RESUMEN
BACKGROUND Cardiac calcified amorphous tumor (CCAT), a peculiar and uncommon non-neoplastic cardiac lesion, was initially characterized by Reynolds and colleagues in the medical literature in 1997. This distinctive entity is hallmarked by its unique feature of pedunculated and diffused calcifications, primarily infiltrating the cardiac structures, with a predilection for the mitral valve annulus initially, followed in sequence by the right atrium, right ventricle, left atrium, left ventricle, and tricuspid valve annulus. The nature of CCATs, despite being benign, poses diagnostic dilemmas, as they frequently masquerade as malignant tumors due to their clinical presentations, which resemble those caused by potential complications such as obstructive masses and thromboembolic events. CASE REPORT A 50-year-old man presented to our hospital with shortness of breath. He had been short of breath for more than 5 years after repeated activities. Transthoracic echocardiography showed a mobile high echogenic mass from the middle of the right ventricular wall and pericardial effusion and right heart insufficiency. The electrocardiogram (ECG) results demonstrated a sinus rhythm, complete right bundle branch block, and T-wave alterations. Additionally, the chest computed tomography (CT) scan revealed a slightly enlarged heart with a lack of density and calcification in the right ventricle. He had an uneventful postoperative recovery after the resection of the cardiac tumor. The mass had not continued to grow when we compared it with preoperative cardiac color doppler echocardiography, after 3 months follow-up. CONCLUSIONS CCAT is a rare non-neoplastic cardiac entity. Diagnosis of CCAT poses a challenge due to the absence of distinct clinical features and its frequent misidentification as a malignant tumor mimic. Surgical resection serves as the sole treatment for symptom relief.
Asunto(s)
Calcinosis , Neoplasias Cardíacas , Ventrículos Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Calcinosis/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Diagnóstico Diferencial , Ecocardiografía , Tomografía Computarizada por Rayos XRESUMEN
Atrial Myxoma is the most common primary benign tumour of the heart, commonly found in the left atrium. It typically presents in young females with characteristic features such as, constitutional symptoms, chest pain, and cardiac murmurs. However, atypical presentations can occur; causing a diagnostic challenge. This case report describes a 75-year-old male who visited the cardiology outpatient department of Dow Institute of Cardiology, Karachi on 18th April, 2023 with a left-sided atrial myxoma in late adulthood without typical features including constitutional symptoms, chest pain, syncope, dizziness, digital clubbing or neurologic findings. Further discussed are the diagnostic techniques used to find the tumour and the treatment strategy. This case report highlights the need for cardiologists to consider Atrial Myxoma as a potential diagnosis, even in the absence of typical symptoms, in elderly male population.
Asunto(s)
Atrios Cardíacos , Neoplasias Cardíacas , Mixoma , Humanos , Mixoma/cirugía , Mixoma/diagnóstico , Masculino , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagen , Anciano , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , EcocardiografíaRESUMEN
BACKGROUND: Cardiac fibromas are extremely rare in adults. The preferred treatment is surgical resection, but antiarrhythmic medications or heart transplantation have also been used previously. The cardiac imaging, particularly MRI, can be useful to help delineate between primary cardiac tumors, and surgical factors such as the extent/size of the fibroma, involvement of the coronary arteries or mitral apparatus and amount of residual myocardium influence whether surgical resection is feasible. CASE PRESENTATION: A 42-year-old male presented with a wide-complex tachycardia, unresponsive to amiodarone. An echocardiogram was performed which showed a possible posterior wall mass. A cardiac MRI showed a well circumscribed lateral wall intracardiac fibroma, measuring 5.2 × 5.1 × 3.8 cm with preserved function. Surgical resection was successful, and he was discharged without a defibrillator. CONCLUSIONS: Cardiac fibromas are encapsulated tumors which do not infiltrate myocardium and should be surgically resected if possible.
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Fibroma , Neoplasias Cardíacas , Taquicardia Ventricular , Humanos , Masculino , Adulto , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Fibroma/cirugía , Fibroma/complicaciones , Taquicardia Ventricular/cirugía , Taquicardia Ventricular/etiología , Imagen por Resonancia Magnética , EcocardiografíaAsunto(s)
Cardiomiopatía Hipertrófica , Neoplasias Cardíacas , Humanos , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/complicaciones , Masculino , Ecocardiografía , Femenino , Persona de Mediana Edad , Diagnóstico Diferencial , Miocardiopatía Hipertrófica ApicalRESUMEN
RATIONALE: Approximately one-fifth ischemic stroke are attributed to cardioembolism. Patients with cardioembolic stroke often develop a more severe disability and a higher risk of stroke recurrence. Cardiac myxoma, although uncommon, can serve as a potentially curable cause of acute embolic strokes. PATIENT CONCERNS: A 55-year-old male patient presented to the emergency department with acute vertigo and unsteady gait, accompanied by left upper limb numbness. Concurrently, purple-like lesions on the left hand were noticed. DIAGNOSES: Brain magnetic resonance imaging showed multiple infarctions in the posterior circulation. Additionally, skin examination showed Janeway lesions, Osler nodes and splinter hemorrhages. There was no evidence of systemic infection. Subsequently, transthoracic echocardiogram revealed a left atrial myxoma. INTERVENTION: Early surgical resection of cardiac myxoma was performed. OUTCOMES: The patient recovered well from the surgery. No recurrent embolic event was reported at 3-month postoperatively. LESSONS: Clinicians should be vigilant for skin manifestations of cardiac embolism. In patients with acute ischemic strokes, the presence of cutaneous embolic phenomena could serve as a warning sign of cardioembolism.
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Atrios Cardíacos , Neoplasias Cardíacas , Accidente Cerebrovascular Isquémico , Mixoma , Humanos , Masculino , Mixoma/complicaciones , Mixoma/diagnóstico , Mixoma/cirugía , Persona de Mediana Edad , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Accidente Cerebrovascular Isquémico/etiología , Atrios Cardíacos/diagnóstico por imagen , Endocarditis/complicaciones , Endocarditis/diagnóstico , EcocardiografíaRESUMEN
ABSTRACT: Lipomatous hypertrophy of the interatrial septum (LHIS) is a rare but benign cardiac tumor that can be found on cardiac imaging such as echocardiogram, or during surgery or an autopsy. Cardiac MRI is the best imaging modality to determine the borders of the tumor and its extension into the intraventricular septum and ventricular free wall. Patients require close monitoring because LHIS may cause right or left outflow tract obstruction or superior vena cava obstruction, requiring cardiac surgical intervention. This article describes a patient with LHIS who underwent cardiac surgery because of her increasing symptomatology.
Asunto(s)
Tabique Interatrial , Neoplasias Cardíacas , Lipomatosis , Humanos , Femenino , Tabique Interatrial/diagnóstico por imagen , Tabique Interatrial/patología , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Lipomatosis/diagnóstico por imagen , Lipomatosis/diagnóstico , Lipomatosis/cirugía , Imagen por Resonancia Magnética , Hipertrofia , Ecocardiografía , Persona de Mediana Edad , Lipoma/cirugía , Lipoma/diagnóstico por imagen , Lipoma/diagnósticoRESUMEN
BACKGROUND Cervical cancer ranks fourth globally among women's cancers. Squamous cell carcinoma constitutes 70% of cervical cancer cases, often metastasizing to lungs and paraaortic nodes. Uncommon sites include the brain, skin, spleen, and muscle, while pericardial fluid metastasis is highly rare. We report a case of squamous cell carcinoma of the uterine cervix that was metastatic to the pericardium and was detected on cytologic evaluation of pericardial fluid. CASE REPORT A 42-year-old woman who was previously treated for stage III squamous cell carcinoma of the cervix presented with symptoms of cough, fever, and shortness of breath for 8 days, and chest pain for 3 days. Clinical workup revealed pericardial effusion, with spread to the lungs and mediastinal and hilar lymph nodes. Cytological analysis of the fluid showed malignant cells, consistent with metastatic squamous cell carcinoma. Immunohistochemistry demonstrated cells positive for p63 and p40, while negative for GATA-3, D2-40, calretinin, and WT1. These findings in conjunction with patient's known history of cervical squamous cell carcinoma was consistent with a cytologic diagnosis of metastatic squamous cell carcinoma to pericardial fluid. CONCLUSIONS History and clinical correlation plays a vital role in determining the primary site causing malignant pericardial effusions. While the occurrence of cervical cancer metastasizing to the pericardium is uncommon, it should be considered, particularly in cases involving high-grade, invasive tumors, recurrences, or distant metastases. This possibility should be included in the list of potential diagnoses when encountering pericardial effusions with squamous cells in female patients.
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Carcinoma de Células Escamosas , Derrame Pericárdico , Neoplasias del Cuello Uterino , Humanos , Femenino , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/complicaciones , Derrame Pericárdico/etiología , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/complicaciones , Adulto , Neoplasias Cardíacas/secundario , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/patologíaRESUMEN
The antemortem diagnosis of secondary cardiac involvement by lymphoma remains suboptimal. Prognosis is worse with delayed diagnosis as the tumor burden increases with the multicompartment participation. Chemotherapy may improve survival, but there is a risk of mortality due to treatment-related complications, such as myocardial rupture and fatal arrhythmias. Modified chemotherapy regimens may prevent such complications, but the data are limited. We report the case of a 72-year-old woman diagnosed with diffuse large B-cell lymphoma with cardiac involvement, where early diagnosis prevented cardiac complications from the disease and its treatment as well. The aim of this case report is to highlight the fact that cardiac involvement in lymphoma is frequent and can be easily missed, leading to complications. Treatment requires an individualized approach.
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Neoplasias Cardíacas , Linfoma de Células B Grandes Difuso , Humanos , Femenino , Anciano , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/complicaciones , Ecocardiografía , Tabique Interatrial/patología , Tabique Interatrial/diagnóstico por imagen , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéuticoAsunto(s)
Cardiomiopatía Restrictiva , Neoplasias Cardíacas , Hemangiosarcoma , Humanos , Hemangiosarcoma/patología , Hemangiosarcoma/complicaciones , Hemangiosarcoma/diagnóstico , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Cardiomiopatía Restrictiva/patología , Cardiomiopatía Restrictiva/etiología , Masculino , Persona de Mediana Edad , Femenino , Resultado FatalRESUMEN
Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a well-defined globular mass attached to the anterolateral papillary muscle. The mass was hyperintense on T1 and T2 weighted images with suppression of signal on fat saturated and short tau inversion recovery (STIR) images. This imaging established the diagnosis of cardiac lipoma attached to the anterolateral papillary muscle, Papillary muscle is a very rare location of lipoma, which is rarely reported in the literature.
Asunto(s)
Neoplasias Cardíacas , Lipoma , Imagen por Resonancia Magnética , Músculos Papilares , Humanos , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/patología , Músculos Papilares/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/patología , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Lipoma/patología , Ecocardiografía , Masculino , Persona de Mediana Edad , Femenino , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: To report the diagnosis and treatment of a rare disease of intravenous leiomyomatosis (IVL) originating from the uterus, growing in the inferior vena cava (IVC) and extending into the right atrium (RA) associated with a pelvic arteriovenous fistula (AVF). This is the first reported case of IVL in the IVC and RA with pulmonary benign metastasizing leiomyoma (PBML) secondary to a pelvic AVF despite the use of GnRH agonists in a nonmenopausal woman. CASE PRESENTATION: The patient was a 50-year-old premenopausal woman with a history of surgical resection for and antiestrogen conservative drug for pulmonary benign metastasizing leiomyoma (PBML) 5 years. The patient nevertheless developed IVL in the IVC, internal iliac vein and RA accompanied by AVF. Vaginal ultrasound combined with echocardiography and computerized tomographic venography imaging assists in the diagnosis of IVL combined with AVF, with histopathology and immunohistochemistry ultimately confirming the diagnosis. The patient ultimately was performed with a combination of hysterectomy, bilateral adnexectomy, and resection of tumors in the IVC and RA without cardiopulmonary bypass and sternotomy. CONCLUSION: BML may be difficult to control with incomplete removal of the uterus and ovaries even with the use of antiestrogenic medications, and medically induced AVF resulting from fibroid surgery may accelerate this process and the development of IVL.
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Fístula Arteriovenosa , Atrios Cardíacos , Leiomiomatosis , Neoplasias Pulmonares , Neoplasias Uterinas , Neoplasias Vasculares , Vena Cava Inferior , Humanos , Femenino , Vena Cava Inferior/patología , Vena Cava Inferior/cirugía , Vena Cava Inferior/diagnóstico por imagen , Persona de Mediana Edad , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/patología , Atrios Cardíacos/patología , Atrios Cardíacos/cirugía , Atrios Cardíacos/diagnóstico por imagen , Leiomiomatosis/patología , Leiomiomatosis/cirugía , Leiomiomatosis/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/patología , Neoplasias Vasculares/patología , Neoplasias Vasculares/cirugía , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Cardíacas/secundario , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/complicaciones , Resultado del Tratamiento , Histerectomía , Vena Ilíaca/patología , Vena Ilíaca/diagnóstico por imagenAsunto(s)
Hallazgos Incidentales , Imagen Multimodal , Humanos , Femenino , Fibroelastoma Papilar Cardíaco/diagnóstico por imagen , Fibroelastoma Papilar Cardíaco/patología , Fibroelastoma Papilar Cardíaco/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Persona de Mediana Edad , Fibroma/diagnóstico por imagen , Fibroma/patología , Fibroma/cirugíaRESUMEN
We present the case of a 49-year-old female of Caucasian European descent with chest tightness, fatigue, and palpitations, ultimately diagnosed with primary intracardiac angiosarcoma. Initial echocardiography revealed a significant mass within the right atrium, infiltrating the free wall. Surgical intervention included tumor excision and partial resection of the superior vena cava. Histopathological examination confirmed a high-grade angiosarcoma. Postoperative imaging identified a recurrent mass in the right atrium, suggestive of thrombus, alongside Takotsubo cardiomyopathy. Considering the elevated surgical risks and the presence of cardiomyopathy, management included anticoagulation therapy with Warfarin and adjuvant chemotherapy with Paclitaxel. Follow-up cardiac magnetic resonance imaging demonstrated a recurrent angiosarcoma with superimposed thrombus. This case presents the complex diagnostic and therapeutic landscape of angiosarcoma, highlighting the critical importance of early surgical intervention, advanced imaging techniques, and vigilant postoperative monitoring.
Asunto(s)
Atrios Cardíacos , Neoplasias Cardíacas , Hemangiosarcoma , Humanos , Hemangiosarcoma/cirugía , Hemangiosarcoma/diagnóstico por imagen , Femenino , Persona de Mediana Edad , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Ecocardiografía/métodos , Imagen por Resonancia MagnéticaRESUMEN
Malignant cardiac tumor is a rare tumor with extremely poor prognosis, and metastatic cardiac tumor causes superior vena cava( SVC) syndrome. A 52-year-old man visited a clinic with a chief complaint of facial edema. Contrast-enhanced computed tomography( CT) revealed a mass in the right atrium( RA)obstructing the SVC. Echocardiography revealed a mass about to incarcerate the tricuspid valve orifice. The patient was transferred to our institution for emergency surgery. Tumor resection was performed under general anesthesia. A cardiopulmonary bypass was established with cannulate in the ascending aorta, in the RA through the right femoral vein, and in the left ventricle for venting. The RA was incised, and the tumor was resected. The SVC was incised, and the tumor and blood clots were removed. Because adhesion between vessel wall and the mass was tight, complete mass removal and recanalization of the SVC was not attempted. Pathological diagnosis was metastatic squamous cell carcinoma. All imaging studies failed to identify primary lesions. The clinical course was uneventful, and the patient was discharged on postoperative day 17. Four months postoperatively, chemotherapy for squamous cell carcinoma was initiated. The patient is alive at approximately 28 months postoperatively.
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Neoplasias Cardíacas , Síndrome de la Vena Cava Superior , Humanos , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/cirugía , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neoplasias Cardíacas/secundario , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/secundarioRESUMEN
BACKGROUND: Primary cardiac synovial sarcoma is a rare condition with limited treatment options for advanced stages. Surgery and chemotherapy are currently the mainstay treatments; however, survival rates remain low. CASE PRESENTATION: A 64-year-old woman presenting with symptoms of chest tightness and shortness of breath was found to have an obstructive right atrial mass, along with pulmonary infarction and metastasis. She was ultimately diagnosed with advanced primary cardiac synovial sarcoma. Following surgery, the patient's symptoms improved, and she underwent chemotherapy and anti-angiogenic therapy, but unfortunately, her survival time was only 8 months. CONCLUSION: This case report aims to enhance clinicians' understanding of the diagnosis and treatment of primary cardiac synovial sarcoma. Enhancing both survival outcomes and quality of life in individuals with primary cardiac synovial sarcoma continues to present a significant challenge.
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Neoplasias Cardíacas , Infarto Pulmonar , Sarcoma Sinovial , Humanos , Sarcoma Sinovial/patología , Sarcoma Sinovial/complicaciones , Sarcoma Sinovial/diagnóstico , Femenino , Persona de Mediana Edad , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/complicaciones , Infarto Pulmonar/patología , Infarto Pulmonar/etiología , Tabique Interatrial/patologíaAsunto(s)
Neoplasias Cardíacas , Rabdomioma , Esclerosis Tuberosa , Humanos , Masculino , Neoplasias Cardíacas/diagnóstico por imagen , Estudios Longitudinales , Imagen por Resonancia Magnética , Rabdomioma/diagnóstico por imagen , Esclerosis Tuberosa/diagnóstico por imagen , Esclerosis Tuberosa/complicaciones , Adulto JovenRESUMEN
Primary cardiac angiosarcoma is a rare, aggressive malignancy that commonly metastasizes to various organs. The presenting symptoms are typically nonspecific, so a comprehensive examination is required to confirm the diagnosis promptly. This case report describes the presentation of an older patient with a history of neoplasms. Echocardiography and biopsy were performed, but despite surgical intervention to resect a large right atrial mass, the patient died. A final diagnosis of primary angiosarcoma was made based on the resected specimen.
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Neoplasias Cardíacas , Hemangiosarcoma , Humanos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Anciano , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/cirugía , Resultado Fatal , Biopsia , Masculino , Atrios Cardíacos/patología , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Ecocardiografía , Procedimientos Quirúrgicos Cardíacos/métodosRESUMEN
Cardiac myxoma is a commonly encountered tumor within the heart that has the potential to be life-threatening. However, the cellular composition of this condition is still not well understood. To fill this gap, we analyzed 75,641 cells from cardiac myxoma tissues based on single-cell sequencing. We defined a population of myxoma cells, which exhibited a resemblance to fibroblasts, yet they were distinguished by an increased expression of phosphodiesterases and genes associated with cell proliferation, differentiation, and adhesion. The clinical relevance of the cell populations indicated a higher proportion of myxoma cells and M2-like macrophage infiltration, along with their enhanced spatial interaction, were found to significantly contribute to the occurrence of embolism. The immune cells surrounding the myxoma exhibit inhibitory characteristics, with impaired function of T cells characterized by the expression of GZMK and TOX, along with a substantial infiltration of tumor-promoting macrophages expressed growth factors such as PDGFC. Furthermore, in vitro co-culture experiments showed that macrophages promoted the growth of myxoma cells significantly. In summary, this study presents a comprehensive single-cell atlas of cardiac myxoma, highlighting the heterogeneity of myxoma cells and their collaborative impact on immune cells. These findings shed light on the complex pathobiology of cardiac myxoma and present potential targets for intervention.