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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.


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Intraoperative specimen. The partially resected tumor obstructed the right ventricular and main pulmonary artery.
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Figure 4: Intraoperative specimen. The partially resected tumor obstructed the right ventricular and main pulmonary artery.

Mentions: After considering the extent of the patient’s disease, we deemed that an operation was the best alternative. The tumor in the right ventricle and main pulmonary artery was surgically resected; it measured 6cm × 5cm (Figure 4). The postoperative course was uneventful, and she was discharged on day 13 after the surgery. Her dyspnea was significantly relieved postoperatively. Histopathological examination of the resected specimen indicated a diagnosis of undifferentiated sarcoma (Figure 5). Immunohistochemical analysis demonstrated that the tumor cells were strongly positive for vimentin and CD68, and moderately positive for Ki-67(+). Focal staining for actin and desmin was also observed, but S-100, CD34(-), CK(pan), CAM5.2 and EMA were all negative.


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)

Intraoperative specimen. The partially resected tumor obstructed the right ventricular and main pulmonary artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Intraoperative specimen. The partially resected tumor obstructed the right ventricular and main pulmonary artery.
Mentions: After considering the extent of the patient’s disease, we deemed that an operation was the best alternative. The tumor in the right ventricle and main pulmonary artery was surgically resected; it measured 6cm × 5cm (Figure 4). The postoperative course was uneventful, and she was discharged on day 13 after the surgery. Her dyspnea was significantly relieved postoperatively. Histopathological examination of the resected specimen indicated a diagnosis of undifferentiated sarcoma (Figure 5). Immunohistochemical analysis demonstrated that the tumor cells were strongly positive for vimentin and CD68, and moderately positive for Ki-67(+). Focal staining for actin and desmin was also observed, but S-100, CD34(-), CK(pan), CAM5.2 and EMA were all negative.

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