Clinical Features and Mid-Term and Long-Term Outcomes of Surgical Treatment of 8 Patients with Primary Ventricular Tumors

OBJECTIVE To summarize the clinical features and surgical treatment of primary ventricular tumors. METHODS Eight patients with primary ventricular tumor, aged 3 to 52 years, underwent surgical treatment. There were 6 males and 2 females. The pathological diagnoses were as follows: multiple left ventricular myxomas in 2 cases; left ventricular rhabclomyoma, fibroma and malignant neurolemmoma in 1 case for each; right ventricular myxoma and malignant neurolemmoma in 1 case for each; intraseptal fibroma in 1 case. The operations were performed through median sternotomy with moderate hypothermic cardiopulmonary bypass in 7 cases; via left anterolateral thoracotomy without extracorporeal circulation in 1 case. Tumors were totally removed in 7 cases and subtotally resectecl in 1 case. RESULTS Cardiac arrest after anaesthetization occurred in 1 case with postoperative coma for 10 days. One case died of massive gastro-intestinal hemorrhage postoperatively. Seven cases survived, During a follow-up period of 1 to 21 years, there was no recurrence or metastasis in the 6 cases who received complete tumor resection including 2 cases with malignant tumor. One case of partial tumor removal had a mild heart murmur without tumor progression. All patients were asymptomatic with cardiac functiongrade I. CONCLUSION Primary ventricular tumors showed diversity in their histological characteristics. The mid- and long-term outcomes of surgical treatment for primary ventricular tumors appear to be satisfactory.     

Unusual Angiographic Pattern of a Muscular Ventricular Septal Defect

The authors report the case of a child with a small muscular ventricular septal defect proved by means of right endocardial phonocardio-gram. Lateral views during left ventriculography showed a peculiar tortuous communication within the septum, ressembling a channel. The possible embryologic origin is discussed.     

Right ventricular metastatic melanoma 27 years after resection of the primary tumor

This article is a case report of a 65-year-old white woman with a history of malignant melanoma, resected from her back in 1959. She presented 27 years later with right-sided heart failure and metastatic melanoma to her right ventricle. To the authors' knowledge, a large ventricular mass as the sole site of disease recurrence has not been described previously.     

Echocardiography Diagnosis of Cardiac Tumours –Royal Children's Hospital,Melbourne Experience, 1979–1983.

Six cardiac tumours have been detected over the preceding five year period and are reviewed. There were four left ventricular rhabdomyomas, one right ventricular myxoma and one intra-pericardial teratoma with a malignant yolk sac component. One patient known to have tuberous sclerosis died at home and at autopsy was discovered to have multiple left and right ventricular rhabdomyomas. The second infant had the diagnosis of a broad-based left ventricular rhabdomyoma made on the basis of the left ventricular angiogram, has mild to moderate left ventricular outflow tract obstruction and has been treated conservatively for three and a half years. Two remaining infants with left ventricular rhabdomyomas had severe left ventricular outflow tract obstruction and underwent emergency excision. The infant with the right ventricular myxoma had severe right ventricular outflow tract obstruction. The infant with the intra-pericardial teratoma was moribund with cardiac compression. These two also underwent emergency excision. All four surgical cases are alive and well six months to five years after surgery. Echocardiography has played an increasing. important role both in the diagnosis and subsequent follow-up of these patients.     

Metastasis of hepatocellular carcinoma to the heart: a case report and review of the literature

Hepatocellular carcinoma (HCC) with extension or metastasis to the right atrium is an uncommon form of cardiac malignancy. This report describes a rare case of right intraventricular metastasis from HCC in a patient who had undergone a partial hepatectomy for HCC more than two years earlier. Open heart surgery was performed and the mass was partially excised. Symptoms (dyspnea, edema of the lower extremities, palpitations) improved after surgery. Two months later a recurrence of the ventricular mass was observed. Systemic chemotherapy with cisplatin and doxorubicin resulted in significant tumor reduction. The patient died of progressive hepatic failure six months later. In addition to this case report, a review of the literature on heart involvement from HCC is presented.     

Metastasising congenital subcutaneous sacrococcygeal ependymoma.

A case of myxopapillary ependymoma located subcutaneously in sacrococcygeal area of a 18 months male child with metastasis to right inguinal lymph nodes is described; the tumour was present since birth. Histological examination of the tumour besides myxopapillary structures, also revealed an ependyma lined cystic space, resembling ventricular cavity. So far only two cases of congenital metastasising subcutaneous sacrococcygeal ependymoma have been described. However, the present case had a very aggressive post-operative biological behaviour.     

Pleomorphic intimal sarcoma of pulmonary artery. A case report

A rare case of pleomorphic intimal sarcoma of pulmonary trunk is reported. The patient presented with symptoms of right ventricular out flow tract (RVOT) obstruction. Metastatic deposits were seen in lungs, diaphragm and thyroid. Bronchial mucosal involvement was also seen. The tumour showed multicentric origin and on electron microscopic examination in a particular cell line was seen.     

Cardiac Metastases of Renal Cell Carcinoma Revealed by Syncope: Diagnosis and Treatment

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.Key words: Renal cell carcinoma, Cardiac metastases, Target therapy     

Parenchymal anaplastic ependymoma with intratumoral hemorrhage: a case report

We report an unusual case of a 56-year-old woman with a supratentorial anaplastic ependymoma localized in the parenchyma without continuity with the ventricular system and brain surface. The patient presented with vertigo, and a calcified mass was detected in the left temporal parenchyma. Five years later, she had seizure of the right extremities. Computed tomographic scanning and magnetic resonance imaging revealed an enhanced mass with an intratumoral hemorrhage adjacent to the calcified mass. Subtotal removal of the tumor was performed. The histological analysis revealed that the tumor was an anaplastic ependymoma. After focal radiation therapy (50 Gy), the outcome was favorable, although the residual lesion was still seen on the images. Ependymomas usually arise from the cells lining the ventricular system and the central canal of the spinal cord. We discuss the summary of published cases of supratentorial ectopic ependymoma since the first case in 1995.     

It is ALL in the heart: a patient with acute lymphoblastic leukemia and cardiac infiltration at time of diagnosis

We report an unusual case of acute lymphoblastic leukemia (ALL) in a 15-year-old boy where a mass lesion, presumed to be a cardiac metastasis, was noted in the right ventricular wall and cavity at the time of initial routine echocardiography. The lesion resolved, without surgical intervention, following the institution of multi-agent chemotherapy.     

8例原发性心室肿瘤外科治疗的中远期效果

目的：介绍原发性心室肿瘤的临床特点和外科治疗体会方法：自1981年10月至2001年7月外科治疗原发性心室肿瘤8例，男6例，女2例，年龄3～52岁其中左心室多发性粘液瘤2例，左心室横纹肌瘤、纤维瘤和恶性神经鞘瘤各1例，右心室粘液瘤和恶性神经鞘瘤各1例，室间隔纤维瘤1例。胸部正中切口、中度低温体外循环下手术7例，左前外切口、非体外循环下手术1例肿瘤摘除或完全切除7例，大部切除1例结果：麻醉后心跳骤停1例，术后昏迷10天，经综合治疗痊愈术后因消化道大出血死亡1例，存活7例，随访1～21年，肿瘤完全切除的6例无复发和转移，大部切除的1例残留轻度心脏杂音，肿瘤无进一步生长，所有患者均无临床症状，心功能Ⅰ级。结论：原发性心室肿瘤的组织学类型呈现多样性，外科治疗的中远期效果良好。     

Primary Cardiac Mass Lesions (A Study of 24 Cases)

Over the last ten years we have come across 24 cases of cardiac mass lesions (tumors and cysts). twenty-one were atrial myxomas, one fibrosarcoma of the right ventricle, one mesothelioma of the pericardium and one hydatid cyst of the epicardium. Of the 21 myxomas, 17 were in the left atrium and three in the right atrium. There was no case of bilateral myxoma or right ventricular myxoma. There was no female prepondrance in our series of myxomas as 11 were males and 10 were females, The myxomas were consistently identified by cine angiocardiography and echocar-diography. Nineteen myxomas were successfully treated surgically with one early mortality and another late mortality. Both died of non-cardiac complications.     

Cardiac metastases in malignant fibrous histiocytoma. A case report

Malignant fibrous histiocytoma metastasizing to the left ventricle is an uncommon form of cardiac malignancy. This report describes a rare case of left ventricular metastases from a malignant fibrous histiocytoma of the posterior compartment of the right thigh, recurring five years after treatment with surgery, hyperthermic perfusion of the limb and radiotherapy. As the patient presented symptoms of cardiac tamponade, open heart surgery was performed through a median sternotomy; however, the tumor was not resectable and only a biopsy was performed. A partial response was obtained with standard and high-dose chemotherapy with peripheral blood progenitor cell transplantation. The response continued to improve with immunotherapy. The patient returned to normal physical activity. He died four years later due to a ventricular arrhythmia.     

Risk factors for the assessment of patients with pulmonary embolism

Pulmonary embolism (PE) occurs frequently among cancer patients, with a spectrum ranging from small, clinically insignificant thrombi to life-threatening massive PE. It is fatal in as many as 14% of cancer patients, primarily by producing right ventricular heart failure and cardiogenic shock. PE diagnosis is difficult because the signs and symptoms imitate other commonly occurring diseases. Clinicians must be able to integrate a wide array of diagnostic imaging tools and laboratory tests to ensure rapid assessment and diagnosis. Risk stratification with the use of cardiac biomarkers and imaging tests to evaluate right ventricular function will identify treatment options. Hemodynamically stable patients can be treated effectively with anticoagulation alone, whereas those with right ventricular dysfunction require an aggressive strategy with thrombolysis, surgical embolectomy, or a catheter-based intervention. When anticoagulation is contraindicated, a vena caval filter may be deployed. PE treatment must be customized to the individual and consider the existing thrombus burden, presence of underlying cardiopulmonary disease and right side heart dysfunction, and cancer status of the patient. Clinicians should focus on providing adequate thromboprophylaxis in hospitalized cancer patients to avoid PE treatment.     

Clinical aspects of tumour involvement of the pulmonary vessels.

The involvement of the pulmonary vessels by tumour emboli may lead to a clinical picture defined as 'subacute cor pulmonale'. Information about this syndrome has been limited to case reports and a few series. A study of 214 autopsied cancer patients was undertaken to investigate the clinical signs and symptoms of tumour involvement of the pulmonary vessels (TIPV). The lungs were removed as a block and 15 sections (3 from each lobe) were analyzed. Clinical data about right ventricular failure, dyspnoea, cough, pleuritic chest pain, cyanosis, engorgement of jugular veins, peripheral oedema, haemoptysis and haemoptoic sputum were obtained from the medical records of each patient. Tumour emboli were detected in 89 cases, and no respiratory symptoms were recorded in 39. The presence of dyspnoea and cyanosis were highly significant in the group with TIVP, and right ventricular failure and peripheral oedema showed slight significant differences between the patients with and without TIPV. The classical picture of subacute cor pulmonale was observed in 13 patients and TIPV was considered to be the main cause of death in 29 cases. Our results indicate that although the development of subacute cor pulmonale was rare in patients with cancer, TIPV may be suspected when the patient presents respiratory distress and should be included in the differential diagnosis of dyspnoea in cancer patients.     

Leiomyosarcoma of the right ventricle

A 58-year-old woman has dyspnea and palpitations which reveal a leiomyosarcoma of the right ventricle. The medical imaging shows a lobulated sessile tumor attached to the ventricular septum and the tricuspid valve extending into the pulmonary artery trunk. The resection is performed with a tricuspid valvoplasty. In spite of chemotherapy (epirubicin-cyclophosphamide), relapse is observed with pulmonary metastases 17 months after the surgery. The death becomes on 18 months in congestive heart failure. From this case, the authors make a review of the literature about this exceptional tumour, and talk over the low possibilities of treatment, despite the capacities of the new ways of diagnosis.     

Echocardiographic abnormalities following cardiac radiation

Five years or more after receiving cardiac radiation, 41 patients with Hodgkin's disease and seminoma in remission were subjected to echocardiography. The abnormalities detected included pericardial thickening in 70%, thickening of the aortic and/or mitral valves in 28%, right ventricular dilatation or hypokinesis in 39%, and left ventricular dysfunction in 39%. In the 23 patients treated by an upper mantle technique with shielding, the incidence of right ventricular abnormalities and valvular thickening was significantly lower than in patients treated with modified techniques. Although no symptoms were attributable to the observed abnormalities, longer follow-up time may reveal important functional implications.     

Supratentorial extraventricular anaplastic ependymoma in an adult with repeated intratumoral hemorrhage

We report the case of a 61-year-old man with supratentorial extraventricular anaplastic ependymoma who presented with repeated intratumoral hemorrhage. The patient was admitted with headache. Computed tomography and magnetic resonance imaging showed an enhancing mass with intratumoral hemorrhage in the right temporal lobe. Gross total resection was performed. The tumor was well demarcated from the brain tissue, and showed no continuity with the ventricular system. Histopathological examination revealed the features of anaplastic ependymoma. Therefore, additional radiation therapy and adjuvant chemotherapy were administered. Ten months later, the tumor recurred with hemorrhage in the spinal canal. This case showed rapid malignant progression and repeated intratumoral hemorrhage within a short period of time, both of which are characteristics of anaplastic ependymomas. Close observation of the central nervous system and adjuvant radiotherapy are mandatory, even if the ependymoma presents with repeated intratumoral hemorrhage.     

溶栓与单纯抗凝初始性治疗术前合并中高危肺栓塞癌症患者的疗效比较

目的 比较对术前合并中高危肺栓塞的癌症患者,初始治疗采用溶栓与单纯抗凝治疗的疗效和出血风险.方法 回顾性分析行手术治疗的26例中高危肺栓塞的癌症患者.比较术前采用单纯抗凝和溶栓治疗,患者右心功能指标、术前准备时间、住院天数、肺栓塞治疗疗效、围术期出血率、术后再发栓塞事件等差异.结果 溶栓组患者右室舒张横径等右心功能指标较抗凝组更早改善;此外,肺栓塞治疗疗效、术前准备时间、住院天数、术后血栓事件,溶栓组优于单纯抗凝组,差异均有统计学意义(P＜0.05).而两者围术期出血率比较,差异无统计学意义.结论 对于术前合并中高危肺血栓栓塞症的癌症患者,初始治疗采用溶栓对比单纯抗凝,能更早改善右心功能指标,缩短患者的术前准备时间,为患者早日手术创造时机,缩短患者的住院天数,且不增加患者围术期出血风险,可以更好的预防患者术后再发血栓栓塞事件,是安全有效的.     

Hyperplastic candidiasis - right-oral cavity, tonsil hypopharynx and larynx

A twenty five year old female, presented with burning in throat, Odynophagia and characteristic history of falling of granules, He had a verrucous type granular lesion right retromolar area., tonsil & its fossa, Lingual Surface Epiglottis & Hypoharyngeal wall, Right Aryepiglottic fold & ventricular fold Oedmatous and Scattered granules on both vocal folds & right Posterolateral border of tongue. Candida was detected in 10% Potassium Hydroxide, gram stained smear, prepared from tissue scrapping. Histopathology report of excised specimen was Fungal Granuloma. She was immunocompetent & was otherwise normal. Disease could possibly be attributed to virulence attributes of Candida. This hyperplastic candidiasis was combinedly treated with surgical excision and oral daily 100mg, fluconazole for six weeks, with Elevan months of follow-up. This is indeed a very rare case & only very few such cases, are reported so far in literature.