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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary tumors of the heart, in contrast to secondary metastatic tumors show a very rare occurrence. About 25% of all primary cardiac tumors are malignant with angiosarcomas being the most frequent type of tumor. The clinical presentation include pericardial tamponade by hemorrhagic pericardial effusion, right heart failure, lung embolism and thoracal pain. Diagnostic procedures include echocardiography, magnetic resonance imaging, CT scan, angiography, pericardioscopy and finally surgical exploration. We report on a 27-year old pregnant woman (23rd week) with a malignant primary angiosarcoma of the right atrium. The patient was admitted to the hospital with progressive shortening of breath due to pericardial tamponade from pericardial effusion. A tumor of the right atrium was detected by echocardiography. Diagnostic procedures had to consider the pregnancy of the patient. Transesophageal echocardiography, magnetic resonance imaging and finally angiography of the right heart with tumor biopsy were performed. Histological examination did not show any signs of malignancy. After corticosteroids pericardial effusion disappeared. Surgical exploration of the tumor was not performed because of the pregnancy. Two weeks later the patient underwent emergency surgery because of progressive heart failure due to obstruction of the tricuspidal valve by the tumor. Thereby intrauterine death of the fetus occurred. The tumor was removed and the right atrium was reconstructed using a Dacron patch. Adjuvant chemotherapy was performed. Eight months later the tumor recurred and heart transplantation was performed. two months later pulmonary metastases were found. the patient died 20 months after onset of symptoms. This is a rare case of the very unusual coincidence of pregnancy and a primary malignant heart tumor.
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PMID:[Malignant angiosarcoma of the right atrium in pregnancy. Diagnostic and therapeutic problems]. 792 28

Three years after heart transplantation and immunosuppressive therapy, a 66-year-old man suffered from dyspnea and showed symptoms mainly due to right heart failure. Malignant tumor cells were discovered within extensive pleural effusion. Computed tomography revealed two lesions of the liver suspicious of metastases, and recurrent blood in the stools was evident. The patient deteriorated rapidly and died 3 weeks after admission. Autopsy findings included an adenocarcinoma of the cecum (grade II) with metastases to the liver. High-grade immunoblastic non-Hodgkin's lymphoma of plasmoblastic differentiation was diagnosed, located within the mediastinal soft tissues and infiltrating the peri- and myocardium. Mesenteric lymph nodes were enlarged with histological verification of malignant lymphoma. The lymphatic tumor masses had caused considerable compression of the heart and vessels, leading to the signs of cardiac failure. The development of metastasizing colonic carcinoma and high-grade immunoblastic non-Hodgkin's lymphoma 3 years after heart transplantation and immunosuppressive therapy must be considered an unusual combination. Malignent lymphomas following heart transplantation have been described several times.
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PMID:[Malignant lymphoma and colon carcinoma 3 years after heart transplantation and immunosuppression]. 819 70

A 76-year-old woman presenting with right heart failure is reported. The investigation showed an ileal carcinoid tumour with multiple metastases and tricuspid regurgitation caused by a cardiac carcinoid lesion. Echocardiographic study and histopathological examination revealed typical characteristics of carcinoid heart disease. Nevertheless, except for the cardiac symptomatology, the patient did not show any other clinical manifestation of the carcinoid syndrome. Isolated right heart failure as the first sign of a carcinoid syndrome is rare; only two other cases have been described in the literature.
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PMID:[Atypical presentation of a carcinoid syndrome]. 1032 57

A 64-year-old woman presented with right heart failure caused by a cardiac tumor centered in the free wall of the right ventricle, accompanied by pericardial effusion. A match between the biopsy specimen and tissue removed 4 years earlier resulted in the diagnosis of a cardiac metastasis from a chordoma. Immunohistochemical staining was also useful in establishing the diagnosis. To alleviate the right ventricular outflow obstruction, a palliative operation was planned, resecting the tumor and performing a right ventriculoplasty, which was cancelled due to the extent of infiltration of the tumor, and instead a right atrium to pulmonary artery shunt was attempted using a vascular prosthesis, only to fail due to an inability to maintain blood flow through the prosthesis. Presently there are no definitive treatment options available, and some palliative chemotherapy is being performed. Single cardiac metastases from a chordoma are extremely rare.
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PMID:Isolated cardiac metastasis from sacral chordoma. 1095 63

A 69-year-old male presented with symptoms of fulminant lung embolism and, despite immediate therapy with plasminogen activator, died of acute right heart failure. At autopsy multiple tumor cell emboli were detected in small pulmonary vessels in addition to widespread liver metastases from an urothelial carcinoma. - In a 23-year-old female a malignant gastric ulcer and multiple liver metastases were diagnosed at initial presentation. She too died from pulmonary hypertension due to a series of lung embolisms which occurred despite heparin therapy. At autopsy, many small pulmonary arteries were filled with adenocarcinoma cells; the primary gastric tumor and liver metastases were confirmed. These cases demonstrate that the shedding of tumor cells from hepatic metastases can obstruct the pulmonary vessels and lead to acute cor pulmonale. Tumor cell emboli should be considered in the differential diagnosis of acute pulmonary hypertension, especially in patients with a known tumor. They may, however, also represent the first clinical signs of previously unrecognized malignancy.
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PMID:[Tumor cell embolism to pulmonary arteries]. 1155 62

We describe a case with placental, and general metastases, resulting in transient intrauterine and general hypoxia, and with additionally clinical features similar to HELLP syndrome. A patient in the third trimester with dyspnea at rest developed right heart failure during c-section. During emergency thoracotomy the patient went into generalized shock and died after intense CPR. Placental insufficiency was based on a multilocal metastatic event, decreasing the utero-placental perfusion.
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PMID:Placental insufficiency and maternal death caused by advanced stage of breast cancer in third trimester. 1178 87

A 68-year old woman was hospitalised because of isolated right heart failure. Doppler echocardiography revealed severe tricuspid regurgitation with thickened, shortened, hypomobile leaflets. Pulmonary valve was thickened with mild pulmonary regurgitation. Mitral and aortic valves were normal. The patient was finally diagnosed with carcinoid heart disease from an isolated ovarian carcinoid cancer without hepatic metastases. Ovarectomy was performed and the patient was considered cured of her cancer. Because of refractory right heart failure, she underwent tricuspid valve replacement with a bioprosthesis. Such cardiovascular manifestations are rarely the presenting symptoms of carcinoid disease. Carcinoid heart disease from ovarian primary cancer is exceptional. In this circumstance, carcinoid cardiac lesions may develop in the absence of hepatic metastases because the venous blood from the ovaries drains into the inferior vena cava without hepatic first past effect. Surgical resection of primary ovarian carcinoid tumor is often curative and the prognosis depends mainly on the cardiac condition. The diagnosis of carcinoid syndrome should be discussed in patients with organic tricuspid regurgitation without left valvular disease.
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PMID:[Isolated carcinoid tumor of the ovary disclosed by tricuspid insufficiency]. 1462 39

A 68-year-old woman with symptoms of dyspnea and peripheral edema was referred to our hospital. Chest computed tomography (CT) scans revealed a huge mass occupying the pulmonary trunk and invading the right main pulmonary artery, with metastatic nodules in the left main and left lower pulmonary artery. She was given a diagnosis of pulmonary thromboembolism and was anticoagulated to no effect, which suggested a neoplasm. Palliative resection of the tumor was carried out even though she was in serious condition with right ventricular failure, liver congestion, renal dysfunction, and coagulopathy disorder. The histopathology, postoperative systemic CT scan, and bone scintigram provided a definitive diagnosis of a primary right ventricle osteosarcoma. Primary cardiac osteosarcoma has a poor prognosis, and this patient was at an advanced stage with pulmonary metastases. Surgical intervention should offer these patients significant palliation to relieve the clinical symptoms due to obstruction.
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PMID:Right ventricular failure due to primary right ventricle osteosarcoma. 1744 67

This case involved a 38-year-old man who was referred to our hospital with general fatigue, appetite loss, weight loss, cough and exertional dyspnea. Within a couple of days, he was admitted due to advanced dyspnea and general fatigue. Severe hypoxemia was identified and acute right heart failure developed on admission. Treatment was initiated using oxygen, antibiotics and heparin sodium, but the patient died of sudden cardiopulmonary arrest 30 h after admission. Autopsy revealed advanced gastric cancer and widespread tumor embolism together with fibrocellular intimal proliferation and thrombus formation in the small arteries. Pulmonary tumor thrombotic microangiopathy (PTTM) with gastric cancer was diagnosed. PTTM is characterized by widespread fibrocellular intimal proliferation of the small pulmonary arteries and arterioles in patients with metastatic carcinoma. Microscopic pulmonary tumor emboli frequently occur in patients with malignant tumors, but very few cases of PTTM have been reported. PTTM should be considered in the differential diagnosis of acute dyspnea or pulmonary hypertension. In cases of acute cor pulmonal, the existence of malignant cells can be examined using pulmonary arterial wedge aspiration cytology where feasible, in addition to positron emission tomography with F-2-deoxy-2-fluoro-D-glucose, which can be used to investigate certain primary tumors and associated metastatic disease. The suitability of gastroendoscopy to screen for malignancies should be examined.
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PMID:[Pulmonary tumor thrombotic microangiopathy caused by signet ring cell carcinoma in gastric cancer]. 1768 68

Cardiac sarcomas are rare entities. The biological behavior of cardiac sarcomas is similar to all soft-tissue sarcomas. Aggressive local growth and metastatic spread are common. Although histologic type affects behavior, survival is dependent on the histologic grade. Chemotherapy and radiation therapy are not adequate for long-term survival. Although surgery provides the best modality for local control it is limited by its inability to control distant metastatic disease. Right heart sarcomas tend to be bulky, infiltrative, cause heart failure late and metastasize early. Based on the surgical approach and clinical behavior, cardiac sarcomas can be classified as right heart sarcomas, left heart sarcomas and pulmonary artery sarcomas. Our limited - albeit the most extensive - experience with cardiac sarcomas has helped improve survival compared with chemotherapy alone. They are usually treated with chemotherapy prior to extensive resection. Left heart sarcomas tend to be more circumscribed, less infiltrative, cause heart failure early and metastasize later. They are usually treated with surgery first, given the possibility of cardiac failure. Pulmonary artery sarcomas tend to be confined to the pulmonary artery, often causing severe right heart failure and metastasize later than right heart sarcomas. They are usually treated with complete resection. Adjuvant therapy is recommended for all patients given that excellent local control is often achieved with surgery, yet long-term survival is often poor due to metastatic recurrence. Cardiac autotransplantation is an excellent technique for resection of posterior or left heart cardiac sarcomas. Surgical outcomes with cardiac autotransplantation are excellent in patients who do not require concurrent pneumonectomy. Pulmonary artery sarcomas allow for radiation therapy in addition to chemotherapy for neoadjuvant control, as the myocardium can be avoided. However, overall, long-term survival after cardiac sarcoma requires improved systemic control. This progress awaits the development of novel chemotherapeutics.
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PMID:Management of primary cardiac sarcomas. 1893 9


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