotherapy modality for the treatment of mobile thoracic tumors, enabling the target to be monitored continuously during irradiation, while the dosimetric plan can be adapted daily if necessary. We report here the case of a patient with intracardiac metastasis secondary to malignant adrenocortical carcinoma, treated with magnetic resonance imaging-guided stereotactic radiotherapy.
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Affiliation(s)
- M Michalet
- Institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée (FOROM), 208, avenue des Apothicaires, 34298 Montpellier, France; Inserm, U1194 IRCM, 208, avenue des Apothicaires, 34298 Montpellier, France.
| | - R Tétreau
- Service d'imagerie médicale, institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - J-L Pasquié
- Service de cardiologie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; CNRS, UMR9214, Montpellier, France; Inserm, U1046 Phymedexp, Montpellier, France; Université de Montpellier, Montpellier, France
| | - O Chabre
- Service d'endocrinologie-diabétologie, CHU de Grenoble-Alpes, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - D Azria
- Institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée (FOROM), 208, avenue des Apothicaires, 34298 Montpellier, France; Inserm, U1194 IRCM, 208, avenue des Apothicaires, 34298 Montpellier, France
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Pallangyo P, Kweka G, Lyimo F, Mayala H, Swai HJ, Mkojera Z, Misidai N, Komba M, Millinga J, Bhalia S, Mwapinga F, Wibonela S, Janabi M. Complete heart block ensuing from a metastatic small cell carcinoma: a case report. J Med Case Rep 2022; 16:77. [PMID: 35144678 PMCID: PMC8830129 DOI: 10.1186/s13256-021-03244-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/28/2021] [Accepted: 12/23/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Notwithstanding the diagnostic and therapeutic advancements, the incidence of cardiac metastases has increased in recent decades. Lung cancers are the most common primary malignant neoplasms with cardiac metastasis potential. The clinical presentation of cardiac metastases is either silent or vague, and largely depends on the infiltrated location and tumor burden. Although arrhythmias are not uncommon in metastatic cardiac tumors, complete heart block is relatively a rare manifestation. We present a case of complete heart block due to a metastatic small cell carcinoma in a 67-year-old male of African origin. Case presentation A 67-year-old male of African origin from rural Tanzania was referred to us for expert management. He is a retired agromechanic with over 30 years exposure to asbestos-containing brake linings. His past medical history was unremarkable, but the family-social history was evident for a heavy alcohol intake and chronic cigarette smoking. He presented with a 24-week history of progressive shortness of breath and an 8-week history of recurrent syncopal attacks coupled with a significant weight loss. He had normal echocardiographic findings, however, the electrocardiogram showed features of complete heart block. Chest X-ray showed a homogeneous opacification on the right side and computed tomography scan revealed a solid right lung mass with metastases to the liver, heart, bowels, and bone. He underwent bronchoscopy, which revealed an endobronchial mass obstructing the bronchus intermedius. Histological examination of a section of lung biopsy taken during bronchoscopy confirmed the diagnosis of a small cell carcinoma. The patient underwent dual chamber pacemaker implantation with successful sinus rhythm restoration. He made an informed refusal of chemotherapy and inevitably died 18 months post pacing. Conclusions Despite the advancements in medical diagnostics and management, lung cancers are often diagnosed in advanced stages, with an inevitable grave prognosis. Small cell carcinoma has the potential to metastasize to the heart, resulting in complete heart block.
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Affiliation(s)
- Pedro Pallangyo
- Department of Research & Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. .,Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Garvin Kweka
- Department of Internal Medicine, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Frederick Lyimo
- Department of Radiology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Henry Mayala
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Happiness J Swai
- Department of Research & Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Zabella Mkojera
- Department of Research & Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- Department of Research & Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Makrina Komba
- Department of Research & Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Faustina Mwapinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Zhong Y, Li C, Sheng Y, Wang J, Wang G. Prognostic Implication of Direct Cardiac Invasion from Lung Cancer in Non-Operatively Treated Patients Based on Lung Computed Tomography Imaging. Heart Lung Circ 2021; 31:733-741. [PMID: 34840061 DOI: 10.1016/j.hlc.2021.10.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lung cancer with direct cardiac invasion (LCCI+) exerts a significant influence on the survival of patients. There is a paucity of comparative research into the prognosis of advanced lung cancer with and without direct cardiac invasion. METHOD In this study, 50 LCCI+ patients and 50 sex-, age-, and TNM stage-matched patients without direct cardiac invasion (LCCI-) were retrospectively analysed. LCCI+ was defined as lung cancer directly invading the heart by penetrating mediastinum or extending into the atrium via the pulmonary vein. The study endpoint was all-cause death. In this study, the survival time was defined as the time from the first detection of direct cardiac invasion to the end of the event. RESULTS During a median follow-up period of 31 months, all-cause death occurred in 44 patients (88.0%) in the LCCI+ group and in 36 patients (72.0%) in the LCCI- group; the overall survival (OS) time among patients in the LCCI+ group was significantly lower compared with those in the LCCI- group (5.0 [interquartile range (IQR), 2.0-12.0] vs 13.8 [IQR, 4.0-18.4] months; p<0.001); the OS rate in the LCCI+ group was significantly lower compared with patients in the LCCI- group (log-rank, p=0.0002). Multivariate Cox regression analysis showed that direct cardiac invasion was an independent predictor of survival in patients with advanced lung cancer (hazard ratio, 2.255; 95% confidence interval, 1.443-3.524). Further analysis indicated that in patients with small cell lung cancer, the survival rate between the LCCI+ group and LCCI- group was insignificant (log-rank, p=0.075; survival time: 4.0 [IQR, 2.0-11.5] vs 11.5 [IQR, 5.0-18.3] months); in patients with non-small cell lung cancer (NSCLC), the survival rate in the LCCI+ group was lower than that of the LCCI- group (log-rank, p=0.01; survival time: 6.0 [IQR, 3.0-13.3] vs 16.3 [IQR, 10.4-27.2] months). CONCLUSIONS Direct cardiac invasion from lung cancer was an independent prognostic factor for survival time in patients with lung cancer. Patients with direct cardiac invasion by NSCLC have a poorer clinical outcome than those without direct cardiac invasion. A careful preoperative evaluation is mandatory and appropriate management of cardiac involvement should be considered in the treatment of NSCLC.
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Affiliation(s)
- Ying Zhong
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ce Li
- Department of Medical Oncology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuehuan Sheng
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiaqi Wang
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guan Wang
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang, China.
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Abstract
The median survival of metastatic renal cell carcinoma (mRCC) is 5 months with a 1-year survival rate of 29%. Cardiac metastasis from RCC is a rare finding and there is scarce data available on treatment options. Recently, the combination of nivolumab and ipilimumab has been approved as a first-line treatment for advanced RCC in patients with a poor prognosis. Here we present a case of a 45-year-old male who presented to the emergency room with cough, dyspnea, and fever. Chest X-ray showed hilar lymphadenopathy and diffuse reticulonodular opacities, whereas a thoracic computed tomography (CT) scan revealed carcinomatosis lymphangitis, pleural carcinosis and multiple heterogenous zones on the cardiac wall. A transthoracic echocardiogram and a cardiac magnetic resonance imaging (MRI) revealed cardiac metastases. Subsequent imaging showed abundant distal metastases whereas a renal biopsy confirmed clear cell RCC making it a high-grade stage IV metastatic RCC. The patient was treated with the combination of nivolumab and ipilimumab. The unique feature about this case is that we have found a rare case of cardiac metastases that persists after a 3-month follow-up. Previously, there was only one case report of a patient with RCC and cardiac metastases who showed persistent response to nivolumab after 12 months. The key points from this case report are that a high index of suspicion is required for diagnosing cardiac metastases given that the signs and symptoms of metastatic cardiac involvement can be non-specific. Spread has been described as directly through the renal vein and vena cava or indirectly via the lymphatic system, which confers a worse prognosis. Furthermore, cardiac metastases can be mistaken for thrombi, endocarditis, or primary tumors, therefore echocardiograms can be limiting. Supplemental imaging with cardiac MRI or positron emission tomography/CT (PET/CT) is often needed for further characterization.
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Affiliation(s)
- Steven Li Fraine
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Diana Coman
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Madeleine Durand
- Division of General Internal Medicine, Department of Medicine, University of Montreal, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Mikhael Laskine
- Division of General Internal Medicine, Department of Medicine, University of Montreal, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
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Abstract
PURPOSE OF REVIEW This study aims to review the various roles and evidence underlying the use of fluorodeoxyglucose (FDG) PET/CT and PET/MR for the assessment of cardiac masses. RECENT FINDINGS The role of FDG-PET for the evaluation of cardiac masses continues to evolve. Studies have shown that FDG-PET is particularly well-suited for differentiating malignant from benign cardiac lesions based on their metabolic activity. Furthermore, FDG-PET is uniquely positioned to investigate patients with cardiac mass as most malignant cardiac lesions are metastasis. Finally, FDG-PET enables staging of patients with primary malignant cardiac tumor, identification of potential biopsy site, and planning of radiotherapy. FDG-PET is a complementary tool for the evaluation of patients with cardiac mass and can help differentiate benign from malignant lesions, as well as provide whole-body staging.
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Affiliation(s)
- Patrick Martineau
- BC Cancer, Vancouver, British Columbia, Canada
- Department of Diagnostic Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Matthieu Pelletier-Galarneau
- Department of Medical Imaging, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec, H1T1C8, Canada.
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Liu M, Armeni E, Navalkissoor S, Davar J, Sullivan L, Leigh C, O'Mahony LF, Hayes A, Mandair D, Chen J, Caplin M, Toumpanakis C. Cardiac Metastases in Patients with Neuroendocrine Tumours: Clinical Features, Therapy Outcomes, and Prognostic Implications. Neuroendocrinology 2021; 111:907-924. [PMID: 32717739 DOI: 10.1159/000510444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac metastases (CM) from neuroendocrine tumours (NET) are rare; however, with the introduction of new molecular imaging modalities, such as 68Ga-DOTATATE PET-CT for NET diagnosis and re-staging, they are now identified more frequently. This study presents a single-institution experience on the NET CM characteristics, management, and prognostic implications. METHODS Between January 1998 and January 2020, 25 NET patients with CM were treated in our unit. A retrospective review of electronic records was performed. Overall survival (OS) was assessed by the Kaplan-Meier method. Cox regression models were used to evaluate the association of various clinical variables with OS. RESULTS The median age in the NET CM cohort was 64 years, with small intestine being the most common primary (84%). Nearly half of the patients suffered either from shortness of breath (48%) or had palpitations (12%). Peptide receptor radionuclide therapy (PRRT) was applied in more than half of the patients (64%), who had an improved trend for a longer median OS compared to those patients who did not receive PRRT (76.0 vs. 14.0 months, p = 0.196). The multivariate analysis demonstrated that concomitant skeletal or pancreatic metastases, as well as N-terminal pro-B-type natriuretic peptide (NT pro-BNP) >2 × upper limit of normal (ULN), were independent poor prognosticators. CONCLUSIONS Clinical features of NET CM ranged from asymptomatic patients to heart failure. Concomitant bone or pancreatic metastases and NT pro-BNP levels >2 ULN predicted shorter survival time. PRRT serves as a feasible therapy with promising survival benefits; however, more data are needed.
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Affiliation(s)
- Man Liu
- Neuroendocrine Tumour Unit, Center for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Eleni Armeni
- Neuroendocrine Tumour Unit, Center for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Joseph Davar
- Cardiology Department, Royal Free Hospital, London, United Kingdom
| | - Luke Sullivan
- Medical School, University College of London, London, United Kingdom
| | - Charlotte Leigh
- Medical School, University College of London, London, United Kingdom
| | | | - Aimee Hayes
- Neuroendocrine Tumour Unit, Center for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dalvinder Mandair
- Neuroendocrine Tumour Unit, Center for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jie Chen
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, Center for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Center for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom,
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Talukder S, Murphy MO, Lyon A, Rosendahl AU. Metastasectomy of left atrial mesenchymal chondrosarcoma. Eur J Cardiothorac Surg 2020; 58:861-863. [PMID: 32413904 DOI: 10.1093/ejcts/ezaa116] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 11/12/2022] Open
Abstract
Metastasis of chondrosarcoma of skeletal origin to the heart is uncommonly reported in the literature, with the majority of cases involving right atrial metastases. Surgical resection remains the mainstay of treatment, and the literature has shown improved median survival with this form of therapy, possibly by reducing thromboembolic risk in this patient population. We report the case of a patient with metastatic mesenchymal chondrosarcoma of the left atrium who underwent resection, following a lack of response to anticoagulation therapy. This is the first report of surgical resection of left atrial metastatic disease prior to the onset of thromboembolic sequelae.
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Affiliation(s)
| | - Michael O Murphy
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
| | - Alexander Lyon
- Department of Cardio-Oncology, Royal Brompton Hospital, London, UK
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Tandon V, Kethireddy N, Balakumaran K, Kim AS. Metastatic squamous cell carcinoma to the heart: an unusual cause of ST elevation-a case report. Eur Heart J Case Rep 2019; 3:5416185. [PMID: 31449588 PMCID: PMC6601241 DOI: 10.1093/ehjcr/ytz029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/27/2019] [Indexed: 01/07/2023]
Abstract
Background Cardiac tumours are typically secondary in nature, and the most common malignancies metastasizing to the heart are cancers of the lung, breast, oesophagus, melanoma, and lymphoma. We present a unique case of squamous cell carcinoma of the tongue, metastasizing to the heart and manifesting with ST elevation in the inferior-leads on electrocardiogram (ECG). Case summary A 25-year-old woman was initially diagnosed with squamous cell carcinoma of the tongue at the age of 23 and treated with hemi-glossectomy with clear-margins. Sixteen months later, the tumour recurred in the oropharynx and the left upper lobe of the lung. She was treated with chemotherapy; however, the tumour progressed. Thus, she was initiated on immunotherapy and radiation therapy. One month later, she presented with chest pain. Electrocardiogram revealed ST elevation in the inferior-leads. Troponin-I was elevated. Transthoracic echocardiogram revealed focal areas of thickening within the left and right ventricular myocardium with associated hypokinesis. These findings suggested ECG changes were likely secondary to infiltrative metastases and not acute-coronary-syndrome. Cardiac magnetic resonance imaging showed infiltrative masses with increased T2-signal and heterogeneous enhancement on perfusion and delayed enhancement sequences. Imaging also demonstrated numerous extra-cardiac metastases. She was treated with analgesics and discharged to home hospice. Discussion Head and neck cancers are a rare cause of cardiac metastasis. ST elevation and troponin release are thought to be due to tumour extension into the myocardium. Cardiac metastases usually present in patients with advanced widespread malignancy. In a cancer patient with cardiac symptoms or ECG changes, it is important to consider a broad differential diagnosis and entertain the possibility of cardiac metastasis.
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Affiliation(s)
- Varun Tandon
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Nikhila Kethireddy
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Kathir Balakumaran
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.,Division of Cardiology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Agnes S Kim
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.,Division of Cardiology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
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Yi JE, Yoon HJ, O JH, Youn HJ. Cardiac and Pericardial 18F-FDG Uptake on Oncologic PET/CT: Comparison with Echocardiographic Findings. J Cardiovasc Imaging 2018; 26:93-102. [PMID: 29971271 PMCID: PMC6024833 DOI: 10.4250/jcvi.2018.26.e10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/08/2018] [Accepted: 04/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Interpretation of cardiac uptake on 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is often confounded by intense physiological FDG uptake and numerous benign conditions. The aim of the study was to describe the echocardiographic features in concordance with cardiac and pericardial 18F-FDG uptake on whole-body oncology PET/CT. METHODS We enrolled 43 consecutive patients (34 solid tumors, 8 lymphomas and 1 leukemia) who were newly diagnosed with non-cardiac malignancy showing incidental cardiac or pericardial 18F-FDG uptake on PET/CT and underwent transthoracic Doppler echocardiography (TTE) within 1 month of PET/CT. The maximum standardized uptake (SUVmax) of all lesions was measured. RESULTS Fifty-six 18F-FDG uptake lesions (32 pericardium, 7 myocardium, 9 cardiac chambers and 8 great vessels) were found, and pericardial effusion was the most common echocardiographic finding (22/43, 51.2%) among study population. Pericardial FDG uptake was shown as pericardial effusion (68.8%), intrapericardial echogenic materials (31.3%), pericardial thickening (28.1%), hyperechogenicity of myopericardium (18.8%), and restricted sliding movement or constrictive pericarditis (15.6%) on TTE. Lesions with regional wall motion abnormality (p = 0.004) or constrictive pericarditis (p = 0.021) had significantly higher mean SUVmax than those without. Myocardial FDG uptake demonstrated pericardial effusion (57.1%), regional wall motion abnormality (57.1%), and increased myocardial wall thickness (42.9%). All cardiac chamber FDG uptakes showed intracardiac mass on TTE. CONCLUSIONS Cardiac or pericardial 18F-FDG uptake on oncology PET/CT shows characteristic echocardiographic features according to which heart sites are involved.
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Affiliation(s)
- Jeong-Eun Yi
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, Seoul, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyuk Jin Yoon
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joo Hyun O
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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10
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Peretz-Larochelle M, Blissett S, Lipes J, Kovacina B, Afilalo J, Rudski L. Clot or Not? ACTA ACUST UNITED AC 2018; 2:47-50. [PMID: 30062308 PMCID: PMC6058399 DOI: 10.1016/j.case.2017.09.010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A case of exertional dyspnea was found to be symptomatic right ventricular masses. Echocardiography is the first-line imaging modality for cardiac masses. Cardiac MRI is useful for tissue characterization of cardiac masses. Multimodality imaging is useful in differentiating thrombus from cardiac tumors.
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Affiliation(s)
| | - Sarah Blissett
- Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Cardiology, London Health Science Centre, London, Ontario, Canada
| | - Jed Lipes
- Department of Critical Care, Jewish General Hospital, Montreal, Quebec, Canada
| | - Bojan Kovacina
- Department of Radiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Jonathan Afilalo
- Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Lawrence Rudski
- Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada
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11
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Shimbori M, Osaka K, Kawahara T, Kasahara R, Kawabata S, Makiyama K, Kondo K, Nakaigawa N, Yamanaka S, Yao M. Large cell neuroendocrine carcinoma of the kidney with cardiac metastasis: a case report. J Med Case Rep 2017; 11:297. [PMID: 29052535 PMCID: PMC5649063 DOI: 10.1186/s13256-017-1460-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/04/2017] [Accepted: 09/19/2017] [Indexed: 01/08/2023] Open
Abstract
Background Primary large cell neuroendocrine carcinoma of the kidney is a rare and generally very aggressive disease. We present a case of a patient with primary large cell neuroendocrine carcinoma of the kidney with cardiac metastasis. Case presentation A 59-year-old Japanese man presented to his previous physician with hematuria. Computed tomography revealed masses in the heart and right kidney, and fluorodeoxyglucose-positron emission tomography showed abnormal uptake in the heart. A cardiac biopsy under transesophageal echocardiographic guidance revealed a metastatic tumor. Subsequently, multiple lung lesions were detected, and a right nephrectomy was performed after these metastases were suspected to have originated from renal carcinoma. Large cell neuroendocrine carcinoma of the kidney was ultimately diagnosed. Pancreatic metastasis was detected on computed tomography postoperatively. Three courses of chemotherapy with carboplatin and irinotecan were administered, and were temporarily effective against the metastatic lesions in the lungs and pancreas. However, our patient’s general condition deteriorated with the progression of the lesions, and he died 9 months after his initial examination. Conclusions Multi-agent chemotherapy, including platinum-based drugs was effective against large cell neuroendocrine carcinoma metastases, albeit only temporarily. This is the first reported case of large cell neuroendocrine carcinoma with cardiac metastasis.
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Affiliation(s)
- Moeka Shimbori
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan.
| | - Kimito Osaka
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryo Kasahara
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Sayuki Kawabata
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Keiichi Kondo
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Noboru Nakaigawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Shoji Yamanaka
- Departments of Anatomy and Clinical Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
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12
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Chan AT, Plodkowski AJ, Pun SC, Lakhman Y, Halpenny DF, Kim J, Goldburg SR, Matasar MJ, Moskowitz CS, Gupta D, Steingart R, Weinsaft JW. Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer. J Cardiovasc Magn Reson 2017; 19:76. [PMID: 29025425 PMCID: PMC5639740 DOI: 10.1186/s12968-017-0390-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/04/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE-) cardiovascular magnetic resonance (CMR) is well-validated for cardiac mass (CMASS) tissue characterization to differentiate neoplasm (CNEO) from thrombus (CTHR): Prognostic implications of CMASS subtypes among systemic cancer patients are unknown. METHODS CMASS + patients and controls (CMASS -) matched for cancer diagnosis and stage underwent a standardized CMR protocol, including LGE-CMR (IR-GRE) for tissue characterization and balanced steady state free precession cine-CMR (SSFP) for cardiac structure/function. CMASS subtypes (CNEO, CTHR) were respectively defined by presence or absence of enhancement on LGE-CMR; lesions were quantified for tissue properties (contrast-to-noise ratio (CNR); signal-to-noise ratio (SNR) and size. Clinical follow-up was performed to evaluate prognosis in relation to CMASS etiology. RESULTS The study population comprised 126 patients with systemic neoplasms referred for CMR, of whom 50% (n = 63) had CMASS + (CNEO = 32%, CTHR = 18%). Cancer etiology differed between CNEO (sarcoma = 20%, lung = 18%) and CTHR (lymphoma = 30%, GI = 26%); cardiac function (left ventricular ejection fraction: 63 ± 9 vs. 62 ± 10%; p = 0.51∣ right ventricular ejection fraction: 53 ± 9 vs. 54 ± 8%; p = 0.47) and geometric indices were similar (all p = NS). LGE-CMR tissue properties assessed by CNR (13.1 ± 13.0 vs. 1.6 ± 1.0; p < 0.001) and SNR (29.7 ± 20.4 vs. 15.0 ± 11.4, p = 0.003) were higher for CNEO, consistent with visually-assigned diagnostic categories. CTHR were more likely to localize to the right atrium (78% vs. 25%, p < 0.001); nearly all (17/18) were associated with central catheters. Lesion size (17.3 ± 23.8 vs. 2.0 ± 1.5 cm2; p < 0.001) was greater with CNEO vs. CTHR, as was systemic disease burden (cancer-involved organs: 3.6 ± 2.0 vs. 2.3 ± 2.1; p = 0.02). Mortality during a median follow-up of 2.5 years was markedly higher among patients with CNEO compared to those with CTHR (HR = 3.13 [CI 1.54-6.39], p = 0.002); prognosis was similar when patients were stratified by lesion size assessed via area (HR = 0.99 per cm2 [CI 0.98-1.01], p = 0.40) or maximal diameter (HR = 0.98 per cm [CI 0.91-1.06], p = 0.61). CTHR conferred similar mortality risk compared to cancer-matched controls without cardiac involvement (p = 0.64) whereas mortality associated with CNEO was slightly higher albeit non-significant (p = 0.12). CONCLUSIONS Among a broad cancer cohort with cardiac masses, CNEO defined by LGE-CMR tissue characterization conferred markedly poorer prognosis than CTHR, whereas anatomic assessment via cine-CMR did not stratify mortality risk. Both CNEO and CTHR are associated with similar prognosis compared to CMASS - controls matched for cancer type and disease extent.
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Affiliation(s)
- Angel T. Chan
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
- Radiology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Shawn C. Pun
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Yuliya Lakhman
- Radiology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021 USA
| | - Samantha R. Goldburg
- Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021 USA
| | - Mathew J. Matasar
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
- Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021 USA
| | - Chaya S. Moskowitz
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Dipti Gupta
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Richard Steingart
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Jonathan W. Weinsaft
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
- Radiology, Memorial Sloan Kettering Cancer Center, New York, NY USA
- Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021 USA
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13
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Ferrari D, Codecà C, Viale G, Bocci B, Broggio F, Crepaldi F, Violati M, Luciani A, Bauer D, Moneghini L, Bulfamante G, Foa P. An unusual case of tracheo-pleural fistula and cardiac metastases in oropharyngeal carcinoma: a case report and review of the literature. Cancers Head Neck 2016; 1:16. [PMID: 31093345 PMCID: PMC6460740 DOI: 10.1186/s41199-016-0018-5] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/21/2016] [Indexed: 01/03/2023]
Abstract
Background Oropharyngeal cancer is frequently associated with human papilloma virus, that also represents a strong prognostic factor. Local relaps and treatment-related complications are frequent, whereas distant metastases occur in about 25% of patients. Case presentation A 49 years-old male presented with a loco-regionally advanced oropharyngeal squamous cell carcinoma and was treated with concomitant chemoradiation. A complete clinical and pathological response was achieved, but the occurrence of necrotising tracheo-esophagitis, with tracheo-mediastino-pleural fistula formation, further complicated the subsequent clinical course. The patient died suddenly. Autopsy revealed multiple myocardial and epicardial metastases from oropharyngeal squamous cell carcinoma. Conclusions Even in case of a transient complete local response, the potential occurrence of severe complications and distant metastases, although infrequent, should be considered. Cardiac metastases are frequently underestimated, as they are often asymptomatic, but may lead to sudden death. Further efforts are needed to improve diagnosis and therapy in this setting.
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Affiliation(s)
- Daris Ferrari
- 1Medical Oncology, San Paolo Hospital, Milan, Italy.,5San Paolo Hospital, via Di Rudinì 8, 20142 Milan, Italy
| | - Carla Codecà
- 1Medical Oncology, San Paolo Hospital, Milan, Italy
| | - Giulia Viale
- 1Medical Oncology, San Paolo Hospital, Milan, Italy
| | | | | | | | | | | | - Dario Bauer
- 2Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Laura Moneghini
- 2Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Gaetano Bulfamante
- 3Department of Medicine, Surgery and Dentistry, Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Paolo Foa
- 4Department of Oncology, Medical Oncology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
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14
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Voss JN, Nkwam NM, McCulloch TA, Mann GS. Collecting Duct Carcinoma With Cardiac Metastases: A Case Report & Literature Review. Urol Case Rep 2016; 5:27-30. [PMID: 26977410 PMCID: PMC4776230 DOI: 10.1016/j.eucr.2015.12.010] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/28/2015] [Indexed: 11/17/2022] Open
Abstract
Collecting duct carcinoma (CDC), is a rare and aggressive form of renal cell carcinoma (RCC) accounting for around 1% of all renal malignancy. It affects younger patients and is associated with rapid progression, distant spread and poor prognosis. Cardiac metastases from all types of RCC, without involvement of the inferior vena cava are very rare. We present the case of a 54 year old man with a history of CDC, who presents with collapse and ventricular tachycardia secondary to multifocal cardiac metastases. We are not aware of any other reports in the literature of CDC and cardiac metastases.
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Affiliation(s)
- James N Voss
- Department of Urology, Nottingham City Hospital, UK
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15
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Pedrotti P, Musca F, Torre M, Pirola R, De Biase AM, Fieschi S, Quattrocchi G, Roghi A, Giannattasio C. Cardiac metastatic melanoma: Imaging diagnostic clues. J Cardiol Cases 2015; 12:33-36. [PMID: 30524534 DOI: 10.1016/j.jccase.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/11/2014] [Revised: 02/08/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
A 47-year-old male was admitted to hospital for severe pericardial effusion; he had undergone surgical removal of cutaneous melanoma 10 years before. Echocardiography-guided pericardiocentesis revealed the presence of intramyocardial masses, which were better defined and characterized, together with pericardial involvement, by cardiac magnetic resonance. Pericardial fluid drained was negative for malignant cells, so video-assisted thoracoscopy was performed and pathologic tissue was biopsied, leading to the diagnosis of metastatic melanoma. Multidisciplinary approach and multimodality imaging played a key role in allowing the diagnostic workup in this complex case. <Learning objective: The diagnosis of cardiac metastases is challenging and histologic characterization is necessary to guide therapy. Multimodality imaging and minimally invasive thoracoscopy are key tools to achieve these goals.>.
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Affiliation(s)
- Patrizia Pedrotti
- Cardiology 4, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Francesco Musca
- Cardiology 4, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Massimo Torre
- Thoracic Surgery, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Roberto Pirola
- Cardiology 4, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Anna Maria De Biase
- Cardiology 4, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Stefano Fieschi
- Thoracic Surgery, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Giuseppina Quattrocchi
- Cardiology 4, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Alberto Roghi
- Cardiology 4, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Cristina Giannattasio
- Cardiology 4, Cardio-thoracic-vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.,Science of Health Department, Bicocca University, Milan, Italy
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16
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Dua MM, Cloyd JM, Haddad F, Beygui RE, Norton JA, Visser BC. Cardiac metastases and tumor embolization: A rare sequelae of primary undifferentiated liver sarcoma. Int J Surg Case Rep 2014; 5:927-31. [PMID: 25460438 PMCID: PMC4275788 DOI: 10.1016/j.ijscr.2014.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/25/2014] [Revised: 09/21/2014] [Accepted: 10/06/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Primary hepatic sarcomas are uncommon malignant neoplasms; prognostic features, natural history, and optimal management of these tumors are not well characterized. PRESENTATION OF CASE This report describes the management of a 51-year-old patient that underwent a right trisectionectomy for a large hepatic mass found to be a liver sarcoma on pathology. He subsequently developed tumor emboli to his lungs and was discovered to have cardiac intracavitary metastases from his primary tumor. The patient underwent cardiopulmonary bypass and resection of the right-sided heart metastases to prevent further pulmonary sequela of tumor embolization. DISCUSSION The lack of distinguishing symptoms or imaging characteristics that clearly define hepatic sarcomas makes it challenging to achieve a diagnosis prior to pathologic examination. Metastatic spread is frequently to the lung or pleura, but very rarely seen within the heart. Failure to recognize cardiac metastatic disease will ultimately lead to progressive tumor embolization and cardiac failure if left untreated. CONCLUSION The most effective therapy for primary liver sarcomas is surgery; radical resection should be performed if possible given the aggressive nature of these tumors to progress and metastasize.
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Affiliation(s)
- Monica M Dua
- Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1).
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1).
| | - Francois Haddad
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, 870 Quarry Road, Stanford, CA 94305, United States.
| | - Ramin E Beygui
- Department of Surgery, Division of Cardiothoracic Surgery, Stanford University School of Medicine, Falk Cardiovascular Research Center, 870 Quarry Road, Stanford, CA 94305, United States.
| | - Jeffrey A Norton
- Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1).
| | - Brendan C Visser
- Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1).
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Bazine A, Fetohi M, Tanz R, Mahfoud T, Ichou M, Errihani H. Cardiac metastases of renal cell carcinoma revealed by syncope: diagnosis and treatment. Case Rep Oncol 2014; 7:560-4. [PMID: 25232327 PMCID: PMC4164104 DOI: 10.1159/000366292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cardiac metastases from renal cell carcinoma are very rare. In this report, we describe a case of ventricular metastases in the absence of vena cava or right atrial involvement. CASE REPORT We report the case of a 60-year-old man who had a past history of heavy tobacco intake and well-controlled arterial hypertension. He experienced sudden-onset palpitations, lost consciousness and, as a result, was involved in an accident on the public highway. Cardiac arrhythmia was suspected and, therefore, transthoracic echocardiography was suggested, which revealed a large right ventricular mass. Chest and abdominal computed tomography demonstrated a mass in the right ventricle, but without contiguous vena cava involvement, and a right renal mass related to the probable neoplasm. An ultrasound-guided renal biopsy showed a clear-cell renal cell carcinoma. A bone scan revealed a metastatic bone disease. The patient was started on sunitinib treatment, which was well tolerated. However, approximately 8 months later, reevaluation showed pulmonary metastases. The patient was subsequently started on treatment with everolimus, which, however, was poorly tolerated. Two months later, the patient died due to terminal respiratory insufficiency. DISCUSSION Based on the literature and our observations in this case, targeted antiangiogenic therapy should be considered as a viable therapeutic alternative to metastasectomy for patients with inoperable cardiac metastatic disease as long as there is no baseline systolic or diastolic dysfunction. The case also emphasizes the importance of a thorough history review and physical examination in the workup of patients with syncope.
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Affiliation(s)
- Aziz Bazine
- Department of Medical Oncology, Military Hospital My Ismail, Meknès, Morocco
| | - Mohamed Fetohi
- Department of Medical Oncology, Military Hospital My Ismail, Meknès, Morocco
| | - Rachid Tanz
- Department of Medical Oncology, Military Hospital Med V, Morocco
| | - Tarik Mahfoud
- Department of Medical Oncology, Military Hospital Med V, Morocco
| | - Mohamed Ichou
- Department of Medical Oncology, Military Hospital Med V, Morocco
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
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18
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Bruixola G, Segura Á, Caballero J, Andrés A, Reche E, Escoín C, Díaz-Beveridge R. Heart failure as first sign of development of cardiac metastases in a patient with diagnosis of papillary thyroid carcinoma on treatment with tyrosine-kinase inhibitors: differential diagnoses and clinical management. Case Rep Oncol 2014; 7:591-9. [PMID: 25298765 PMCID: PMC4178319 DOI: 10.1159/000366192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac metastases from papillary thyroid carcinoma are very uncommon. Their incidence is rising due to improvements in survival and diagnosis; nevertheless, our patient is the fourth case reported up to date. There are no clinical trials available in this scenario. Therefore, treatment choice is made based on clinical experience and case reports; notably, the largest case report series was prior to the approval for using tyrosine-kinase inhibitors in thyroid cancer. PATIENT A 73-year-old lady had dedifferentiated papillary thyroid cancer with ongoing sorafenib. After 9 months on this treatment, she presented with dyspnea and heart failure. Differential diagnosis included infection, progression of disease and cardiotoxicity. After a comprehensive assessment (echocardiography, computed tomography, PET, magnetic resonance), we found progression of lung disease, and the appearance of heart metastases. RESULTS After recovering from the basal status, she started on second-line treatment with sunitinib, which was well-tolerated. She achieved stable disease with a decrease in tumor marker levels. CONCLUSIONS We should include cardiac metastases in the differential diagnosis of heart failure in cancer patients. Magnetic resonance imaging is the gold standard for assessment. Sorafenib is the mainstay of the first-line therapy in metastatic thyroid cancer, achieving long-term disease control with good tolerance. Sunitinib could be a safe second-line treatment option (not cardiotoxicity related) with promising results. Therefore, our report presents a sequence of treatment with tyrosine-kinase inhibitors in metastatic thyroid carcinoma with an encouraging outcome, which deserves further investigation.
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Affiliation(s)
- Gema Bruixola
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ángel Segura
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Javier Caballero
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana Andrés
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Encarnación Reche
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Corina Escoín
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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19
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Abdullah HN, Nowalid WKWM. Infiltrative cardiac lymphoma with tricuspid valve involvement in a young man. World J Cardiol 2014; 6:77-80. [PMID: 24575174 PMCID: PMC3935062 DOI: 10.4330/wjc.v6.i2.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/12/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Cardiac metastases are among the topics with limited systematic reviews. Theoretically, the heart can be infiltrated by any malignancy with the ability to spread to distant structures. Thus far, no specific tumors are known to have a predilection for the heart, but some do metastasize more often than others, for example, melanoma and primary mediastinal tumors. We report a case of cardiac metastasis from a diffuse large B cell lymphoma in a young man. The peculiarity of this case is that besides the involvement of right ventricle and atrium, the tricuspid valve was also infiltrated. Valvular metastasis is rarely reported in the medical literature.
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20
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Scully P, Victor K, Chiribiri A, Carr-White GS, Kapetanakis S, Rajani R. Multimodality imaging of metastatic squamous cell cardiac carcinomatosis. Int J Cardiol 2013; 167:e156-8. [PMID: 23623343 DOI: 10.1016/j.ijcard.2013.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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21
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Rodriguez A, Roubertie F, Thumerel M, Jougon J. Pulmonary metastatic chondrosarcoma with massive extension into left atrium and left ventricle: outcome of surgical management in emergency. Eur J Cardiothorac Surg 2013; 44:e341-2. [PMID: 23999561 DOI: 10.1093/ejcts/ezt426] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of metastatic chondrosarcoma to the lung that invaded the right inferior pulmonary vein with massive cardiac extension and presented with an acute heart failure. CT scan showed a large mass of the right lower lobe which invaded and filled almost all the left atrium with an extension into left ventricle through the mitral valve. Surgical resection was performed in emergency. The patient is still alive 4 months after development of cardiac symptoms and surgery.
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Affiliation(s)
- Arnaud Rodriguez
- Department of Thoracic Surgery, University of Bordeaux, Pessac, France
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22
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Agrawal K, Mittal BR, Manohar K, Kashyap R, Bhattacharya A, Varma S. FDG PET/CT in Detection of Metastatic Involvement of Heart and Treatment Monitoring in Non-Hodgkin's Lymphoma. World J Nucl Med 2012; 11:33-4. [PMID: 22942783 PMCID: PMC3425230 DOI: 10.4103/1450-1147.98746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 01/27/2023] Open
Abstract
Cardiac metastasis occurs in up to a quarter of patients with metastatic cancer and is seen most commonly in melanoma and lymphoma. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. We describe a patient of non-Hodgkin's lymphoma detected to have involvement of right atrium on F-18 FDG PET/CT and monitoring of response to chemotherapy.
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Affiliation(s)
- Kanhaiyalal Agrawal
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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