Free‐Floating Tumor Thrombus in the Left Atrium Associated with Non‐Small Cell Lung Cancer

Uçak, Alper; İnan, Kaan; Onan, Burak; Temizkan, Veysel; Alp, Ibrahim; Yılmaz, Ahmet

doi:10.1111/j.1540-8191.2009.00927.x

Cited by 11 publications

(14 citation statements)

References 11 publications

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“…Similarly, a more recent retrospective analysis of 4668 patients who underwent surgery for lung cancer found pathological evidence of pulmonary vein and LA involvement in 34 (0.7%) and 25 (0.5%) subjects, respectively [17]. LA invasion usually occurs by two main mechanisms, including direct infiltration of myocardial tissue by contiguity [18–20] and extension into the left atrium via the lymphatics and/or the pulmonary veins [21–28]. Patients most commonly suffer symptoms related to lung cancer (e.g., cough, hemoptysis, and weight loss) or sometimes related to cardiac complications as the first clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Mass Invasion from Pulmonary Neoplasm Extension via the Right Upper Pulmonary Vein Presenting as Ipsilateral Stroke

Ballo

Laureano

et al. 2016

Case Reports in Medicine

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Left atrial invasion by lung cancer via haematogenous pathways is a relatively uncommon but potentially life-threatening event. While several cardiac complications of cardiac involvement have been previously described, the evolution towards cerebral stroke has been rarely reported. In this case report, we describe an atypical case of haematogenous metastatic invasion of the left atrium from pulmonary neoplasm extension presenting as an ipsilateral stroke whose ASCO classification changed during the clinical management.

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Section: Discussionmentioning

confidence: 99%

Left Atrial Mass Invasion from Pulmonary Neoplasm Extension via the Right Upper Pulmonary Vein Presenting as Ipsilateral Stroke

Ballo

Laureano

et al. 2016

Case Reports in Medicine

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“…Improved dose-delivery techniques also increase the utility of radiation (1,25). The 18 previous cases (1,(5)(6)(7)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) show that surgery combined with chemotherapy is the most common treatment for this condition, however, prognosis remains extremely poor, with overall survival times ranging between 4 and 17 months. In the present case, surgery was not advised due to the presence of distant metastasis and the high risk of the surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, there have only been 18 cases published in the English literature over the last two decades. In these 18 cases, squamous cell carcinoma was the most common pathological type and was present in 5 cases (7,9-12), followed by 4 neuroendocrine carcinoma cases (13-16), 3 adenocarcinoma cases (1,17,18), 3 sarcoma cases (5,6,19), 1 large cell carcinoma case (20) and 1 neuroectodermal tumor case (21). The pathology of a further case was reported as sarcoma mixed with squamous carcinoma (16); although histopathological examination demonstrated that the primary tumor was poorly-differentiated, the cardiac and intravascular portions of each tumor were less differentiated and more necrotic than the primary focus in the lung (3).…”

Section: Discussionmentioning

confidence: 99%

“…The slides were then washed 3 times with TBST followed by distilled water for 1 min. Staining was visualized under a microscope (BX41; Olympus Corporation, Tokyo, Japan Positron emission tomography (PET; GE Discovery ST; GE Healthcare) exhibited intense 18 F-fluorodeoxyglucose uptake in the hilar tumor and the mass in the left atrium; additionally, a hot spot was located in the left adrenal gland (Fig. 3).…”

Section: Case Reportmentioning

confidence: 99%

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Stereotactic radiotherapy for the treatment of lung cancer with a giant left atrial tumor thrombus: A case report and literature review

Lou

Qiu

et al. 2016

Oncology Letters

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Abstract. Lung cancer presenting with a giant atrial tumor thrombus is particularly rare. Surgical resection, aided by a cardiopulmonary bypass, is the standard treatment of choice if there is no distant metastasis. However, this form of surgery carries a high risk, with the subsequent patient prognosis being extremely poor. The current study describes the case of a 52-year-old man presenting with left lung squamous cell carcinoma that had extended into the left atrium. The patient was treated with stereotactic radiotherapy, and regarding the atrial disease, a complete response was achieved within 12 months. The present case demonstrates that stereotactic radiotherapy may be a beneficial palliative treatment for patients with stage IV lung cancer invading the left atrium. IntroductionAdvanced non-small cell lung cancer with associated atrial involvement is uncommon, occurring in ~10% of patients presenting with bronchogenic carcinoma (1,2). Patients with the disease usually possess circulatory and respiratory symptoms, and coughing, hemoptysis, dyspnea, weight loss and an extremely poor performance status are the typical associated features (3). Furthermore, an associated intra-atrial tumor thrombus is particularly rare, with tumor thrombi potentially leading to widespread systemic embolization and/or outflow tract obstruction (4-6). As a result, treatment is always warranted. If there is no presentation of distant metastasis, surgical resection is considered as the gold-standard therapy. However, chemotherapy may also be administered. Cases of non-small cell lung cancer with associated intra-atrial tumor thrombi are usually diagnosed using enhanced computed tomography (CT).Due to the rarity of this condition, incidence and mortality rates remain unknown, however, patient prognosis is extremely poor with an overall survival time of 4-17 months (1,7). The present study reports the case of a patient with stage IV lung cancer with invasion into the left atrium, for which a complete response was achieved following treatment with stereotactic radiotherapy. Case reportIn April 2012, a 52-year-old man was admitted to the Center of Radiation Oncology, Wujing Hospital (Shanghai, China) presenting with a 3-month history of progressive dyspnea and coughing. The patient also had a history of hypertension and smoking. An enhanced CT scan (Optima CT660 FREEdom; GE Healthcare, Piscataway, NJ, USA) revealed a left hilar tumor wrapped around the left pulmonary artery and vein, along with a large mass in the left atrium (Fig. 1A). A transbronchial biopsy was performed. Subsequently, tissue was formalin-fixed (Shanghai Ziyi Reagent Factory, Shanghai, China) paraffin-embedded (Leica Microsystems, Ltd., Milton Keynes, UK) and cut into 4 µm sections for hematoxylin and eosin (Baso Diagnostics Inc., Zhuhai, China) staining and immunohistochemistry. The biopsy revealed that the primary site was consistent with nests and trabecula of carcinoma cells proliferating with necrotic debris and intercellular bridges structures ( Fig. 2A and B)...

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“…Surgical treatment of lung tumours invading the pulmonary veins and atrium (T4) has been extensively reported and it is usually performed under cardiopulmonary bypass (CPBP) . However, the presence of a secondary isolated neoplastic thrombus in the pulmonary veins and/or left atrium has been rarely described; it has not yet been described so far in case of pulmonary carcinoid tumours.…”

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confidence: 99%

Lung carcinoid with pulmonary vein and left atrial neoplastic thrombus

Anile

Mazzesi

Diso

et al. 2013

ANZ Journal of Surgery

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Surgical treatment of lung tumours invading the pulmonary veins and atrium (T4) has been extensively reported and it is usually performed under cardiopulmonary bypass (CPBP). 1,2 However, the presence of a secondary isolated neoplastic thrombus in the pulmonary veins and/or left atrium has been rarely described; 3 it has not yet been described so far in case of pulmonary carcinoid tumours.A 44-year-old woman presented with cough and hemoptysis. Chest X-ray and computed tomography (CT) scan showed the presence of a 6 cm right lower lobe mass; CT also showed a thrombus floating in the lower pulmonary vein with a 1.5-cm protrusion inside the atrium (Fig. 1a,b). There were no connections between the primary tumour and the thrombus. Immediate surgery was planned to avoid the risk of neoplastic embolism.At operation, a right thoracotomy was performed. Intraoperative transesophageal echo (TEE) showed an increase in the protrusion of the thrombus within the atrium (up to 1.8 cm; Fig. 1c), probably caused by the lateral decubitus of the patient during surgery. CPBP was available in the operatory room and ready to be instituted if required. The lower lobe pulmonary artery and bronchus were closed and sectioned with staplers. The pericardium was opened and both pulmonary veins were isolated. The interatrial groove was sharply dissected. Under TEE, monitoring a large clamp was placed on the left atrium beyond the thrombus, avoiding crushing it. A tourniquet was placed on the right upper pulmonary vein to avoid blood flow from the upper lobe. The atrial wall was incised; the origin of the pulmonary vein and the thrombus were safely removed en bloc with the lower lobe (Fig. 2). Before closing the 4-0 Prolene atrial wall suture line, the tourniquet on the upper pulmonary vein was released to allow de-airing. The atrial clamp was removed. Complete hilar and mediastinal lymph node dissection was performed. The postoperative course was uneventful and the patient was discharged after a week. Histology confirmed the diagnosis of mixed typical and atypical carcinoid (Fig. 3) in the primary lesion; only atypical carcinoid was present in the thrombus, in the pulmonary vein wall and in the lower paratracheal lymph nodes (station number 4). The patient was referred for adjuvant chemoradiotherapy; she is alive and without recurrence one year after surgery.Bronchopulmonary carcinoids are generally considered as moderately aggressive tumours. However, involvement of hilar and/or mediastinal lymph nodes, local invasion and metastatic spread has been described, especially in case of atypical carcinoids. In some of these situations, complete resection might be technically difficult and even unfeasible. 4 Atypical carcinoids are more aggressive (as confirmed by the present case report) and survival is clearly worse (70% at 5 years and 50% at 10 years) and 25% of the patients experience recurrence, especially at distant sites.Treatment guidelines and tumor node metastasis staging are the same as for other lung cancers.The presence of a thrombus ...

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Free‐Floating Tumor Thrombus in the Left Atrium Associated with Non‐Small Cell Lung Cancer

Cited by 11 publications

References 11 publications

Left Atrial Mass Invasion from Pulmonary Neoplasm Extension via the Right Upper Pulmonary Vein Presenting as Ipsilateral Stroke

Left Atrial Mass Invasion from Pulmonary Neoplasm Extension via the Right Upper Pulmonary Vein Presenting as Ipsilateral Stroke

Stereotactic radiotherapy for the treatment of lung cancer with a giant left atrial tumor thrombus: A case report and literature review

Lung carcinoid with pulmonary vein and left atrial neoplastic thrombus

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