Atrial Metastasis Research Articles

Left Atrial Metastasis of Wilms Tumour in Abeokuta, Nigeria: A Case Report

Left Atrial Metastasis of Wilms Tumour in Abeokuta, Nigeria: A Case Report

Multiple thrombi mimicking metastases in the right atrium of patients with non-Hodgkin’s lymphoma diagnosed by multimodal cardiac imaging: one case report

BackgroundRight-side heart mass can be found incidentally on routine transthoracic echocardiography (TTE). Accurate diagnosis of cardiac mass often requires more than one imaging method. We present a mid-age woman with non-Hodgkin lymphoma who was found to have multiple right atrial masses mimicking metastases on routine TTE, which were finally diagnosed as thrombi by multimodal cardiac imaging.Case presentationA 52-year-old woman was diagnosed with primary mediastinal diffuse large B cell lymphoma (DLBCL) almost six months prior. The TTE revealed multiple masses in the right atrium with normal cardiac function when she was being evaluated for the next chemotherapy. On arrival, she was hemodynamically stable and asymptomatic. Physical examination was no remarkable. Laboratory findings showed leukocytosis of 17,900 cells/mm3, hemoglobin of 7.5 mg/dL, and a normal D-dimer level. The suspicious diagnosis of right atrial metastasis was made by TEE. However, the diagnosis of right atrial thrombi was made by contrast CMR. Finally, the 18 F-FDG PET-CT demonstrated no metabolic activity in the right atrium, which further supported the diagnosis of thrombi. Eventually, the masses were removed by cardiopulmonary bypass thoracotomy because of a high risk of pulmonary embolism. Histopathology confirmed the diagnosis of thrombi.ConclusionsThis case highlights the importance of multimodality cardiac imaging in the appropriate diagnosis of a RA masses in patient of lymphoma. Diagnosis of RA masses can be made using multimodal cardiac imaging like TTE, TEE and CMR, even PET. Echocardiography is the most commonly used on multimodal imaging in cardiac thrombus. CMR has high specificity in differentiating a tumor from thrombus, while 18 F-FDG PET has good sensitivity to determine the nature of the masses.

Atrial hepatocellular carcinoma metastasis after liver transplantation.

Recurrence of hepatocellular carcinoma following liver transplantation usually occurs within two years, and atrial metastases are extremely rare. This article examines a case of hepatocellular carcinoma recurrence with atrial metastasis 18 years after a liver transplantation.

Case report: role of multidisciplinary approach in a case of spine osteosarcoma with oligometastatic heart disease

Introduction. Primary spinal osteosarcoma and rare metastatic heart lesion are considered significant factors for poor prognosis. The available work indicates that combined treatment, including the radical surgery of heart solitary metastatic lesion, probably provides the best outcome.Case report. Man, 27-year-old, with Th8 spinal osteosarcoma and solitary left atrial metastasis. From October 2019 to February 2020 5 cycles of chemotherapy (high doses of platinum and doxorubicin) were carried out with positive effect. Next steps were surgery: March 2020 – spondylectomy of the Th8 vertebra with combined stabilization; September 2020 – subtotal resection with plasty of the right atrium, tricuspid valve and prosthesis of the right coronary artery. Between the first and second surgery, 4 more same chemotherapy cycles were carried out. Currently, 24 months after completion of treatment, there are no signs of the disease.Conclusion. The article presents a unique case of treatment of primary osteosarcoma and metastatic lesion of rare location. Multidisciplinary approach and combination treatment in specialized centers increase the probability of favorable outcome in such cases.

Right Atrial Metastasis from Melanoma Treated with Immunotherapy

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Right and left atrial metastasis of renal cell carcinoma: A case report

Introduction and importanceCardiac tumors are uncommon with an estimated incidence of 0.002–0.3 % in autopsy series. Most cardiac tumors are metastatic in nature. Renal cell carcinoma (RCC) metastatic to the heart without inferior vena cava (IVC) contiguous involvement is extremely rare with about 31 cases reported in the literature and only one case with bilateral atrial metastases.Case presentationIn this report, the surgical management of metachronous RCC involving the right and left atrium is described in a 41-year-old male patient three years after initial diagnosis who presented with worsening episodes of cough, dyspnea, chest pain and hemoptysis. Transesophageal echocardiogram revealed significant inflow obstruction. The patient underwent bilateral atrial mass excision via median sternotomy. The postoperative period was unremarkable, and the patient was referred to medical oncology to pursue further treatment.Clinical discussionAmong the reported cases of cardiac RCC metastases without contiguous IVC involvement, bilateral atrial metastases are exceedingly rare. To our knowledge, this is the first case with bilateral atrial involvement to undergo surgical resection reported in the literature.ConclusionIsolated biatrial cardiac metastases from RCC can be successfully resected with good outcomes in selected patients.

P1703 Cardiac metastasis of germ cell tumor "like beads" in the right heart chambers and also left atrium

Abstract Introduction Testis tumors constitute 1-2% of all malignant tumors in men. But it is the most common solid tumor in men between 15-35 years of age. Germ cell tumors constitute for almost 90% of all testis tumors. Intracardiac metastasis of testicular carcinomas is rare. We now report a case of a testicular germ cell tumor with right atrial metastasis. Case report A 30-year-old male patient was diagnosed with B-cell ALL.Chemotherapy and radiotherapy were completed in 2016. In January 2017, the patient applied to the hospital with pain in the right testicle.A mass detected and orchiectomy was performed.Pathologic examination revealed mixed germ cell tumor and B-cell ALL infiltration.Chemotherapy was started. The patient was admitted to our hospital with fever, in March 2018.Antibiotics were started but fever contuniued.Transthoracic echocardiography showed a large,hypoechogen,mobile mass in the right atrium.Then transesophageal echocardiography revealed a 2x3,3 cm mobile mass within the right atrium that prolapsed through the tricuspid valve into the right ventricle in diastole.We could not distinguish if it is a vegetation or a metastatic mass. The patient underwent cardiac surgery.Pathologic examination revealed mixed germ cell tumor metastasis. After the surgery, the patient was transferred to the intensive care unit because of sepsis. Antibiotics were expanded due to fever. Control transthoracic echocardiography and also transesophageal echocardiography showed a 1,8 x 0,6 cm mobile mass extending from the inferior vena cava into the right atrium and through the patent foramen ovale into the left atrium. One week after the surgery, a mass was detected in the transthoracic echocardiography. But no further examination was done. We thought that the mass may not have been completely removed in the the operation (residual tumor?). The patient was evaluated with the department of oncology and cardiovascular surgery. It was decided that reoperation would be very risky. Conclusion Metastatic tumors of the heart are seen more frequently than primary tumors. Although intracardiac metastasis of testicular germ cell tumors are rare (less than %1), it has been related to short survival. They may lead to the congestive heart failure, paradoxical systemic emboli and vena cava superior syndrome. Most cases in the literature are associated with right atrial mass. But in our case, the mass was extending from the inferior vena cava into the right atrium and through the patent foramen ovale into the left atrium. We wanted to share our experience and also wanted to discuss the treatment modality for similar patients. Abstract P1703 Figure.

A right atrium metastasis of breast cancer after long-term endocrine therapy

We report a case of right atrial metastasis in a 66-year-old female patient with breast cancer. The patient presented with palpitation and dyspnea after long-term endocrine therapy. A large echo-dense mass was found in the right atrium after the examination. In order to relieve the symptoms, the patient underwent a resection of the atrial lesion, and the pathology confirmed that it was metastatic breast cancer. Next-generation sequencing (NGS) of the entire exon was taken to explore the gene expression of the metastatic lesion. Forty-eighty genes were identified with mutations, and the mutations of ATM and ESR1 were considered to be associated with the development and metastasis of breast cancer in this case.

DEADLY PALPITATION: A RARE CASE OF LEFT ATRIAL MASS

SESSION TITLE: Lung Cancer: Expect the Unexpected SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/22/2019 3:45 PM - 4:45 PM INTRODUCTION: Case series suggest that two thirds of all cardiac metastases involve the pericardium, one third the epicardium or the myocardium and only 5% the endocardium. The pericardium tumors were mesothelioma and carcinoma of the lung, ovary, stomach and prostate. The epicardium involved most often by melanoma, lung squamous cell carcinoma and bronchoalveolar carcinoma. The myocardium most often involved by melanoma and lymphomyeloproliferative processes, whereas the endocardium was especially involved by melanoma, kidney carcinoma and liver carcinoma.[1] We are present this case to help recognize possible presenting symptoms of cardiac tumors including heart failure, arrhythmias, inflow/outflow tract obstruction, peripheral embolism, or symptoms of primary tumor. CASE PRESENTATION: A 54 year old female presented to emergency room with palpitations for two months with associated cough. Past medical history significant for active tobacco use, hypertension. She denied weight loss and other cardiopulmonary symptoms. CT chest obtained in the emergency room was notable for right lower lobe consolidation. Transthoracic echocardiogram to further investigate these palpitations showed a left atrial mass measuring 2.2x3.3 cm. She was treated with antibiotics for pneumonia and improved clinically. With the impression of left atrial myxoma, cardiac catheterization was performed that showed normal coronaries with preserved LV function. Cardiovascular surgeon proceeded with excision of left atrial mass. The tumor was found to be adherent to left atrial wall without involvement of pulmonary veins and was excised completely. His impression was that this mass was not a benign morphology of myxoma. Pathology reported squamous cell carcinoma of unknown origin. Given her risk factors for lung cancer, CT chest was repeated after completion of pneumonia treatment which showed evidence of right lower lobe lung mass. CT guided biopsy was performed which confirmed a poorly differentiated squamous cell carcinoma. PET scan showed evidence of liver, adrenal glands, and skeletal metastasis. Patient was diagnosed with stage IV poorly differentiated squamous cell carcinoma of the lung. DISCUSSION: Presentations vary from primary cardiac symptoms versus primary tumor symptoms. In our case, palpitations were our patient’s main complaint. 80% of cardiac tumors are benign with 50% of these benign tumors being myxomas. The incidence of myxomas in women is 2-4 times higher than in men CONCLUSIONS: Cardiac metastasis is very rare. Surgical excision of atrial metastasis can achieve long term survival in some cases, but overall the prognosis is poor, especially in patients like ours with non-small-cell lung cancer who already tend to have low survival rates. Our patient underwent surgical resection of left atrial mass and at least improved clinically from this standpoint. Reference #1: Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007;60(1):27-34.C DISCLOSURES: No relevant relationships by John Lung, source=Web Response No relevant relationships by Nooraldin Merza, source=Web Response No relevant relationships by Andrew Pham, source=Web Response No relevant relationships by AHMED QASIM, source=Web Response No relevant relationships by Kaylee Shepherd, source=Web Response

Clinical features, treatment and prognosis of 12 patients with primary hepatoblastoma combined with central nervous system metastasis

Objective To investigate the clinical characteristics, treatment and prognosis of hepatoblastoma (HB) patients with the central nervous system (CNS) metastasis. Methods The clinical data of 12 patients with CNS metastasis who were admitted to Beijing Tongren Hospital, Capital Medical University from January 2011 to June 2016 were retrospectively analyzed.The clinical features, treatment and prognosis of HB patients with CNS metastasis were summarized. Results (1) Clinical features: all 12 patients were diagnosed as stage-Ⅳ patients according to posto-perative Children ′s Oncology Group (COG ) stage system.The primary positions of extrahepatic metastatic characteristics were as follows: lung metastasis in 12 cases, bone metastasis in 3 cases, and adrenal metastasis in 2 cases, right atrial metastasis in 1 case, and abdominal lymph node metastasis in 1 case.Fetal and epithelial mixed type was the most common type in pathologic Pathologic classification of HB (50%, 6/12 cases). CNS metastasis was detected in all 12 cases during the course of treatment.Brain metastasis were found in 11 cases of CNS imaging features, and 1 case had spinal metastatic tumors.(2)The treatment for CNS metastasis: all cases were given chemotherapy-based comprehensive treatment after being diagnosed as CNS metastasis of HB.Ten cases of CNS metastasis were treated by maintenance chemotherapy and 2 cases received chemotherapy plus intracranial tumor resection.(3)The prognosis of HB with CNS metastasis: the follow-up time was from 7 months to 54 months in 12 HB cases with CNS metastasis, and the median follow-up time was 20 months.The survival time of HB was 1-15 months, and the median survival time was 3.5 months after the diagnosis of CNS metastasis.Two cases of CNS metastasis were given intracranial tumor resection and chemotherapy and were followed up to June 2016, and survival time was 15 months and 5 months respectively.The survival time of other 10 cases without intracranial surgery was 1-6 months, and the median survival time was 3 months.By drawing survival function curve and applying Log-Rank test for CNS transfer children, the survival time of patients given intracranial tumor resection and chemotherapy was longer than those without surgery (P<0.05). Conclusions The occurrence of CNS metastasis occurred in HB patients in phase-Ⅳ patients with pulmonary metastasis.The most common site of CNS metastasis is brain metastasis, which is hematogenous metastatic pathway, and 1 case of spinal cord metastasis was considered as the local invasion and metastasis.For HB cases with CNS metastasis, the survival time is short and the prognosis is poor, but the survival time might be prolonged for the phase-Ⅳ patients with intracranial tumor resection. Key words: Hepatoblastoma; Metastasis; Prognosis

Right atrial metastasis of GIST detected by 18F-FDG PET/CT

Right atrial metastasis of GIST detected by 18F-FDG PET/CT

Left Atrial Metastasis Presenting as Right-sided Heart Failure in a Patient with Acute T-cell Lymphoblastic Leukemia

Background: Cardiac metastasis is usually seen with lung carcinomas or malignant melanoma, but rarely with leukemia, and is usually a post-mortem diagnosis. Secondary cardiac tumors arising from the left atrium, where benign myxomas predominate, are uncommon. Case presentation: We report a 22-year old Filipino male, recently diagnosed with acute T-cell lymphoblastic leukemia, presenting with right-sided heart failure symptoms. On work-up, transthoracic echocardiogram showed a mass with mixed echogenicity, irregular borders and broad-base attachment to the anterior and posterior walls of the left atrium. He was treated with nitrates, ivabradine, captopril and digoxin; and subsequently underwent chemotherapy with vincristine, doxurubicin, intrathecal methotrexate and cytarabine. Right-sided heart failure symptoms improved after initiation of chemotherapy. Resolution of the left atrial tumor was documented after completion of induction chemotherapy. Conclusion: Cardiac metastasis should be considered in patients with acute lymphoblastic leukemia presenting with right-sided heart failure. Chemotherapy and supportive cardiac medications should be considered in these cases. Other treatment options should also be investigated.

Right atrial metastasis of GIST detected by 18F-FDG PET/CT.

Right atrial metastasis of GIST detected by 18F-FDG PET/CT.

A rare cause of left atrial mass: endometrial stromal sarcoma metastasis

Endometrial stromal sarcomas (ESS) are rare tumors of the uterus. The metastasis of ESS to the cardiac structures is extremely infrequent. Several cases of right-sided heart metastasis have been previously reported. To our knowledge, only one similar case is available in the published studies that presented with recurrent embolic strokes due to left atrial metastasis of ESS. In this report, we describe a 53-year-old woman with endometrial stromal sarcoma; she was referred to our hospital with subacute onset of severe dyspnea and a left atrial mass causing severe mitral stenosis.

Right Atrial Metastasis of Uterine Leiomyosarcoma Causing Obstructive Shock

Uterine leiomyosarcomas are rare tumours, and secondary cardiac metastases are even rarer. We present the case of a 56-year-old ethnic Chinese woman who was being treated with adjuvant pelvic radiation for uterine leiomyosarcoma when she presented with signs of right heart failure and shock. She was rapidly diagnosed with a solid mass attached to the tricuspid valve. Subsequent surgical resection revealed leiomyosarcoma metastasis. Metastases of uterine leiomyosarcoma to the heart are extremely rare, but clinicians should be aware of this phenomenon. Surgical resection, when feasible, can be associated with longer survival.

Solitary atrial myocardial metastasis revealing ileal neuroendocrine carcinoma

A previously healthy 56-year-old man presented with chest pain. Echocardiography and cardiac magnetic resonance imaging revealed minimal pericardial effusion associated with an isolated myocardial mass, protruding into the left atrium. The tumor was surgically removed. Cardiac valve morphology was strictly normal. Histology revealed a well-differentiated neuroendocrine carcinoma. Positron emission tomography scan and thin-slice abdominal computed tomography demonstrated ileal tumor, without evidence of liver metastasis. Histological study of the removed ileal tumor confirmed a neuroendocrine carcinoma, and histology of liver biopsy was negative. Somatostatin analogue treatment was started. No tumoral recurrence was observed after 1 year of follow-up. In conclusion, we report an unusual presentation of neuroendocrine carcinoma, revealed by a large solitary atrial metastasis, in the absence of liver involvement or carcinoid syndrome.

Complete resection of asymptomatic solitary right atrial metastasis from renal cell carcinoma without inferior vena cava involvement

pump speed to approach the lower operating limit of 1800 rpm. Implications include (1) lower accuracy of estimated flow at lower speeds, (2) less ability to correct suction conditions by lowering pump speed, and (3) increased potential for pump thrombosis or rotor instability. Second, the HeartWare HVAD inflow cannula length was designed for placement through the left ventricular apex and is not optimized for the right ventricle. Shortening the length of the inflow cannula to accommodate the shallower right ventricular cavity in the right ventricular outflow tract is achieved by placing additional felt rings under the fixation ring (Figure 2, B). Other locations that may potentially allow normalchestclosure includeplacementintotherightatrium or the diaphragmatic surface of the right ventricle. For this patient, the goals for pump flows were 3 to 4 L/min through the RVAD and 5 to 6 L/min through the LVAD. Anticoagulation strategy consisted of aspirin and warfarin sodium, with an international normalized ratio goal of 2 to 3. We were successful in this case; however, this is the first report of HeartWare HVAD use in the role of RAVD after HeartMate II implantation. Firm recommendations regarding the potential widespread applicability of this therapy are therefore limited.

Testicular Germ Cell Tumor Metastatic to the Right Atrium

We describe a right atrial metastasis of a testicular germ cell tumor, which was successfully removed from the tricuspid valve and subvalvular apparatus without the need for valve replacement.

A case of left atrial metastasis from hepatocellular carcinoma: life-saving palliative resection using cardiopulmonary bypass.

Hepatocellular carcinoma (HCC) with metastasis to the heart is uncommon. We report a rare case of left atrial metastasis of HCC which was resected palliatively as a live-saving procedure with the use of cardiopulmonary bypass. Despite chemoembolization, which was undertaken 11 times, cardiac metastasis occurred. Moreover, the right and left atria and left ventricle were involved simultaneously. The severe dyspnea improved dramatically after surgery. Following this, the patient underwent systemic chemotherapy and lived a life without recurrence of symptoms associated with mitral valve obstruction.

Left atrial metastasis from hepatocellular carcinoma with liver cirrhosis

Surgical treatment in hepatocellular carcinoma patients with cardiac involvement is challenging, and its prognosis remains unclear because of its rarity. A 48-year-old male hepatocellular carcinoma patient presented with right atrial involvement through the inferior vena cava and a left atrial mass, which nearly occluded the mitral valve, and extended from a pulmonary metastasis. Emergent surgery was performed due to sudden severe respiratory failure despite profound liver cirrhosis (Child-Pugh class B). Nevertheless, the patients postoperative course was uneventful, and over six months of follow-up, he has shown no remarkable symptoms and has maintained a tolerable liver function.