心脏转移性肿瘤的超声心动图特征及其与病理学的关系

目的 :探讨心脏转移性肿瘤的超声心动图特征及其与病理学改变的关系。方法 :回顾性分析 2 4 5例心脏转移性肿瘤患者的超声心动图学改变和病理学特征等资料。结果 :①鳞状细胞癌、腺癌和淋巴瘤是转移到心脏的最常见肿瘤 ,三者占全部心脏转移性肿瘤的 74 .3% (182 / 2 4 5 ) ;②经胸超声心动图检查结果显示 2 2 6例(92 .2 % )有心包渗出、增厚或心脏肿物等异常表现 ,仅 19例 (7.8% )未发现有诊断意义的变化 ;其中有 5 5 .5 %的患者 (12 5 / 2 4 5 )肿瘤累及心包 ,同时发现 2个或 2个以上肿物者占 2 1.2 % (48/ 2 4 5 ) ;③右侧心脏转移性肿瘤明显多于左侧心脏 [36 .7% (83/ 2 2 6 )∶10 .6 % (2 4 / 2 2 6 ) ,P <0 .0 5 ],肿瘤同时累及右房和下腔静脉者明显多于同时累及右房和右室者 (5 .8%∶0 .4 % ,P <0 .0 1) ;④虽然腺癌 (43/ 5 7,73.7% )和间皮瘤 (11/ 12 ,91.7% )转移至心包的比例较鳞状细胞癌 (44 / 96 ,37.5 % ;P <0 .0 1)为高 ,但这两种肿瘤很少同时转移至右房和右室 (P <0 .0 5 )。结论 :在心脏转移性肿瘤的诊断中 ,超声心动图是一种较敏感的检查手段 ,并有助于肿瘤病理类型的判定     

转移性心脏肿瘤

转移性心脏肿瘤较少见,在全部肿瘤患者中一般不超过5％;但近年颇有增加倾向,西方国家几份报告分别为18％、20.6％、21.2％,日本冈田等报告为9.8％。作者医院近十年来共尸解恶性肿瘤425例,其中51例有心脏转移,占12％。较易向心脏发生转移的肿瘤为肺癌(32％)、网状细胞肉瘤(27％)和白血病(23.5％);据其它报告还有乳癌(21.1或33％)、黑色素瘤(44％)等。转移至心脏的部位主要是心包(28例)、心包 心肌9例、心包 心肌 心内膜2例,共占76.4％;但在Gassman等的报告中转移至心肌者比心包多见。心内膜转移最少见。     

胰腺肿瘤心腔内转移致右室流出道梗阻一例

恶性肿瘤的心脏转移并不少见。而恶性肿瘤的心腔内转移导致右室流出道梗阻极为少见。本通过报道1例胰腺肿瘤心腔内转移的诊治经过及相关献复习．以期提高临床医师对肿瘤心脏转移的认识。     

原发性非黏液性心脏肿瘤六例临床分析

心脏黏液瘤是最常见的心脏肿瘤,而非黏液性肿瘤较为少见,我院自2003年至2007年共诊治6例非黏液性心脏肿瘤,现将其病例资料进行回顾性分析,以积累更多的心脏肿瘤诊治经验.     

肿瘤疾病的心脏表现

由于肿瘤的生长转移以及在治疗过程中,会出现心脏异常表现。因此本文重点介绍肿瘤疾病的心脏表现,供临床参考。一、心脏肿瘤的概况人类心脏发生肿瘤的机会是较少的,通常可以分为原发性、继发性和假性。根据尸检统计心脏肿瘤发     

原发性心脏肿瘤的诊治

原发性心脏肿瘤是一种少见的肿瘤,其中良性肿瘤约占80%,恶性肿瘤占20%。近几年来,由于检查方法和手术技术的提高,对一些心脏肿瘤能较早地做出诊断,早期手术治疗,从而改善了心脏肿瘤病人的预后。目前,某些临床上罕见的心脏肿瘤,尤其是恶性肿瘤已成为可用外科治疗的心脏病,。一、分类及特征 (一)良性肿瘤: 1.粘液瘤:是一种常见的心脏肿瘤,占良性心脏瘤的50%.此瘤多见于30～60岁女性,75%起源于左房,20%起于右房,少数可侵及双房或心室.此瘤虽为良性,但有再发及恶变的倾向,有远处转移的可能。临床表现酷似二尖瓣狭窄,极少数由于瘤体     

心脏转移瘤42例临床分析

癌瘤的播散与转移是患者常见的致死原因。心脏转移瘤以肺癌、乳腺瘤、恶性淋巴瘤多见,以肺癌的心脏转移占首位,一般预后不良。为了总结经验,提高诊疗水平．回顾性分析我院1999年-2004年临床资料较完整的转移性心脏肿瘤42例,报告如下。     

心肌内治疗起搏器综合征一例

患者女,62岁,起搏器植入3个月出现起搏器综合征,术前组织多普勒显示左室内和左右室之间均有较明显不同步运动,同时伴有二尖瓣狭窄和关闭不全.该患者在体外循环下进行二尖瓣置换术,同期进行右室电极转移至右室流出道心肌内.术后和随访1.5年患者心脏超声同步性改善,电极的起搏阈值并没有明显变化.结论 :在心脏直视术同期将右室电极转移至流出道,是治疗心脏不同步运动及起搏器综合征的可选择的方法.     

肿瘤与心律失常的关系

肿瘤心脏病学作为心血管病学新兴的一个分支而日益受到临床重视,而肿瘤导致心律失常的病理生理学机制尚不明确,可能与原发心脏肿瘤和心脏转移瘤对心肌的直接损害、肿瘤相关治疗对心脏的间接损伤及肿瘤本身所致的全身各系统功能紊乱等多方面因素对心脏结构和功能的影响有关。本文通过对国内外文献报道进行归纳总结,对肿瘤与心律失常的关系做一综述。     

超声心动图诊断原发性肝癌心脏转移

目的探讨超声心动图对原发性肝癌心脏转移的诊断价值。方法对病理证实的原发性肝癌并发心脏实质性占位的患者进行心动超声检查,应用二维及彩色多普勒超声观察肿瘤的大小、形态、内部回声、与所在心腔组织的关系、肿瘤内部及周边血供情况、肿瘤随心动周期的运动状态必要时结合腹部超声观察肝静脉、下腔静脉有无癌栓。结果心动超声检查发现2例患者心脏转移性肿瘤均出现在右心房,呈偏强回声,内部回声不均匀（100%）,1例瘤体可随心动周期运动（50%）,1例瘤体不随心动周期运动（50%）。结论超声心动图诊断原发性肝癌心脏转移具有较大的临床价值,但由于病例较少,在总结不同原发灶所致的心脏转移性肿瘤特征性声像图表现上仍存在一定局限性。     

Early cardiac metastasis from squamous cell carcinoma of the tongue in 2 patients

Cardiac metastasis from primary tumors is rare. Cardiac metastasis from squamous cell carcinoma of the tongue is rare; in the English-language medical literature, we read of only 4 patients with this condition. Here, we discuss the cases of 2 such patients who presented at our institution only a few months apart. In both, with the use of 2-dimensional echocardiography, we incidentally found cardiac metastasis from squamous cell carcinoma of the tongue. Resection of the cardiac masses was precluded. These cases illustrate the usefulness of early cardiac evaluation with 2-dimensional echocardiography in patients with head and neck cancer and known metastatic disease.     

Cardiac metastasis of hepatocellular carcinoma in a young non-cirrhotic patient, to the left ventricle

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver.(1,2) The most common extrahepatic metastatic sites are lung, abdominal lymph nodes and bone, while its cardiac metastasis is rare.(2,3) Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor invasion of vena cava inferior with continuous extension into the right cardiac cavity.(4,5) Right heart metastasis without invasion of inferior vena cava, which may be caused by hematogenous spread of cancer cells, is rarely reported.(6,7) This paper announces an unusual case of isolated involvement of left ventricle (LV) together with myocardial invasion of HCC. Our patient is known to be the first case with isolated HCC metastasis to the left ventricle. Strikingly, the patient was young and non-cirrhotic with negative serum HBsAg, and anti-HCV results.     

Anaplastic thyroid carcinoma with prominent cardiac metastasis, accompanied by a marked leukocytosis with a neutrophilia and high GM-CSF level in serum.

Cardiac metastasis of thyroid carcinoma is extremely rare. We treated a case of anaplastic thyroid carcinoma with prominent cardiac metastasis. The 61-year-old male was admitted because of high fever. Investigations revealed a cardiac mass and anaplastic thyroid carcinoma. Resection of the cardiac mass revealed that it was metastasis from the thyroid carcinoma. After 4 months, he died in spite of intensive therapy. Marked leukocytosis was observed during the clinical course, and a concomitant increase of granulocyte macrophage-colony stimulating factor (GM-CSF) level was demonstrated in the sera. It was suggested that the high GM-CSF level in serum contributed to leukocytosis.     

Cardiac metastasis due to pulmonary metastasis from a transitional cell carcinoma

We report a rare case of symptomatic cardiac metastasis froma transitional cell carcinoma of the renal pelvis diagnosedby echocardiography. A 75-year-old patient with a long historyof neoplasm since 1999 and coronary artery disease with CABGin 2003, was admitted to our department. He underwent cardiacsurgery using cardiopulmonary bypass with tumor excision. Histologicallyit was the same type of transitional cell neoplasm which wasoperated seven years before. We present all medical history, detailed 2D and 3D echocardiography,intraoperative pictures and discuss possible chain of changesfrom renal pelvis cancer to clinical manifestation of cardiacmass. There is proved a rapid progression of cardiac tumor withclinical manifestation few months after control TEE examinationwithout any evidence of cardiac mass. It is important that thisis a very rare case of left heart metastasis from right sideof circulatory system through pulmonary stage of cancer progression.     

Case Report: Metastasizing Leiomyoma to Heart

Cardiac smooth muscle tumors are rare. Three different clinical settings for these tumors have been reported, including benign metastasizing leiomyoma from the uterus, primary cardiac leiomyoma and leiomyosarcoma, and intravenous cardiac extension of pelvic leiomyoma, which is the most common. We present a case of a 55-year-old woman with a benign metastasizing leiomyoma to the heart 17 years after hysterectomy and 16 years after metastasis to the lung. Immunohistochemical stains for smooth muscle actin, desmin, and estrogen and progesterone receptors were positive, indicating a smooth muscle tumor of uterine origin. To our knowledge, this is only the fourth reported case of benign metastasizing leiomyoma to the heart and the first case of long-delayed cardiac metastasis after successful treatment of pulmonary metastasis. It illustrates that benign metastasizing leiomyoma should be included in the differential diagnosis of cardiac tumors in patients with a history of uterine leiomyoma, especially when associated with pulmonary metastasis.     

Giant metastatic alveolar soft part sarcoma in the left ventricle: appearance in echocardiography, magnetic resonance imaging, and histopathology

Alveolar soft part sarcoma is a rare soft-tissue neoplasm that accounts for <1% of all soft-tissue sarcomas. Most cases arise in the extremities and head and neck region of young adults. The common sites of metastasis are lung, brain, and bone. Cardiac metastasis is extremely rare, in particular. Here we present the diagnostic evaluation and successful surgical resection of such a cardiac tumor in a patient aged 50 years with a histology-confirmed diagnosis of metastatic alveolar soft part sarcoma.     

Carcinoma of uterine cervix with myocardial metastases associated with chest pain and asystolic arrest

We report a case of secondary deposition of carcinoma of the uterine cervix in the myocardium with development of ischaemic cardiac pain, ST segment elevation and asystolic cardiac arrest. The coronary arteries were free of obstruction. To the best of our knowledge, this is a unique presentation of a rare myocardial metastasis.     

Cardiac metastasis from a Merkel cell skin carcinoma. A case report

The authors report the case of a cardiac metastasis of a Market cell skin tumour in a 72 year old woman, presenting with chest pain and infero-lateral myocardial ischaemia simulating an acute coronary syndrome. The diagnosis, suspected on echocardiography, was confirmed by thoracic CT scan. Markel cell carcinoma is a rare skin tumour classified among the malignant neuroendocrine tumours. It has a high metastatic potential, especially to the gastrointestinal tract and the lung. On the other hand, cardiac metastases are quite exceptionally rare.     

RVOT mural and mitral valve endocarditis: A case report

Mural endocarditis is a very rare condition. This entity involves bacterial growth on cardiac walls. In addition, concomitant valvular endocarditis, along with mural endocarditis, is an extremely rare combination. The diagnosis of mural endocarditis is difficult and requires more advanced cardiac imaging, such as a transesophageal echocardiogram. The differential diagnoses of mural masses include vegetations, thrombi, metastasis, and benign and malignant tumors. We present a rare and unusual case of Methicillin-Resistant Staphylococcus aureus bacteremia with findings of both right ventricular outflow tract mural endocarditis and valvular endocarditis involving the mitral valve.     

Resection of right atrial metastatic large-cell neuroendocrine carcinoma

The incidence of cardiac metastases is rising due to increasingly sensitive diagnostic investigations and longer patient survival as a result of improved treatment for malignancies. We report a rare case of right atrial metastasis from a large cell neuroendocrine carcinoma successfully resected with cardiopulmonary bypass. The surgical management of advanced cardiac malignancy is discussed. In appropriately selected cases surgical resection of cardiac metastases can be beneficial, allowing improvement in quality of life, and prolongation of life.