Cardiac metastasis from colorectal cancer： A case report

The heart is an unusual site of metastasis from any malignancy. We report a case of cardiac metastasis from colorectal cancer. A 70-year-old woman was referred with a presumptive diagnosis of sigmoid colon cancer with cardiac myxoma. Two-dimensional echocardiography showed a 4 cm x 4.5 cm mobile mass on the lateral right atrial wall, and computed tomography revealed a low attenuated Iobulating mass in the right atrium. The patient underwent anterior resection for sigmoid colon cancer （T4N2）. Thereafter, she experienced progressive shortness of breath. Therefore, a cardiac operation was performed 2 wk after the colorectal operation. Histological examination revealed adenocarcinoma, which was identical to the primary lesion. Although two- dimensional echocardiography has become the diagnostic test of choice for detecting cardiac tumors, in patients with colorectal cancer showing a cardiac mass, further diagnostic evaluation such as a magnetic resonance imaging might be necessary.     

Asymptomatic metastatic osteosarcoma to the right ventricle: Case report and review of the literature

Metastatic cardiac tumors are far more common than primary tumors, and benign primary cardiac tumors are common than malignant tumors. We report a 22-year-old Saudi woman with right femur osteosarcoma who was found to have a large right ventricular mass by transthoracic and transesophageal echocardiography. Diagnosis was highly suggestive by cardiac magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan. We performed a review of the literature for metastatic osteosarcoma of the right ventricle.     

The diagnosis of primary cardiac lymphoma by right heart catheterization and biopsy using fluoroscopic and transthoracic echocardiographic guidance

We describe a case of primary cardiac lymphoma diagnosed by transvenous biopsy under fluoroscopic and transthoracic echocardiographic guidance. A 38-year-old man was admitted because of exertional dyspnea. ECG revealed complete atrioventricular block. Transthoracic echocardiography revealed a large mass attached to the interventricular septum and protruding into the right atrium. The patient underwent a right heart catheterization and a biopsy was taken from the mass using fluoroscopic and transthoracic echocardiographic guidance. Diagnosis of malignant lymphoma was established by the biopsy specimen. The use of transthoracic echo in conjunction with fluoroscopy may be useful for the diagnosis of intracardiac mass transvenously.     

A pedunculated left ventricular hemangioma initially misdiagnosed as thrombus in a woman with atypical chest pain

The incidence of cardiac masses increased as echocardiography is becoming increasingly popular. Benign tumors of the heart constitute about 72% of all primary cardiac neoplasms and hemangioma accounts for 5–10% of benign cardiac tumors. Cardiac hemangiomas are generally asymptomatic and diagnosed incidentally during echocardiography or magnetic resonance imaging (MRI). We reported a 52-year-old woman presented with atypical chest pain and exertional dyspnea. The echocardiographic examination revealed a hyperechoic round mass in the left ventricle. With an initial diagnosis of left ventricular thrombus, the patient underwent cardiac MRI. The mass was found compatible with cardiac hemangioma. It was removed surgically and histopathologic evaluation identified a cardiac hemangioma. As reports of cardiac hemangioma are extremely rare and cardiac masses are mostly thought to be thrombi or myxomas (being the most common primary cardiac tumor), such hemangioma cases warrant attention as possibility of hemangioma should also be kept in mind.     

Les lymphomes non-Hodgkiniens cardiaques

Cardiac non-Hodgkin lymphoma (CNHL) is a rare extranodal lymphoma with a poor prognosis. Secondary cardiac lymphoma is more frequent than primary cardiac lymphoma. CNHL often involves the right side of the heart. Diagnosis of CNHL can be suggested by echocardiography and magnetic resonance imaging. Cytological examination of pericardial fluid or histological of cardiac tissue is essential. The majority of cases are diffuse B-cell lymphoma. A prompt immediate diagnosis and early treatment are essential for better outcome. Management should be individualized and the most effective treatment is chemotherapy containing anthracycline variably combined with radiotherapy. A multidisciplinary approach is essential to the successful treatment of CNHL.     

Primary cardiac lymphoma. Report of a case

Malignant non-Hodgkins lymphomas have a secondary cardiac localisation in 20% of cases. However, a cardiac primary site is rare (44 cases described up to now). A positive diagnosis is rarely made before death. There is great interest in echocardiography, a non-invasive method, to identify these tumours early. The prognosis remains nevertheless gloomy. We report the case of a child aged 8 years, admitted with a scenario of low output right cardiac insufficiency. Chest radiography identified cardiomegaly with a prominent right border, and the electrocardiograph showed right auricular hypertrophy. A tumour mass infiltrating the right atrium, the right ventricle and the lateral face of the left ventricle was discovered on trans-thoracic echocardiography. Investigation for tumour spread was negative. The patient died before operation in a state of extreme low output. The histology favoured a highly malignant non-Hodgkins lymphoma type B.     

Severe nonthrombotic pulmonary embolism due to primary cancer of the pancreas--a case report

We describe a patient with a severe, neoplastic pulmonary embolism due to primary cancer of the pancreas. The 40-year-old male was admitted to the haematology department with an initial diagnosis of lymphoma. Transthoracic echocardiography showed a mass in the right atrium. Transoesophageal echocardiography was performed and revealed two moving tumours: the first in the extend of the vena cava superior and the second one in the tricuspid valve annulus. After bronchoscopy the patient's haemodynamic condition deteriorated and was followed by cardiac arrest. Post-mortem examination showed extensive tumour emboli in the left pulmonary artery as well as pancreatic cancer at an advanced stage.     

Primary cardiac diffuse large B cell lymphoma presenting with superior vena cava syndrome

Primary cardiac lymphomas are rare extranodal lymphomas that should be distinguished from secondary cardiac involvement by disseminated non-Hodgkin’s lymphoma. Cardiac lymphomas often mimic other cardiac neoplasms, including myxomas and angiosarcomas, and often require multimodality cardiac imaging, in combination with endomyocardial biopsy, excisional biopsy or pericardial fluid cytology, to establish a definitive diagnosis. A 60-year-old immunocompetent man who presented with superior vena cava syndrome secondary to a right atrial, primary cardiac diffuse large B cell lymphoma (non-Hodgkin’s lymphoma) is described in the present article. The patient had no clinical evidence of disseminated lymphoma and was successfully treated with prompt surgical excision of his atrial mass, followed by anthracycline-based chemotherapy. The patient required multimodality cardiac imaging to accurately identify and plan surgical excision of his cardiac lymphoma. The therapeutic management and clinical and radiological features of primary cardiac lymphoma are reviewed.     

Primary Cardiac Lymphoma: Echocardiography and F‐18‐Fluorodeoxyglucose Positron Emission Tomography in Selection of a Biopsy Site

A 63‐year‐old man was referred to our hospital because of a cardiac tumor. Transthoracic echocardiography revealed a rough, mobile tumor in the dilated right atrium, and transesophageal echocardiography showed that the tumor consisted of small, botryoidal masses. Catheter‐based biopsy carried a high risk of embolism. Therefore, we used F‐18‐fluorodeoxyglucose positron emission tomography (FDG‐PET), which revealed an abnormal accumulation in the right cervical lymph nodes, as well as in the heart. We safely performed biopsy of the lymph nodes and diagnosed the patient with primary cardiac lymphoma. We concluded that echocardiography and FDG‐PET are useful for selecting an appropriate biopsy site in primary cardiac lymphoma.     

Clinical perspectives of primary cardiac lymphoma

Primary cardiac lymphoma is a very rare malignancy, which is typically of a non-Hodgkin type, and involves only the heart and pericardium with no or minimal evidence of extracardiac involvement. Primary cardiac lymphoma account for about 1% of the primary cardiac tumors and 0.5% of the extranodal lymphomas. On the other hand, disseminated lymphoma with cardiac involvement can occur in up to 20% of patients with lymphoma. About 80% of cases of the primary cardiac lymphoma in immunocompetent hosts are of diffuse B-cell lymphoma, and in patients with immunodeficiency states, small noncleaved or immunoblastic lymphomas are more frequent. The right atrium and right ventricle are the 2 most frequently involved sites. Clinical presentation is heterogeneous and is generally related to the site of involvement in the heart. The diagnosis is suspected when patients present with a cardiac mass or an unexplained refractory pericardial effusion. A thorough workup should include transthoracic and transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Diagnosis is confirmed by cytology of the serous fluid from pericardial or pleural effusion or biopsy of the pericardial mass or endomyocardial tissue. The exploratory thoracotomy should not be delayed if indicated. Chemotherapy has been used alone or combined with radiotherapy. Similarly, palliative cardiac surgery has been performed, mainly for tumor debulking. Combination of chemotherapy and radiation therapy is considered as the treatment of choice. The survival is generally less than a month without treatment but has been prolonged up to 5 years with palliative treatments in selected cases.     

Right atrial tear associated with a tumour in the right atrium after blunt chest trauma

Occult cardiac injury following blunt trauma is more commonthan generally suspected. Myocardial contusion is not rare,however, it is generally a benign disorder which often remainsundiagnosed. We report a case of a right atrial rupture afterblunt chest trauma causing a tamponade. A 24-year-old man was involved in a violent car accident andhe presented in a state of collapse. A multislice computed tomographyindicated a pericardial effusion (Figure 1). A transthoracicechocardiography was performed and confirmed pericardial effusionwhich was hyperechoic (Figure 2, Movie 1). Concerns abouta possible mass in the right atrium led to examination withtransesophageal echocardiography (Figure 3, Movie 2) whichrevealed the presence of a voluminous mass in the right atrium.The patient successfully underwent cardiac surgery to removethe mass, identified as a blood clot, and to repair the atrialtear. The present case is of special interest because of therarity of documented incidents of blunt chest trauma causingright atrial tear and illustrates the usefulness of transesophagealechocardiography in completing the diagnosis in the event ofhaemopericardium.     

Use of a B-type Natriuretic Peptide in Evaluating the Treatment Response of a Relapsed Lymphoma with Cardiac Involvement

A 50-year-old woman received a diagnosis of diffuse large B-cell non-Hodgkin's lymphoma in 2000 and achieved complete remission. In April 2004, echocardiography and computed tomography examinations identified a tumor attached to the tricuspid valve and protruding within the right atrium. Bone marrow and lymph node biopsies showed a relapse of large cell lymphoma. The patient had a markedly elevated level of B-type natriuretic peptide (BNP) but a normal level of cardiac troponin I. The follow-up evaluation of the BNP level after chemotherapy showed that it had returned to within normal limits, and an echocardiogram showed regression of the tumor. Use of the BNP level as a monitor in the treatment of cardiac lymphoma has never been reported. This article is the first to report the use of BNP monitoring before and after chemotherapy to evaluate a patient with an unusual relapsed lymphoma with cardiac involvement.     

Primary cardiac lymphoma: diagnosis and treatment. Report of 6 cases and review of the literature

Primary cardiac lymphoma (PCL) is the rarest primary cardiac tumour and carries a poor prognosis. Early diagnosis, often difficult, to introduce appropriate treatment as soon as possible, seems to have a positive impact on prognosis. The authors report their experience of 6 patients with PCL. None of the patients had immune depression. The presentations were tamponade (N= 2), right heart failure (N= 1), general ill health (N= 3). A PCL was suspected on echocardiography and thoracic CT scan showing tumour invading the right heart chambers in all cases. The diagnosis of PCL was confirmed by surgical biopsy in 5 patients and by endomyocardial biopsy in 1 patient. A diffuse large cell type B lymphoma was found in 5 patients and an anaplastic lymphoma in 1 patient. One patient died of right heart failure 4 days after diagnosis and before starting chemotherapy. All the other patients received chemotherapy. Two patients died during their first course. The other three patients had several courses of chemotherapy: there are two survivors 17, 5 months later and one patient died 62 months after diagnosis. The diagnosis of PCL should be suspected in patients with a cardiac tumour associated or not with pericardial effusion. Early, appropriate chemotherapy seems to have a positive impact on the prognosis, justifying aggressive approaches to obtain a rapid histological diagnosis.     

Primary cardiac lymphoma

Primary cardiac lymphoma is a rare entity. We report on the clinicopathological features of 2 patients with primary cardiac lymphomas: one involving the right atrium resulting in intractable right heart failure, and the other involving the pericardium with massive pericardial effusion. In the first patient, sternotomy and surgical biopsy of the tumor were performed to arrive at the diagnosis. In the second patient, CT thorax and transesophageal echocardiography helped to diagnose the pericardial tumor, and cytological examination of the pericardial fluid established the pathological diagnosis of lymphoma. Combination chemotherapy (COPP) was started in both patients. The first patient died on the first day of chemotherapy due to intractable heart failure, while the second attained a partial response to chemotherapy but died of progressive disease 8 weeks later. This is followed by a literature review of 21 patients with primary cardiac lymphoma. In conclusion, the prognosis of primary cardiac tumor remains poor. Am. J. Hematol. 54:79–83, 1997 © 1997 Wiley-Liss, Inc.     

Multiple intracavitary cardiac masses; an uncommon presentation of African Burkitt's lymphoma.

A 29-yr-old patient is described, who presented with rapid general deterioration and right heart failure. Two-dimensional echocardiography revealed massive intracardiac tumor involving the right atrium, the right ventricle and the left atrium. At histology the diagnosis of Burkitt's lymphoma was made. This report presents what we believe to be the first case of a patient with primary cardiac manifestations and multiple intracardiac masses in this disease.     

A case of primary cardiac B cell lymphoma associated with ventricular tachycardia, successfully treated with systemic chemotherapy and radiotherapy: a long-term survival case

We experienced a long-term survival case of primary cardiac lymphoma (PCL) demonstrating ventricular tachycardia (VT) as an initial sign, which was related to localized myocardial damage by lymphoma cells. A 70-year-old woman with sustained VT was admitted to the Kofu Municipal Hospital. VT ceased with the administration of disopyramide intravenously. The origin of the VT was the free wall of the right ventricular outflow tract (RVOT) as observed by electrocardiography on admission. A solitary mass in the free wall of the RVOT was found by echocardiography, chest computed tomographic scanning and magnetic resonance imaging. There was no evidence of extracardiac involvement. The patient was histologically diagnosed as PCL by endomyocardial biopsy. Chemotherapy started immediately after the diagnosis and the mass showed a marked reduction in size. After 8 cycles of chemotherapy, radiotherapy was performed. Pericardial thickness in the free wall of the RVOT developed without severe side effects. Complete remission has been maintained for 30 months after the initial diagnosis, and no recurrence and arrhythmias have been detected during the follow-up period. It was demonstrated that rapid diagnosis and chemotherapy followed by radiotherapy for PCL achieved better survival.     

Contrast echocardiography as a useful additional diagnostic tool in evaluating a primary cardiac tumor.

The current report describes a case of a primary cardiac lymphoma. For early and appropriate treatment of a cardiac mass it is not only important to determine its localization and extension but also to differentiate between malignant and benign lesions. This report demonstrates that not only transthoracic echocardiography but also the other different forms of echocardiography such as transesophageal echocardiography, as well as contrast and intracardiac echocardiography, are useful tools in the diagnostic workup of cardiac masses.     

Cardiac lymphoma disclosed by ischemic accident. A case report

We report on the detection of a primitive cardiac lymphoma revealed by a cerebral vascular accident in a context of deterioration of the general state with fever. The diagnosis of the cerebral vascular accident was verified by the brain scan. The echocardiography, in particular the transesophageal ultrasound, suggested the diagnosis of cardiac lymphoma due to the existence of an inhomogeneous multilobar mass invading the right ventricle and largely encompassing the right auricle. The histologic diagnosis of a malignant non-Hodgkin's lymphoma of type B malignancy was confirmed by anatomopathology. The evolution was, unfortunately, rapidly unfavorable, with the patient dying in a state of cerebral suffering despite a combination treatment of chemotherapy and radiotherapy.     

Primary cardiac lymphoma mimicking infiltrative cardiomyopathy

Primary cardiac lymphoma is a rare malignancy which has been described as thickened myocardium due to the infiltration of atypical lymphocytes and accompanying intracardiac masses. Here, we report a case of a primary cardiac lymphoma without demonstrable intracardiac masses, mimicking infiltrative cardiomyopathy. A 40‐year‐old male presented with exertional dyspnoea and was diagnosed as having restrictive cardiomyopathy with severely decreased LV systolic function. Endomyocardial biopsy was performed and the diagnosis of primary cardiac lymphoma was confirmed. After appropriate chemotherapy, he recovered his systolic function fully.     

心脏粘液瘤的诊断与外科治疗（附71例报告）

共收治71例心脏粘液瘤患者。左房粘液瘤62例,其中多发瘤3例、合并室间隔缺损2例、二尖瓣关闭不全1例,右房粘液瘤9例、均由超声心动图确诊,并在全麻体外循环下手术摘除粘液瘤,同期行二尖瓣成形和二尖瓣替换术各1例,室缺修补术2例。术后2例死亡（2．8％）。随访9个月－16年,2例复发（2．8％）。认为超声心动图对心脏粘液瘤的诊断具有特殊价值,心脏粘液瘤一经诊断应立即手术,彻底切除是预防复发 的关键。