Diagnosis Of Cardiac Angiosarcoma Research Articles

Caring for a Pregnant Patient With a New Diagnosis of Cardiac Angiosarcoma

The use of Jean Watson's theory of human caring science provided a framework for reflecting on the care of patient who had a complex diagnosis. A 34-year-old gravida 1 para 0 woman was admitted at 31-weeks gestation with shortness of breath. She was found to have a pulmonary embolism for which she was admitted for anticoagulation therapy. The imaging revealed a cardiac mass, which was found to be a cardiac angiosarcoma with pulmonary metastases, a life-limiting diagnosis. The patient was treated in the cardiac unit; for 6 weeks, obstetric nurses assessed and completed daily fetal nonstress tests. Multidisciplinary meetings were held among cardiology, oncology, and obstetrics to discuss treatment and birth planning. Many nurses developed a relationship with the family. The patient’s goal was to have a vaginal birth and to breastfeed her baby. To achieve her goals, she was induced at 36 4/7 weeks; however, she needed a cesarean because of nonreassuring fetal heart tracing. The cesarean surgery went smoothly, and the patient accomplished skin-to-skin contact with her newborn and attempted to breastfeed at birth. She was transferred to the surgical intensive care unit for immediate postoperative care. She was ultimately discharged home on Day 5 from the mother–baby unit, with continued treatment for her cancer. Her male newborn weighed 1,975 g and had stable Apgar scores, although he remained in the NICU for hypoglycemia and thermoregulation. He was discharged to home on day of life 22. Caring for patients with complex diagnoses is common in our institution, but caring for this family impacted nursing staff in a different way. Although the patient received a serious diagnosis, it was the relationship with the family that impacted the nurses. When a patient receives terminal diagnosis while she is, instead, expecting to celebrate a new life, it affects everyone involved. Through the use of Watson’s theory of human caring, the nurses involved with this patient shared clinical narratives of how being present and caring for self and others are integral to nursing care. Their stories helped others to process the experience, recover, heal, and identify opportunities for future practice. Strategies could include journaling, sharing their stories, multidisciplinary debriefing, and validation that caring for the care team is as important as caring for the patients.

Right sided reconstruction of the heart for invasive angiosarcoma of the right atrium

Introduction Primary cardiac tumors are a rare entity (0.0017 to 0.033%, based on autopies). Most cardiac tumors are metastastic locations of other primary tumors. About 75% of the primary cardiac tumors are benign, and 75% of these benign tumors are myxomas. The remaining 25% of the primary tumors of the heart are malignant, with a majority of sarcomas (75%). Median survival for cardiac sarcomas is only six months. A 35-year-old male presented with new diagnosis of cardiac angiosarcoma. We describe the case, diagnosis, treatment modalities and first observations concerning survival. Case description A 35-year-old male presented with palpitations and progressive dyspnea since five weeks. ECG showed atrial fibrillation and transthoracic echocardiography (TTE) demonstrated a large right intra-atrial mass (7.8x5.2cm), infiltrating the interatrial septum and the tricuspid valve. There were no signs of right ventricular inflow obstruction. TEE and cardiac MRI confirmed a large intra-atrial mass (59x49x68 mm) and because of the density, the irregular shape and the localization, an angiosarcoma was suspected (Figure 1). In addition infiltration of the pericardium and pericardial effusion were found. A FDG-PET/CT scan did not show signs of metastatic disease. Coronary angiography showed normal coronary arteries. Results and conclusion After fourteen days, a resection was performed under general anesthesia and full extracorporeal circulation (Figure 2). A reconstruction of the fibrous part of the septum and tricuspid annulus allowed implantation of a tricuspid bioprosthesis (Mosaic 33). Right and left atrium and the basal part of the right ventricle were reconstructed using pericardial patches. The vena cava superior was reconstructed using a PTFE graft. CABG was performed on branches of the right coronary artery using a saphenous vein graft. A permanent pacemaker was implanted after ten days because of persistent total AV-block. Patient recovered uneventfully of the intervention. Take-home message Pathologic examination showed a classic angiosarcoma, with resection margins free of tumor. CD31 and CD34 immunohistochemical staining was positive, confirming vascular differentiation and the diagnosis of an angiosarcoma (Figure 3). After multidisciplinary consultation between oncologists, pathologists, radiologists and cardiac surgeons an intensive adjuvant chemotherapy treatment was initiated. Up until the moment of evaluation there is a survival of six months, with a NYHA classification I and with no arguments for metastatic liver disease on PET-CT. We therefore believe that a radical and aggressive resection combined with optimal medical treatment can improve survival in this devastating disease.

The disastrous “sun ray” sign in cardiac magnetic resonance: an indicator of angiosarcoma

Distinguishing the benign and malignant cardiac masses is usually a diagnostic challenge, and safe, non-invasive, and reliable techniques are necessary to avoid any delay in treatment. The previously described "sun ray" appearance is an important sign in the diagnosis of cardiac angiosarcoma, and in this report we present 3-T magnetic resonance imaging findings to distinguish the rare but fatal cardiac angiosarcoma.

Cardiac Angiosarcoma Management and Outcomes: 20-Year Single-institution Experience

To identify the clinicopathologic characteristics, treatments, and outcomes of a series of patients with primary cardiac angiosarcoma (AS). This retrospective case series was set in a tertiary referral center with a multidisciplinary clinic. Consecutive patients with institutionally confirmed pathologic diagnosis of cardiac AS from January 1990 to May 2011 were reviewed. Main outcome measures included patient demographics, tumor characteristics, management strategies, disease response, and survival. Data from 18 patients (78 % male) were reviewed. Sixteen patients (89 %) had AS originating in the right atrium. At diagnosis, eight patients (44 %) had localized/locally advanced disease and ten patients (56 %) had metastatic disease. Initial treatment strategies included resection (44 %), chemotherapy (39 %), and radiotherapy (11 %). Of the eight patients with localized/locally advanced AS, two underwent macroscopically complete resection with negative microscopic margins, one underwent macroscopically complete resection with positive microscopic margins, one underwent macroscopically incomplete resection, two received chemotherapy followed by surgery and intraoperative radiotherapy, one received chemotherapy alone, and one died before planned radiotherapy. Median follow-up was 12 months. Median overall survival (OS) was 13 months for the entire cohort; median OS was 19.5 months for those presenting with localized/locally advanced AS and 6 months for those with metastatic disease at presentation (p = 0.08). Patients who underwent primary tumor resection had improved median OS compared with patients whose tumors remained in situ (17 vs. 5 months, p = 0.01). Cardiac AS is associated with poor prognosis. Resection of primary tumor should be attempted when feasible, as OS may be improved. Nevertheless, most patients die of disease progression.

Angiosarcoma of the right atrium presenting as collapse

Pericardial effusion may originate from a wide variety of underlying pathology. Primary cardiac malignancy should always be considered as a rare underlying cause. Angiosarcoma is the most common cardiac malignancy, which often arises as a mass in the right atrium. We describe a young patient with collapse due to pericardial effusion caused by a primary cardiac angiosarcoma. The case is an example of the difficulties and dilemmas which may be encountered in assessing the diagnosis of cardiac angiosarcoma.

Cardiac angiosarcoma: Report of a case diagnosed by echocardiographic‐guided fine‐needle aspiration

The authors present a case of cardiac angiosarcoma diagnosed by fine-needle aspiration (FNA) in a 33-year-old male. A percutaneous right atrial mass biopsy was performed via a right internal jugular venous approach and under echocardiographic guidance. FNA showed pleomorphic spindle-shaped cells present singly and in small clusters in a background of hemorrhage. Occasional pseudo-acini or microacinar structures were observed, that are lined with abnormal spindly to polygonal cells, indicative of vasoformative structures. Immunostain for CD31 was strongly positive. A diagnosis of cardiac angiosarcoma was made, following which, the patient underwent treatment with chemotherapy.

Cardiac angiosarcoma

Primary tumors of the heart are extremely rare, with a prevalence rate of around 0.01% in collective autopsy studies. Majority of the primary cardiac tumors are benign. Myxoma is the most common primary cardiac tumor, while angiosarcoma is the commonest primary malignant tumor. We present a case report of a 20-year-old patient with history of breathlessness and hemoptysis. A malignant mass was seen arising in the right atrium, with pericardial effusion and multiple metastases in the lung. A complete autopsy was performed and a diagnosis of cardiac angiosarcoma was confirmed on histology and immunohistochemistry.

Angiosarcoma causing cardiac rupture

We report the 7th known case in the literature of cardiac angiosarcoma resulting in cardiac rupture. A 34-year-old woman was admitted presenting chest pain and pericardial effusion. After the patient had been treated for 3 months under the diagnosis of pericarditis of unknown etiology, she became hypotensive. Doppler echocardiography showed increased pericardial effusion and a communication between the right atrium and the pericardial cavity. An emergency operation was undertaken to drain the effusion and explore the etiology. We found the ruptured right atrium and the irregularly shaped tumor extending from the pericardium near the inferior caval vein to the right ventricle. There was no apparent tumor on the right atrium, but its wall was extensively thin, which we replaced with autologous pericardium. The patient died on the 44th postoperative day. Clinical diagnosis of cardiac angiosarcoma is usually very difficult. If Doppler echocardiography demonstrates pericardial effusion and find a ruptured right atrium with or without mass formation, we should suspect cardiac angiosarcoma.