Conservative Management of Cardiac Hemangioma for 11 Years

Cardiac hemangiomas are benign tumors with an unpredictable natural history. Surgical resection is the treatment of choice; however, conservative management can be an alternative in some patients.We report a case of a left-sided cardiac hemangioma that we managed conservatively for 11 years without obvious major complications in the patient, an adult woman.     

Recurrent Primary Cardiac Lymphoma on Aortic Valve Allograft: Implications for Therapy

Primary malignant cardiac lymphomas associated with grafts are extremely rare: to our knowledge, only 6 cases of prosthesis-associated B-cell lymphoma have been reported. Ours is the first report of recurrent diffuse large B-cell lymphoma associated with aortic valve allografts.We treated a 60-year-old man who presented in early 2007 with aortic valve endocarditis. He underwent aortic valve replacement with an allograft; the resected native valve showed active endocarditis without tumor. In January 2011, the patient underwent repeat aortic valve replacement because of symptomatic aortic regurgitation. The explanted valve specimen displayed diffuse large B-cell lymphoma. In September 2011, the patient presented with fever and a mass around the aortic valve. He died in January 2012. On autopsy, the explanted replacement valve displayed recurrent diffuse large B-cell lymphoma. The recurrent lymphoma on a new graft leads us to believe that this tumor is more aggressive than had been thought. We propose early systemic chemotherapy, in addition to tumor resection, for the possibility of a better prognosis. We discuss our patient''s case and review the relevant medical literature.     

Resolution of Right-Sided Heart Failure Symptoms after Resection of a Primary Ovarian Carcinoid Tumor

Carcinoid tumors are rare neuroendocrine malignancies that typically originate from the gastrointestinal tract. Patients who are diagnosed with carcinoid heart disease generally have poor prognoses because of advanced metastases during staging and few therapeutic options. We present the case of a 61-year-old woman with right-sided heart failure, secondary to carcinoid heart disease caused by a primary ovarian carcinoid tumor. After undergoing surgical resection of the left ovary and fallopian tube, the patient experienced complete resolution of her heart failure symptoms. In addition to the patient''s case, we discuss the diagnosis, nature, and treatment of this rare condition.     

Primary Cardiac Lymphoma in an Immunocompetent 71-Year-Old Man

Isolated cardiac lymphomas are very rare, especially in immunocompetent patients. As a consequence, little is known about the best therapeutic management and about patients'' outcomes in these cases. Diffuse large B-cell lymphoma is the most frequent subtype; anthracycline-based chemotherapy has been the most successful treatment. We describe the case of a primary cardiac lymphoma in an immunocompetent 71-year-old man. As of December 2015, the patient had been in clinical remission for 2 years. The most relevant literature on primary cardiac lymphoma is reported and discussed.     

Cardiac Papillary Fibroelastoma: Single-Institution Experience with 14 Surgical Patients

In general, treatment for symptomatic and asymptomatic cardiac papillary fibroelastoma is surgical resection—particularly of left-sided lesions, because of the risk of systemic embolization. However, few institutions have enough experience with these tumors to validate this approach. We present our institutional experience with papillary fibroelastoma and discuss our current approach.We searched our institution''s cardiac tumor database, identified all patients diagnosed with cardiac papillary fibroelastoma from 1992 through 2014, and recorded the clinical and pathologic characteristics of each case. We found 14 patients (mean age, 60.5 ± 12.3 yr) who had 18 lesions. Eleven patients (79%) were symptomatic; however, we could not always definitively associate their symptoms with a cardiac tumor. Most lesions were solitary and ≤1.5 cm in diameter; half involved the left side of the heart. All 18 lesions were surgically excised. There were no operative or 30-day deaths, and no patient needed valve replacement postoperatively. There was one late death; at one year, another 3 patients were lost to follow-up, and the others were alive without tumor recurrence.Because of the embolic risk inherent to intracardiac masses and our relatively good postoperative outcomes, we recommend the surgical resection of all left-sided papillary fibroelastomas in surgical candidates, and we discuss with patients the advisability of resecting right-sided lesions.     

Intimal Sarcoma in the Aortic Arch Partially Obstructing the Aorta with Metastasis to the Brain

Primary tumors of the aorta are rare entities. We report the unusual manifestation of an aortic intimal sarcoma that presented as a brain metastasis in a 56-year-old, otherwise healthy woman. After the brain mass had been resected, multiple imaging methods revealed pseudocoarctation and the primary tumor in the aortic arch. To our knowledge, this is the first report of the diagnosis of an aortic intimal sarcoma with use of real-time, 3-dimensional transesophageal echocardiography.     

大肠非霍奇金淋巴瘤的内镜诊断分析

目的探讨原发性大肠非霍奇金淋巴瘤(NHL)的内镜表现,以提高对原发性大肠非霍奇金淋巴瘤的诊断率。方法回顾性分析近6年来我院经手术及病理证实的8例原发性大肠NHL临床和内镜资料。结果病变部位位于盲肠者占62.5%。内镜下表现为弥漫型3例,溃疡型4例,息肉型1例。电子结肠镜检查结合病理组织活检诊断阳性率达87.5%。结论本病好发于盲肠,多为单发病灶。本组病例中内镜下病灶形态表现以溃疡型多见。结肠镜检查联合内镜下活检、免疫组织化学检查有助于提高对大肠NHL内镜诊断阳性率。     

Unusual Presentation of Listerial Myocarditis and the Diagnostic Value of Cardiac Magnetic Resonance

Listeria monocytogenes is an infrequent cause of bacterial myocarditis. Myocarditis without evidence of endocarditis is even rarer. Management in such cases involves early diagnosis, antibiotic therapy, and emergency treatment of arrhythmias.We report the case of a 47-year-old man who presented with features of acute ST-segment-elevation myocardial infarction complicated by ventricular tachycardia that necessitated urgent electrical cardioversion. Contrast-enhanced cardiac magnetic resonance images revealed hypertrophy, necrosis, and a mass that was determined to be an abscess caused by L. monocytogenes. Antibiotic treatment led to resolution of the listerial myocarditis.In addition to reporting our patient''s case, we discuss the comparative advantages of cardiac magnetic resonance versus transthoracic echocardiography in characterizing myocarditis, upon presentation and in follow-up evaluation.     

Cardiac Sarcoidosis Presenting as Constrictive Pericarditis

In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association.We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient''s clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient''s case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.     

Papillary Fibroelastoma in Differential Diagnosis of Left Atrial Appendage Masses

Papillary fibroelastomas are benign tumors that usually originate from cardiac valves but may have other endocardial origins. We report the cases of 2 patients in whom left atrial appendage masses were initially diagnosed as thrombus. They were treated for embolic stroke and their symptoms resolved; however, their left atrial appendage masses did not regress. After surgery, histologic analysis of the resected masses revealed papillary fibroelastoma in both cases. We discuss the diagnostic and therapeutic dilemmas encountered in patients with papillary fibroelastomas and cardiac masses other than thrombus.     

Multimodality Imaging in the Assessment of Cardiac Lymphoma Presented as New‐Onset Atrial Fibrillation

Cardiac involvement by non‐Hodgkin's lymphoma is not uncommon, however rarely diagnosed during life due to nonspecific clinical presentation. We report a case of secondary cardiac lymphoma in patient who presented with new‐onset atrial fibrillation. Cardiac lymphoma was in a form of bulky right atrial mass, infiltrating the atrial septum and cavo‐atrial junction with concomitant mild pericardial effusion. In the present case, we illustrate complementary role of transthoracic, transesophageal echocardiography and multislice CT scan with three‐dimensional reconstruction, in detection and evaluation of secondary cardiac tumor. Usefulness of echocardiography to follow up the effects of chemotherapy is also shown. (Echocardiography 2010;27:332‐336)     

A Case of Isolated Cardiac Burkitt Lymphoma Causing Right-Sided Heart Failure

Primary cardiac tumors are rare, as the most common cause of cardiac masses is from metastatic disease. In this article, a unique case of isolated cardiac Burkitt lymphoma causing right-sided heart failure in a 70-year-old man who presented to the emergency department with abdominal distension and lower-extremity swelling is described. The right ventricular mass was initially identified via computed tomographic scans of the abdomen and pelvis. Further workup included transthoracic echocardiogram and cardiac magnetic resonance imaging that showed extension of the mass into the right atrium and pericardium. Staging imaging and bone marrow biopsy revealed no evidence of metastatic disease. Cytology of the peritoneal fluid and biopsy of the right ventricular mass confirmed Burkitt lymphoma. The cardiac mass substantially decreased in size and the right-sided heart failure resolved after the initiation of chemotherapy, which highlights the importance of prompt diagnosis and treatment of Burkitt lymphoma.     

Benign Metastasizing Leiomyoma in the Heart of a 45-Year-Old Woman

We report a rare case of benign metastasizing leiomyoma in the heart of a 45-year-old woman 2 years after a uterine leiomyoma had been discovered during hysterectomy. Computed tomograms at presentation showed a large mixed cystic mass in the pelvis and bilateral lung nodules suggestive of metastatic disease. A large cardiac mass, attached to the chordae of the tricuspid valve and later shown to be histopathologically consistent with uterine leiomyoma, was successfully resected through a right atriotomy. This case suggests that benign metastasizing leiomyoma should be considered in the differential diagnosis of right-sided cardiac tumors.     

Papillary Fibroelastoma of the Aortic Valve: Analysis of 21 Cases,Including a Presentation with Cardiac Arrest

Cardiac papillary fibroelastoma is a rare, benign tumor, arising predominantly from cardiac valves. This tumor can cause a variety of symptoms due to thromboembolism. We describe our single-center surgical experience with papillary fibroelastoma of the aortic valve.From April 2004 through June 2013, 6,530 patients underwent cardiac surgery. Of those, 6,098 patients were included in the final analysis. Twenty-one patients (0.34%) underwent surgical resection of 30 papillary fibroelastomas of the aortic valve.Most patients (67%) were incidentally diagnosed to have cardiac papillary fibroelastoma. The usual symptom was cerebral infarction (in 5 of 7 symptomatic patients). A rare presentation of papillary fibroelastoma in one patient was cardiac arrest caused by left main coronary artery ostial obstruction. Tumor size was not related to patient age (Pearson correlation coefficient, 0.34; P=0.13). Neither the number of tumors (1.43 ± 0.72 vs 1.43 ± 0.62) nor tumor size (8.14 ± 2.42 vs 8.07 ± 3.31 mm) was significantly different between symptomatic and asymptomatic patients. All lesions were resected by means of the simple shave technique. There were no operative or 30-day deaths. Follow-up echocardiograms showed no tumor recurrence (mean follow-up duration, 17 ± 14 mo).We identified no significant relationship among tumor size, number of tumors, symptoms, or patient age. Because simple shave excision of the tumor can be safely achieved without evidence of tumor recurrence, we conclude that surgical resection can be reasonable in asymptomatic patients.     

Ochronotic Involvement of the Aortic and Mitral Valves in a 72-Year-Old Man

Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis.     

Clinicopathologic study of primary intestinal B cell malignant lymphoma

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原发性非粘液瘤性心脏肿瘤的影像学评价

目的:分析原发性心脏非粘液瘤性肿瘤的影像学特征,评估几种常用的影像学诊断方法的主要优势及局限性。方法:搜集1979年1月至2004年3月来有完整临床、影像学及病理资料证实的原发性非粘液瘤性心脏肿瘤65例, 其中接受电子束计算机断层摄影术(EBCT)检查23例,磁共振成像(MRI)检查19例。结果:X线胸片示异常50例,超声心动图(UCG)诊断敏感性86.15%(56/65),EBCT和MRI所有肿瘤均检出,部分诊断与手术病理结果一致。结论:X线胸片适合做常规检查,UCG可做首选初查且对心腔或心包腔内的肿瘤诊断准确率高;EBCT或(和)MRI 能从肿瘤大小、形态甚至组织学特征如脂肪、纤维、出血、囊肿、钙化等全面评价肿瘤,做出诊断与鉴别诊断。     

Primary Cardiac Lymphoma: Case Report and Brief Review of the Literature

Primary cardiac lymphoma is defined as a non-Hodgkin's lymphoma mainly located in the heart and/or the pericardium. It is rare and affects elderly men. Common manifestations are pericardial effusion and heart failure. Diagnosis is usually late and prognosis is poor. We report a case of a patient with a large primary cardiac lymphoma who presented with chest pain and negative T-waves in electrocardiogram. Transthoracic echocardiogram showed a large mass in the right atrium and right ventricle while transesophageal echocardiogram also revealed the presence of large mobile masses in the right atrium, which were considered to be thrombi. Tissue biopsy showed a high-grade B-cell diffuse lymphocytic lymphoma. The patient was treated with chemotherapy and radiation with complete remission and prolonged survival.     

原发性肺淋巴瘤2例并文献复习

目的提高原发性肺淋巴瘤的诊治水平。方法对二例原发性肺淋巴瘤进行分析,结合文献对其临床特点、影像改变、诊断及治疗方法进行分析。结果原发于肺的淋巴瘤无特异性临床表现和影像改变,易误诊。确诊依靠组织病理检查。结论及时进行有创检查有利于早期诊断。