1/17. Myxoid leiomyosarcoma of the left atrium: a rare malignancy of the heart and its comparison with atrial myxoma.Primary tumours of the heart are rare. The majority of these tumours are benign, with myxomas located in the left atrium being the most common form. Almost all malignant tumours are sarcomas and occur preferentially in the right side of the heart. An exception to this rule is leiomyosarcoma, a rare form of primary cardiac sarcoma that occurs predominantly in the left atrium, as does cardiac myxoma. The case of a 53-year-old woman who presented with symptoms of mitral valve stenosis and pulmonary hypertension is reported. cardiac catheterization, angiography and echocardiography revealed a left atrial mass that was interpreted as atrial myxoma. At the time of operation, the myxoid appearance of the tumour mass further supported this assumption. The tumour, including a wide rim of atrial septum, was removed with cautery. Histopathological examination unexpectedly showed that the tumour was not an atrial myxoma but rather a myxoid variant of a primary leiomyosarcoma. immunohistochemistry and electron microscopy confirmed the diagnosis. Local radiotherapy was considered but deemed contraindicated in view of the longstanding pulmonary hypertension. Two months after excision, a repeat echocardiogram indicated recurrence of tumour in the left atrium, and the patient died a few days later. The preferential left atrial location and the frequently myxoid appearance of primary leiomyosarcomas of the heart make it particularly difficult to differentiate them preoperatively from atrial myxomas. The authors recommend resection of all atrial myxoid tumours with a wide (at least 1 cm) margin, combined with intraoperative frozen section diagnosis, because complete surgical resection appears to correlate with prolonged survival in the few reported cases of atrial leiomyosarcomas. In cases of incomplete initial resection or local recurrence in the absence of metastatic disease, heart transplantation may be a valid option in appropriately selected patients.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/17. Primary cardiac leiomyosarcoma with pulmonary metastases: a diagnostic problem.A case of primary cardiac leiomyosarcoma is reported. Tumour growth into the right ventricular cavity led to multiple pulmonary metastases with haemorrhage. Failure of diagnostic procedures including cardiac catheterisation, angiography and thoracotomy is noted. The incidence and presentation of primary malignant cardiac tumours is briefly discussed.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
3/17. pulmonary artery leiomyosarcoma with thyroid metastases.Primary pulmonary artery sarcomas are uncommon and usually fatal tumours. The diagnosis of these tumours is delayed in most cases as they are mistaken for pulmonary thromboembolism. We present a fatal case of a woman referred to us five months after a primary diagnosis of pulmonary thromboembolism, due to an increase in dyspnea and presence of hemoptysis despite having undergone anticoagulant treatment. On the basis of the findings obtained by computed tomography, echocardiogram and MRI, a mass arising from the pulmonary trunk was evidenced, that suggested other diagnostic hypotheses. The worsening of patient's conditions did not allow an endovascular catheter biopsy and diagnosis was made at autopsy. The mass was a leiomyosarcoma of the pulmonary artery with thyroid metastases, which is an uncommon findings.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
4/17. Surgical treatment for primary cardiac leiomyosarcoma causing right ventricular outflow obstruction.A 55-year-old man was admitted to another hospital because of dry cough and dyspnea that rapidly worsened before admission. Chest computed tomography revealed a low-density mass that nearly obstructed the main pulmonary arterial trunk. Pulmonary thromboembolism was suspected and treated with catheter-directed thrombolysis therapy. Despite optimal thrombolysis and anticoagulant therapy, his symptoms persisted. He was referred for further examination and possible surgery for presumed pulmonary thromboembolism. The mass appeared more likely to be a tumor than a thrombus on careful analysis of the magnetic resonance imaging. At surgery, the anterior wall of the main pulmonary arterial trunk, the pulmonary valve, annulus, and the right ventricular outflow tract were all invaded by what was found to be a tumor and were resected under conventional cardiopulmonary bypass. The resected area was reconstructed with a 25-mm-diameter bioprosthetic valve and Xenomedica patch. Final pathological diagnosis was primary cardiac leiomyosarcoma involving the pulmonary valve. Postoperative course was uneventful, and he was discharged 11 days after surgery without adjuvant therapy because he refused it. Ten months later, the patient was well, but a chest X-ray revealed some coin lesions in the bilateral lung fields that were thought to be metastatic tumor.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
5/17. Coughing and central venous catheter dislodgement.Silastic central venous catheters are subject to dislodgement from a variety of causes. Only one occurrence of catheter dislodgement has been previously reported in connection with coughing. We report four additional cases of silastic central venous catheter dislodgement associated with forceful coughing paroxysms, alone or in combination with emesis or rectal tenesmus. Three episodes of catheter dislodgement occurred in adolescents or young adults with cystic fibrosis, who may constitute a particularly high-risk group. Dislodgement in two patients was asymptomatic. These case suggest that patients with frequent or severe paroxysms of increased intrathoracic pressure may be at higher risk of catheter dislodgement. Since dislodgement may be initially asymptomatic and can cause serious complications, a high index of suspicion for dislodgement in patients with silastic central venous catheters and coughing paroxysms is advised.- - - - - - - - - - ranking = 10keywords = catheter (Clic here for more details about this article) |
6/17. Primary leiomyosarcoma of the truncus pulmonalis. Report of a case with typical features and unusual metastases.We present the fatal case of a patient with a primary leiomyosarcoma of the pulmonary trunk. During the patient's clinical course of 2 months, the pulmonary valve and the proximal segment of the truncus pulmonalis had to be removed surgically. At autopsy, we found an extensive local tumour recurrence with an almost complete obliteration of the right ventricular outflow. The right pulmonary artery was subtotally obliterated by a tumour thrombus, and the lungs and both adrenal glands showed extensive tumour metastases. A solitary tumour metastasis within the lumen of the right vena iliaca communis obviously was associated with diagnostic manipulations in the course of heart catheterization.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
7/17. Uterine leiomyosarcoma with cardiac metastases.leiomyosarcoma metastatic to the heart is rare and is usually fatal. The authors present the case of a 58-year-old woman who had a history of uterine leiomyosarcoma. echocardiography and cardiac catheterization revealed a large right ventricular mass. Computed tomography confirmed the presence of the mass which extended into the pulmonary artery. The inferior vena cava was free of disease. At operation, a large tumour originating in the right ventricle and protruding through the pulmonary valve was found. Histologically, it was a leiomyosarcoma. Because there were numerous septal and intramural foci of tumour, complete resection was impossible, but palliative resection was performed successfully and the patient was alive and active 1 year after operation.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
8/17. Coronary artery embolism following cancer chemotherapy.A 16-year-old patient underwent partial gastrectomy for leiomyosarcoma of the stomach. Following resection, he received combination chemotherapy that included Adriamycin and dimethyltriazenoimidazole carboxamide (DTIC), with the cumulative Adriamycin dose being 405 mg/m2. The patient was subsequently treated with vincristine, actinomycin D, and cyclophosphamide. Six hours after receiving his fourth dose of cyclophosphamide, the patient developed signs and symptoms of acute anterior wall myocardial infarction. Although he recovered from this initial cardiac event, he subsequently experienced several additional episodes of vascular occlusion involving the cerebral, femoral, coronary, and pulmonary arteries. cardiac catheterization demonstrated all coronary arteries to be normal. Both ventricles were hypokinetic, and bilateral mural thrombi were demonstrated; these were the presumed source of the embolic phenomena. To our knowledge, this is the first description of repeated coronary artery embolization following cancer chemotherapy in a patient without evidence of preexisting cardiac abnormalities.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
9/17. Catheter suction biopsy in diagnosis of an intrapulmonary artery tumor.Unsuspected intracardiac masses are occasionally encountered when cardiac catheterization is performed in a patient with right ventricular or pulmonary artery occlusive disease. In one of two patients, suction biopsy of the mass has been successful in obtaining a histological diagnosis. The method and its contraindications are discussed.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
10/17. superior vena cava syndrome associated with gynecologic malignancy.superior vena cava syndrome is an infrequently noted complication associated with gynecologic malignancy. Three cases illustrate modern diagnostic and management methods. patients developed superior vena cava syndrome secondary to mediastinal metastatic endometrial carcinoma, uterine leiomyosarcoma, and secondary to thrombosis induced by a subclavian hyperalimentation catheter. awareness of this condition on oncology units and by physicians using central venous catheters is important to afford the prompt diagnosis and appropriate management of this life-threatening condition.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
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