scholarly journals P1248 What are the suspicious echocardiographic features of a malignant cardiac mass?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Paolisso ◽  
G Saturi ◽  
L Bergamaschi ◽  
E C D"angelo ◽  
M Coriano ◽  
...  

Abstract BACKGROUND Cardiac Masses (CM) represent a rare and heterogeneous group with a prevalence of 0.3% at autopsy, divided in benign masses - primary tumors and pseudotumors - and malignant ones - primitive tumors and metastasis, either directly invading the heart and pericardium or as a consequence of hematologic spread. 2-D Echocardiography is nowadays the first line approach to define nature and management of CM, but is it enough to guide a therapeutic strategy? PURPOSE To evaluate echocardiographic CM malignancy features in patients admitted to our Centre between 1997 and 2017. MATERIALS AND METHODS We retrospectively evaluated a population of 180 consecutive patients (45% males; mean age 60 ± 16 years; BMI 25 ± 5 Kg/m2), referred to our echocardiographic lab with suspicion CM. All patients were examined in both left lateral and supine position, and heart was visualized from all available echocardiographic windows. Definite diagnosis was obtained by histologic examination of biopsy, surgical samples or, in cases of cardiac thrombi, by radiological evidence of thrombus resolution after adequate anticoagulant treatment. We excluded normal anatomical variants in the group of pseudotumors due to the impossibility of obtaining histological examination. Comparisons between categorical variables were performed by Chi-square or Fisher exact test. P values ≤ 0.05 were considered significant. Variables with statistical signification lower than p ≤ 0.05 in univariable analysis were included in logistic regression analysis to determinate independent predictors of malignant masses. RESULTS We detected 129 benign CM (76% primitive tumors and 24% pseudotumors) and 51 malignant cardiac tumors (45% primitive tumors and 55% metastasis). In 7 cases a poor acoustic window did not allow an optimal examination; in remaining 173 patients, the classical 2-D echocardiogram identified 157 masses with a diagnostic accuracy of 91%. Benign tumors and pseudotumours were localized predominantly in left heart chambers, while malignant primitive tumors and metastasis were mainly detected in right heart, in pericardium or in pulmonary artery branches (p < 0.001). The largest ecocardiographic diameter appeared greater for the malignant masses (mean of 49 ± 26 mm) than benign ones (30 ± 16 mm, p = 0.003). The occurrance of any pericardial effusion (p < 0.001), extension to pericardium (p = 0.01) or to main vessels (p = 0.006) were also associated with malignant masses. Finally, multivariate analysis showed only largest diameter (p = 0.001) and pericardial effusion (p < 0.001) were independent predictors of malignancy. CONCLUSION 2D Echocardiography is an excellent, non invasive technique for first line evaluation of patients with suspicion CM. It is safe, accurate and have high diagnostic accuracy in identifying CM and their benign or malignant nature. In particular, a large mass associated with any pericardial effusion must pose suspect of malignancy.

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Paolisso ◽  
E C D"angelo ◽  
L Bergamaschi ◽  
A Foa ◽  
M Coriano ◽  
...  

Abstract BACKGROUND Cardiac Masses (CM) represent an heterogeneous group with a prevalence of 0.3% at autopsy, divided in benign masses (primary tumors and pseudotumors) and malignant ones (primitive tumors and metastasis). 2-D Echocardiography is nowadays the first line approach to define nature and management of CM, but is it enough to guide a therapeutic strategy? PURPOSE To evaluate echocardiographic diagnosis accuracy for CM in patients admitted to our Centre between 1997 and 2017. MATERIALS AND METHODS We retrospectively evaluated a population of 180 consecutive patients (45% males; mean age 60 ± 16 years; BMI 25 ± 5 Kg/m2), referred to our echocardiographic lab with suspicion CM. All patients were examined in both left lateral and supine position, and heart was visualized from all available echocardiographic windows. Definite diagnosis was obtained by histologic examination of biopsy, surgical samples or, in cases of cardiac thrombi, by radiological evidence of thrombus resolution after adequate anticoagulant treatment. We excluded normal anatomical variants in the group of pseudotumors due to the impossibility of obtaining histological examination. Sensitivity, specificity, predictive accuracy for a positive test, and predictive accuracy for a negative test were calculated by standard formulas (corrected for prevalence by Bayes theorem). RESULTS We detected 129 benign CM and 51 malignant cardiac tumors. In 7 cases a poor acoustic window did not allow an optimal examination; in remaining 173 patients, the classical 2-D echocardiogram identified 157 masses with a diagnostic accuracy of 91%. Of 173 CM diagnosed, 146 were classified by echocardiographer as benign masses (125 true benign on histological examination) and 27 as malignant ones (all malignant after histological confirmation); the results showed 56% sensitivity, 100% specificity, 100% positive predictive value, 98% negative predictive value, with 88% overall diagnostic accuracy in identifying the nature of masses. 23 cases were undetermined and needed second level instrumental investigations to be characterized. Diagnostic accuracy for distinguishing primary benign tumors and pseudotumors decreased to 80%, with a significant increase in both "false" benign tumors (9 out of 91) and "false" pseudotumors (15 out of 34) with 85% sensitivity, 68% specificity, 10% positive predictive value, 99% negative predictive value. CONCLUSION 2D Echocardiography is an excellent, non invasive technique for first line evaluation of patients with suspicion CM. It is safe, reliable with a high predictive value and diagnostic accuracy in identifying CM and their benign or malignant nature. In contrast, these results were insufficient to start an anticoagulant in suspicion thrombus or cardiac surgery for primary tumor, since second level instrumental examinations needed. 2D Echocardiography alone seems unuseful for classifying malignant masses in primitive or metastasis.


2018 ◽  
Vol 22 (4) ◽  
Author(s):  
Beata Kucińska ◽  
Bożena Werner

The increase in the availability of transthoracic echocardiography allows the diagnosis of not only congenital heart defects, which are the most common congenital defects in children, but also detection of cardiac masses such as thrombi, vegetations or heart tumors. Performing transthoracic echocardiography one should remember about normal anatomical structures in the atria and ventricles. The presence of central catheters and intracardiac leads favors the formation of thrombi in the heart. The vegetations which are characteristic for infective endocarditis mostly occur on the aortic and/or mitral valve. Primary cardiac tumors in children are very rare (approximately 0.2% of the population) and are usually oligosymptomatic. About 90% of them are benign tumors. The most common is the rhabdomyoma, which often coexists with tuberous sclerosis. The second most frequent tumor in children is a fibroma. Less common primary tumors in children are: teratomas, hemangiomas, lipomas, papillary fibroelastomas. In the differential diagnosis of cardiac masses comprehensive assessment and analysis of both imaging results, as well as medical history, physical examination, laboratory tests and other additional tests are extremely important.


2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 133-133
Author(s):  
Juan Rodrigo Briones Carvajal ◽  
Mahdi Farzad Naimi ◽  
Liying Zhang ◽  
Urban Emmenegger

133 Background: Second generation androgen receptor signaling inhibitors such as A and E are commonly used first-line treatment options for mCRPC. While differences in the side effect profile of these agents are well documented, there are no predictive markers of response to A versus E, and there is a paucity of comparative outcome data. Methods: We conducted a retrospective exploratory analysis of 100 mCRPC patients (pts) treated at Odette Cancer Centre (Toronto, ON, Canada) between August 2012 and June 2020 with either A (n = 50) or E (n = 50). Pts undergoing first-line mCRPC therapy were randomly selected from a list of 327 A and 254 E patients. Following extraction of disease and pt characteristics, as well as outcome data, we applied the Wilcoxon rank-sum nonparametric test or the Fisher exact test for continuous or categorical variables, respectively, for between group comparisons. For time to event analyses, we created Kaplan-Meier (KM) curves with log-rank testing. Two-sided p-values < 0.05 were considered significant. Results: The A and E cohorts were comparable regarding diagnostic PSA, Gleason score categories, and treatments prior to presentation with mCRPC. The median time to CRPC in the A cohort was 23.3 (95%CI 15.6-29.9) months, compared to 24.1 (19.4-37.4) months in the E cohort (p = 0.942). At initiation of A or E therapy both the median (Q1,Q3) age (77(70,82) vs 76(69,81) years) and median Charlson Comorbidity Index (10(9,11) vs 10(9,11)) were similar (p = 0.469 and p = 0.736, respectively). The rate of diabetes was significantly lower in the A group (8% vs 38%; p < 0.001), but there were no significant differences in cardiovascular comorbidities. Pts starting A therapy had a higher rate of bone metastasis (92% vs 68%; p = 0.005); otherwise, the metastatic pattern did not differ. The median PSA at start of A was 46.75 (13.77,176.80), compared to 27.07 (8.64,136.20) in the E group (p = 0.218). Baseline ALP, hemoglobin and albumin were all comparable. Median follow-up was 13.7 (8.3,26.3) and 19.5 (9.8,34.0) months in the A and E groups (p = 0.091). 38% of A pts and 44% of E pts went on to further lines of systemic therapy upon progression (p = 0.685). The median time to next line of systemic therapy was 11.3 (95%CI 8.3-15.9) months for the A cohort and 12.7 (9.7-16.6) for the E cohort (p = 0.844). The actuarial median overall survival from KM estimations was 35.7 (20.4-52.5) months for the A group, and 34.0 (25.7-38.0) months for the E group. Conclusions: In men undergoing first-line A or E therapy for mCRPC, time to next line of systemic therapy and overall survival did not differ significantly, while baseline pt and disease characteristics were largely similar. A substantial number of pts do not receive ≥2 lines of therapy for mCRPC under real-world circumstances.


2017 ◽  
Vol 26 (1) ◽  
pp. 47-49 ◽  
Author(s):  
Aitizaz U Syed ◽  
Mansour B Al Mutairi ◽  
Mustafa Al Muhaya ◽  
Mofeed Morsey ◽  
Ahmed Al Hujailey ◽  
...  

Primary tumors of heart are rare in infants. We report a case of inflammatory myofibroblastic tumor in a 4-month-old baby girl who presented with a massive pericardial effusion. She underwent complete surgical excision of the tumor. This is the first reported case from the Middle Eastern region. The clinical behavior and management of these rare infantile cardiac tumors are discussed briefly in this report.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1042-1042 ◽  
Author(s):  
Andrea Rocca ◽  
Giuseppe Bronte ◽  
Sara Ravaioli ◽  
Maurizio Puccetti ◽  
Maria Maddalena Tumedei ◽  
...  

1042 Background: The androgen receptor (AR) is widely expressed in breast cancers but its role in estrogen receptor (ER)-positive tumors is still controversial. However, the AR/ER ratio may impact prognosis and the response to antiestrogen endocrine therapy (ET). Methods: We assessed whether AR in primary tumors and/or matched metastases is a predictor of efficacy of first-line ET in advanced breast cancer (ABC). We evaluated patients treated with first-line ET (2002–2011), excluding those receiving concomitant chemotherapy or trastuzumab or pretreated with > 2 lines of chemotherapy. ER, progesterone receptor (PgR), Her2, Ki67 and AR expression was determined by immunohistochemistry. A cut-off of < 1% immunostained cells was used to categorize AR expression. AR expression was analyzed in relation to the other conventional biomarkers (ER, PgR, Her2 and Ki67), best response (CR, PR, SD, PD), and time to progression (TTP) (months). TTP was estimated using the Kaplan-Meier method and compared with the log-rank test. Hazard ratios and their 95% confidence intervals (95% CI) were estimated using the Cox regression model. The Chi-square test was used to evaluate correlations between categorical variables and best response. p values < 0.05 were considered statistically significant. Results: Of the 102 evaluable patients (93% were treated with an aromatase inhibitor), biomarkers were assessed in primary tumors in 70 cases, in metastases in 49 and in 17 in both). Median TTP was 17 months (95% CI 14-21.5, median follow-up 75 months). The overall concordance rate between primary tumors and metastases was 64.7% (95% CI 42%-87.4%) for AR expression. Differences in TTP according to AR status were not statistically significant. AR/PgR ≥ 0.96 was associated with a significantly shorter TTP (HR = 1.65, 95% CI 1.05-2.61, p = 0.030). AR status in primary tumors or metastases was not associated with PD as best response. In contrast, Ki67 > 20% and PgR < 10% showed a significant association with PD as best response. Using a cut off of ≤10% for AR expression, results did not change. Conclusions: AR expression does not appear to be useful to predict the efficacy of ET in ABC. Ki67 and PgR exert a greater impact on the efficacy of hormone therapy than AR.


2021 ◽  
Vol 49 ◽  
Author(s):  
Roseane Oliveira Feitosa ◽  
Saulo Romero Felix Gonçalves ◽  
Janilene De Oliveira Nascimento ◽  
Diana Guiomar Ferreira De Sena ◽  
Edna Michelly De Sá Santos ◽  
...  

Background: The chemodectoma is a rare neoplasm that originates from chemoreceptors located mainly in the aortic body, and carotid body and sinus, and responsible for detecting variations in blood pH, oxygen pressure and carbon dioxide. Dogs of brachiocephalic breeds and aged between 7 and 15 years have greater propensity. A neoplasm involves infiltrative growth in the vessels at the heart base, which leads to Congestive Heart Failure (CHF). The definitive diagnosis is performed by histopathological and/or immunohistochemical examination. The aim was to report a case of chemiodectoma in a dog, showed the disease clinical characteristics.Case: A 13-year-old male undefined breed dog was examinated in the medical clinic of small animal of Veterinary Hospital, Federal Rural University of Pernambuco (UFRPE) with respiratory effort, hyporexia, and edema in face, cervical, ventral thorax and thoracic limbs, with thirty days evoluted. About physical examination, we observed cachexia, orthopneic position, cyanosis and edema with a positive Godet sign, as well as 8% dehydration degree. Thoracic auscultation presented mixed dyspnea and muffled heart sounds. Chest radiography detected an radiopacity increase in pulmonary section and metastatic neoplastic process associated with pleural and pericardial effusion. Fluid therapy with lactated ringer and posterior thoracentesis in the right hemithorax region was performed for greater respiratory comfort for the patient. Hematological count and biochemical profiles stated normochromic normocytic anemia, relative and absolute lymphopenia, thrombocytopenia, as well as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The patient died after 12 hours when was submitted to necroscopic examination and histopathological evaluation. An infiltrative tumor of cardiac base was observed invading the light of the right atrium, obstructing the venous return, as well as a large thrombus located in the left ventricle and diffuse nodules in the lungs. Hydrothorax and hydroperitoneum were observed with serous fluid, with hepatic, renal and brain congestion, and duodenum hemorrhage. Histologically, the tumor was characterized as a chemodectoma with pulmonary metastasis.Discussion: Cardiac tumors are uncommon for canine population. A study sampled 729,265 dogs with observed incidence reaching 0.19%. The most common type is hemangiosarcoma with 69%, followed by chemiodectoma and lymphoma. Authors describe predisposed brachycephalic breeds such as Boxer, Boston Terrier and French Bulldog. In our case, the patient had elongated snout and undefined breed. Deregulation of chemoreceptors, which detect changes in pH and partial oxygen and carbon dioxide pressures, can result in hyperpnea and dyspnoea. Edema represents a deficit in venous return from the cranial and cervical regions, with consequent increase in hydrostatic pressure and liquid leakage into the thoracic cavity and subcutaneous tissue, thus inferring the Caudal Vena Cava Syndrome (CVCS). Tumors from the cardiac base, integrated with the large arteries insertion and adjacent to the atria, can cause pericardial effusion observed in this case. Chemodectomas are described as essentially benign tumors with low metastatic potential. In this case, pulmonary metastasis was detected. Surgical treatment is recommended when feasible. In this case, the patient had late veterinary care, in addition to the contraindication for surgery by the lung metastasis presence.


2018 ◽  
Vol 30 (1) ◽  
pp. 1-10
Author(s):  
SM Badruddoza ◽  
FA Azim ◽  
AJE Nahar Rahman ◽  
M Kamal ◽  
AR Barua ◽  
...  

Transitional cell carcinoma (TCC) comprises about 90% of all primary tumors of urinary bladder. The accuracy of multiple voided urine cytology justifies its continued use as a first line diagnostic and detection technique, particularly for high grade invasive cancers and clinically unsuspected case of carcinoma particularly carcinoma in-situ. In this study 57 cases were taken to see correlation of cytology, histology, stage, morphological pattern and sensitivity and specificity of urothelial cancers. Out of 57, 53 (92.99)% were positive for malignancy and 4(7.01%) were negative. There were 14 (24.56%) non-invasive papillary tumors, 1(1.76%) carcinoma in-situ and 42 (76.68%) invasive carcinoma of all grades and types. Of 14 grade-II non-invasive papillary tumors, 12 (85.72%) were cytologically positive. With only two exceptions, out of 39 all of the invasive carcinomas of all grades and types were identified by cytology as cancerous. A 100% positive cytology was noted in the detection of flat carcinoma in-situ, papillary adenocarcinoma and squamous cell carcinoma of the urinary bladder. Of the total 57 cases of malignant lesions of urinary tract, 53 (92.99%) were positive on cytological examination. The two TCC of the renal pelvis also gave a 100% positive cytologic results. Among invasive carcinoma, stage B1 and B2 urothelial cancers yield highest positive cytologic diagnosis rather than stage 0 and stage A urothelial cancers. For all tumors the sensitivity was 92.99%. The specificity was 100% since there were no false positive cases. The diagnostic accuracy was 93% (approximately). Comparison with previously published data this study showed highest diagnostic accuracy, sensitivity, specificity of voided urine cytology, good correlation with cytology histology and stage of tumor. So voided urine cytology, a very cheap and purely non invasive technique, can be done as an effective method to diagnose urothelial cancers in a developing country like Bangladesh where facilities for other investigations are practically limited.TAJ 2017; 30(1): 1-10


Author(s):  
Filippo Boriani ◽  
Edoardo Raposio ◽  
Costantino Errani

: Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis prognosis and therapy.The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.


Respiration ◽  
2021 ◽  
pp. 1-5
Author(s):  
Haizea Alvarez Martinez ◽  
Jolanda C. Kuijvenhoven ◽  
Jouke T. Annema

Primary cardiac tumors are extremely rare. Obtaining a tissue diagnosis is difficult and commonly requires open-heart surgery with associated morbidity. Esophageal endoscopic ultrasound (EUS) and EUS with the EBUS scope (EUS-B) provide real-time sampling of centrally located lung tumors and mediastinal lymph nodes. They also provide an excellent view of the left atrium, since it is located adjacent to the esophagus. To date, left atrium tumor diagnostics by endosonography is poorly explored. We describe 2 exceptional diagnostic cases of left atrium tumors in which cardiac surgery was hazardous due to the clinical condition or previous surgical interventions. During EUS-B-guided fine-needle aspiration (FNA), the left atrial masses were successfully and safely sampled, revealing a Burkitt lymphoma and a synovial sarcoma. FNA including cell block analysis enabled specific tumor diagnosis and molecular subtyping. Our findings suggest that in selected cases, linear endosonography qualifies as a minimally invasive technique for intracardiac tumor diagnostics.


2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Erzat Toprak ◽  
Ayça Nazlı Bulut

AbstractObjectivesOur aim was to evaluate the effect of standard surgical and N-95 respiratory mask use on maternal oxygen saturation, vital signs and result on non-stress tests in term pregnancies.MethodsIt is a prospective observational study. The study included healthy, not in labor, singleton pregnant women of 370/7–410/7 weeks who were applied to our hospital for routine obstetric control examination between March 1, 2020, and August 31, 2020. Patients were randomised by coin toss method. Oxygen saturation, systolic, and diastolic arterial blood pressure, pulse, respiratory rate, and temperature of pregnant women using surgical masks and respiratory masks were measured before and after the non-stress test. The tolerance of the masks was also evaluated. Student’s t-test was used for variables showing parametric distribution and the Mann Whitney U-test was used for non-parametric tests. The categorical variables between the groups was analyzed by using the Chi square test or Fisher Exact test. The statistical significance level was taken as p<0.05 in all tests.ResultsA total of 297 pregnant women using masks were included in the study. The effect of mask type on oxygen saturation before and after the non-stress test was found to be significant (97.1±1.8 corresponds to 95.3±2.6 for the surgical mask, p=0.0001; 97.8±1.7 corresponds to 93.7±2.0 for the respiratory mask, p=0.0001). Mask tolerance of patients using respiratory masks was significantly higher than those using surgical masks (mean 8, 1–10, p=0.0001).ConclusionsSurgical mask and respiratory mask usage decreased significantly in oxygen saturation in term pregnancies.


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