Surgical Treatment of Malignant Tumors of the Right Heart.

Kubota, Hiroshi; Takamoto, Shinichi; Kotsuka, Yutaka; Miyairi, Tsuyoshi; Murakawa, Tomohiro; Makuuchi, Haruo; Kawauchi, M; Furuse, Akira; Sudo, Kenichi

doi:10.1536/jhj.43.263

Cited by 15 publications

(9 citation statements)

References 16 publications

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“…A final diagnosis depends on histopathological confirmation. At the time of discovery, up to 75% have systemic metastases 1) and the effect of surgical resection is only temporary, 2) and hence the prognosis is relatively poor. A pathological diagnosis with cardiac biopsy is established antemorten in only 50% of patients.…”

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confidence: 99%

Cardiac Angiosarcoma Diagnosed by Transvenous Endomyocardial Biopsy With the Aid of Transesophageal Echocardiography and Intra-Procedural Consultation

et al. 2010

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SummaryWe report a case who had confirmed tumor cells in the biopsy specimens by transvenous endomyocardial biopsy with intra-procedural consultation and fast smear cytology. A 57-year-old female was admitted to our hospital because of shortness of breath and left back pain. Transthoracic echocardiography (TTE) and contrast-enhanced computed tomography (CT) scans demonstrated a large mass in the right atrium and multiple liver tumors thought to be due to spread of the disease. Coronary angiography showed the right coronary artery was involved in the mass. In order to confirm the histological diagnosis, we attempted transvenous endomyocardial tumor biopsy under fluoroscopic guidance. However, we failed to obtain adequate tissue material. Due to several risks associated with a surgical procedure such as an open surgical biopsy, transvenous endomyocardial tumor biopsy was again attempted with the aid of transesophageal echocardiography (TEE). Intra-procedural consultation and fast smear cytology enabled us to finish the procedure. Hematoxylineosin stained sections demonstrated spindle-shaped cells. Immunohistochemical stains of these cells were positive for anti-factor VIII antigen, CD31, and CD34. These findings indicated a definite diagnosis of angiosarcoma. Since there was no surgical indication for this tumor, the patient underwent chemotherapy with docetaxel and radiotherapy. Three months later, CT scans showed a reduction in the size of the cardiac tumor. (Int Heart J 2010; 51: 367-369) Key words: Primary cardiac angiosarcoma, Transvenous endomyocardial biopsy, Transesophageal echocardiography, Intra-procedural consultation, Smear cytology P rimary cardiac tumors are extremely rare and difficult to diagnose. A final diagnosis depends on histopathological confirmation. At the time of discovery, up to 75% have systemic metastases 1) and the effect of surgical resection is only temporary, 2) and hence the prognosis is relatively poor. A pathological diagnosis with cardiac biopsy is established antemorten in only 50% of patients.3) The specimen material is usually obtained by open biopsy or surgical resection. There have been reports of transvenous biopsy for cardiac tumors under transesophageal echocardiography (TEE) guidance, 4-7) although sometimes specimen material is not successfully obtained. 8) Case ReportA 57-year-old woman was admitted to our hospital because of shortness of breath and left back pain. She had been healthy previously without recent chest pain or pyrexia, and she denied any exposure to vinyl chloride. On physical examination, her heart rate was 94/minute, blood pressure was 90/54 mmHg, and SpO 2 was 98% with a 10 L/minute O 2 . Jugular vein dilatation and hepatomegaly were detected. Neither heart murmur nor lung rales were detected. The electrocardiogram showed sinus tachycardia (94 beats/minute), low voltage in limb leads, and a QS pattern in V 1 and V 2 leads. Chest X-rays revealed cardiomegaly and bilateral pleural effusion. Transthoracic echocardiography (TTE) showed reasonable left ve...

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confidence: 99%

Cardiac Angiosarcoma Diagnosed by Transvenous Endomyocardial Biopsy With the Aid of Transesophageal Echocardiography and Intra-Procedural Consultation

et al. 2010

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“…Although aggressive surgical treatment has been successfully performed in occasional patients with IVC with or without RA tumor thrombi [9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20], most such patients will die of tumor recurrence within 1 year after surgical procedures [10, 11, 12, 13, 14, 15, 17, 19]. In addition, such aggressive procedures are highly risky: 4 out of the 27 (15%) patients died within 4 weeks after their operation [17, 28, 30, 33].…”

Section: Discussionmentioning

confidence: 99%

“…Articles were excluded if they were mainly composed of an imaging study without the mention of specific therapy for cardiac tumors. A total of 27 cases with RA tumor thrombi in HCC who had received various treatments were identified [9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 28, 29, 30, 31, 32, 33]. Including the 3 patients in this presentation, there were 19 men and 11 women, with a median age of 58.5 years (range, 18–83).…”

Section: Literature Reviewmentioning

confidence: 99%

“…The likely outcome for HCC patients with symptomatic, intra-atrial tumor growth was dismal, with a median survival ranging from 1 to 4 months [4, 5, 6, 7, 8]. Although heroic aggressive surgical treatments, including the use of extracorporeal cardiopulmonary bypass and hepatic vascular exclusion techniques, as well as several nonsurgical local treatment modalities had been successfully performed in occasional patients [9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23], such procedures are usually prohibited in most advanced HCC patients because of coexisting underlying cirrhosis, an advanced stage of the primary tumor, the presence of metastatic disease, or a combination of the above.…”

Section: Introductionmentioning

confidence: 99%

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Hepatocellular Carcinoma with Intra-Atrial Tumor Thrombi

Chang

Chao

et al. 2004

Oncology

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Background: In patients with advanced hepatocellular carcinoma (HCC), inferior vena cava/intra-right atrial (IVC/RA) tumor thrombi are not uncommon findings and are usually associated with extremely poor outcome. Surgical interventions as well as nonsurgical approaches, such as transcatheter arterial chemoembolization and radiotherapy, have been used in the treatment of patients with symptomatic IVC/RA tumor thrombi. However, such therapeutic modalities are usually not feasible when a patient shows poor general performance, the presence of metastatic disease, and underlying hepatic dysfunction. Such patients show limited survival. Material and Methods: Herein we describe 3 patients with advanced-stage HCC whose IVC/RA tumor thrombi and primary tumors regressed remarkably after low-dose thalidomide (200–400 mg/day) therapy. An Entrez PUBMED search of English Literature articles was performed to identify other cases of RA tumor thrombi in HCC who had received various treatments. Results: Two of our patients survived for more than 15 months after the diagnosis of IVC/RA tumor thrombi, while the other had effective symptomatic palliation associated with a drastic fall of AFP serum levels and significant tumor regression within 4 weeks of thalidomide therapy. A literature review suggested that the survival of our patients is comparable with that of occasional patients who had received aggressive surgical intervention. Conclusions: Our results suggest that, despite the low tumor response rate in earlier studies, thalidomide therapy may sometimes provide effective palliation for patients with far advanced HCC with symptomatic IVC/RA tumor thrombi and who are not candidates for alternative treatment options.

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“…Among the malignant cardiac tumors angiosarcoma is the most common, at 31.2%, then leiomyosarcoma, at 20.8%, mesothelioma, 15.2%, fibrosarcoma, 11.2%, and malignant lymphoma, at 5.6% (4, 7). A primary cardiac osteosarcoma is very rare; to our knowledge only 36 cases have been reported worldwide (4,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) (13). In the present case radiation therapy was performed to suppress the local invasion.…”

Section: Most Cardiac Tumors Are Metastatic Tumors From Malig-nant Mementioning

confidence: 99%

Primary Cardiac Osteosarcoma in a Young Man with Severe Congestive Heart Failure

et al. 2007

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Surgical Treatment of Malignant Tumors of the Right Heart.

Cited by 15 publications

References 16 publications

Cardiac Angiosarcoma Diagnosed by Transvenous Endomyocardial Biopsy With the Aid of Transesophageal Echocardiography and Intra-Procedural Consultation

Cardiac Angiosarcoma Diagnosed by Transvenous Endomyocardial Biopsy With the Aid of Transesophageal Echocardiography and Intra-Procedural Consultation

Hepatocellular Carcinoma with Intra-Atrial Tumor Thrombi

Primary Cardiac Osteosarcoma in a Young Man with Severe Congestive Heart Failure

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