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An unusual case of metastasis of a pulmonary undifferentiated pleomorphic sarcoma to the right ventricle: a case report.

Xu G, Shi X, Shao G - J Med Case Rep (2013)

Bottom Line: Symptoms of cardiac neoplasms usually appear late in the course of the disease and are often ignored because of the more severe effects of the primary malignancy or its therapy.In some patients, surgery can be used to relieve symptoms.We have reported the first case of symptomatic cardiac metastases from an undifferentiated pleomorphic sarcoma of the lung.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic & Cardiovascular Surgery, Lihuili Hospital, Ningbo Medical Center, Affiliated Hospital of Medical School of Ningbo University, Xingning Road, Ningbo 315041, P, R, China. xuguodong5306750@gmail.com.

ABSTRACT

Introduction: Undifferentiated pleomorphic sarcoma is defined as a pleomorphic high-grade sarcoma whose line of differentiation cannot be determined. These tumors constitute less than 5% of all sarcomas in adults. Cardiac neoplasms are rare, and most are metastatic in origin. More than one-third of cardiac metastases originate from lung cancer. Symptoms of cardiac neoplasms usually appear late in the course of the disease and are often ignored because of the more severe effects of the primary malignancy or its therapy. We present the case of a patient with undifferentiated pleomorphic sarcoma of the lung presenting with symptomatic right-heart failure secondary to cardiac metastasis. The purpose of this report is to present this unusual case.

Case presentation: Our patient was a 59-year-old Chinese woman with symptomatic metastasis of an undifferentiated pleomorphic sarcoma of the lung to the right ventricle. She had a history of a stage IV, pulmonary, undifferentiated pleomorphic sarcoma that had been successfully treated with chemotherapy and radiotherapy 4 years ago. A complete response was obtained, and she was in remission until the cardiac metastasis. She underwent surgical excision of the cardiac mass because it caused dyspnea and posed a high risk of sudden death, pulmonary embolism or tricuspid obstruction. Histopathological and immunohistochemical examinations of the surgical specimen established the diagnosis of undifferentiated pleomorphic sarcoma and confirmed that the cardiac tumor was a metastasis from the lung.

Conclusions: In patients who have known metastatic neoplasms and present with cardiac manifestations, whether detected during history taking or physical examination, the clinician should be alert to the possibility of cardiac metastases. In patients with cardiac metastases, the therapeutic alternatives are limited to palliative treatment of symptoms and chemotherapy. In some patients, surgery can be used to relieve symptoms. We have reported the first case of symptomatic cardiac metastases from an undifferentiated pleomorphic sarcoma of the lung. Our patient underwent surgical resection, and her symptoms improved significantly. This case is unique because it is the only reported case of undifferentiated pleomorphic sarcoma of the lung which metastasized to the heart, and in which symptomatic improvement was effectively obtained with surgical resection.

No MeSH data available.


Related in: MedlinePlus

Preoperative, transthoracic echocardiographic scan (parasternal short-axis view of aortic root). A tumor measuring approximately 5cm × 5cm and extending from the right ventricle to the pulmonary valve can be seen (arrow).
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Figure 3: Preoperative, transthoracic echocardiographic scan (parasternal short-axis view of aortic root). A tumor measuring approximately 5cm × 5cm and extending from the right ventricle to the pulmonary valve can be seen (arrow).

Mentions: Contrast-enhanced computed tomography (CT) showed a large mass measuring 5cm × 6cm, filling defects in the main pulmonary artery and right ventricle and hydropericardium (Figure 2). No abnormal findings were seen in the lung. Transthoracic echocardiography revealed enlargement of the right ventricle, hydropericardium and a tumor measuring approximately 5cm × 5cm and extending from the right ventricle to the pulmonary valve (Figure 3). The liver, spleen, pancreas, and kidneys appeared normal. The patient had no evidence of tumor recurrence in the left lung. Her electrocardiogram showed sinus rhythm with no significant ST-T abnormalities. Serum levels of the tumor markers alpha-fetoprotein, carcinoembryonic antigen, carcinoma antigen (CA)-125 and CA 19–9 were not elevated.


An unusual case of metastasis of a pulmonary undifferentiated pleomorphic sarcoma to the right ventricle: a case report.

Xu G, Shi X, Shao G - J Med Case Rep (2013)

Preoperative, transthoracic echocardiographic scan (parasternal short-axis view of aortic root). A tumor measuring approximately 5cm × 5cm and extending from the right ventricle to the pulmonary valve can be seen (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750226&req=5

Figure 3: Preoperative, transthoracic echocardiographic scan (parasternal short-axis view of aortic root). A tumor measuring approximately 5cm × 5cm and extending from the right ventricle to the pulmonary valve can be seen (arrow).
Mentions: Contrast-enhanced computed tomography (CT) showed a large mass measuring 5cm × 6cm, filling defects in the main pulmonary artery and right ventricle and hydropericardium (Figure 2). No abnormal findings were seen in the lung. Transthoracic echocardiography revealed enlargement of the right ventricle, hydropericardium and a tumor measuring approximately 5cm × 5cm and extending from the right ventricle to the pulmonary valve (Figure 3). The liver, spleen, pancreas, and kidneys appeared normal. The patient had no evidence of tumor recurrence in the left lung. Her electrocardiogram showed sinus rhythm with no significant ST-T abnormalities. Serum levels of the tumor markers alpha-fetoprotein, carcinoembryonic antigen, carcinoma antigen (CA)-125 and CA 19–9 were not elevated.

Bottom Line: Symptoms of cardiac neoplasms usually appear late in the course of the disease and are often ignored because of the more severe effects of the primary malignancy or its therapy.In some patients, surgery can be used to relieve symptoms.We have reported the first case of symptomatic cardiac metastases from an undifferentiated pleomorphic sarcoma of the lung.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic & Cardiovascular Surgery, Lihuili Hospital, Ningbo Medical Center, Affiliated Hospital of Medical School of Ningbo University, Xingning Road, Ningbo 315041, P, R, China. xuguodong5306750@gmail.com.

ABSTRACT

Introduction: Undifferentiated pleomorphic sarcoma is defined as a pleomorphic high-grade sarcoma whose line of differentiation cannot be determined. These tumors constitute less than 5% of all sarcomas in adults. Cardiac neoplasms are rare, and most are metastatic in origin. More than one-third of cardiac metastases originate from lung cancer. Symptoms of cardiac neoplasms usually appear late in the course of the disease and are often ignored because of the more severe effects of the primary malignancy or its therapy. We present the case of a patient with undifferentiated pleomorphic sarcoma of the lung presenting with symptomatic right-heart failure secondary to cardiac metastasis. The purpose of this report is to present this unusual case.

Case presentation: Our patient was a 59-year-old Chinese woman with symptomatic metastasis of an undifferentiated pleomorphic sarcoma of the lung to the right ventricle. She had a history of a stage IV, pulmonary, undifferentiated pleomorphic sarcoma that had been successfully treated with chemotherapy and radiotherapy 4 years ago. A complete response was obtained, and she was in remission until the cardiac metastasis. She underwent surgical excision of the cardiac mass because it caused dyspnea and posed a high risk of sudden death, pulmonary embolism or tricuspid obstruction. Histopathological and immunohistochemical examinations of the surgical specimen established the diagnosis of undifferentiated pleomorphic sarcoma and confirmed that the cardiac tumor was a metastasis from the lung.

Conclusions: In patients who have known metastatic neoplasms and present with cardiac manifestations, whether detected during history taking or physical examination, the clinician should be alert to the possibility of cardiac metastases. In patients with cardiac metastases, the therapeutic alternatives are limited to palliative treatment of symptoms and chemotherapy. In some patients, surgery can be used to relieve symptoms. We have reported the first case of symptomatic cardiac metastases from an undifferentiated pleomorphic sarcoma of the lung. Our patient underwent surgical resection, and her symptoms improved significantly. This case is unique because it is the only reported case of undifferentiated pleomorphic sarcoma of the lung which metastasized to the heart, and in which symptomatic improvement was effectively obtained with surgical resection.

No MeSH data available.


Related in: MedlinePlus