대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1209 Date 2020-12-24

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  • Courtesy of Heekyung Kim / Eulji University hospital
  • Age/Sex 73 / M
  • Chief ComplaintDyspnea, PHx: leiomyosarcoma (Lt. flank)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Intracardiac metastasis of leiomyosarcoma
Radiologic Findings
Fig 1. Chest PA shows no active lesion without cardiomegaly.
Fig 2-5. CT scans reveals about 9 x 3.4 x 6.4cm peripherally poorly enhancing (average HU 40), lobulated margin, irregular shape large mass, filling entire RV of the heart. And small polypoid extrusion detected from main mass in RVOT.
Fig 6. PET/CT scans reveals uneven hypermetabolic, large mass involving entire RV
Brief Review
Leiomyosarcoma (LMS) is a soft tissue sarcoma that originates from smooth muscle cells. It is commonly found in the uterus but it can occur throughout the body including the retroperitoneal space, abdominal cavity, and any vascular structure. In previous reports, metastatic cardiac tumors were up to 20 times more common than primary tumors and the incidence of cardiac metastatic LMS ranges from 6% to 34% (1).
Patients with metastatic cardiac tumors have new cardiac symptoms such as heart failure, valvular disease, conduction defect, arrhythmias, or syncope. The most common symptom is dyspnea, but it doesnt suggest cardiac metastasis obviously because the lung metastasis may be seen in many of the patients (2). When evaluating the cardiac metastasis, pericardium should be closely observed as pericardial involvement has been reported in up to 40% of the patients with cardiac metastasis and 15% of cytological examination of pericardial effusion are malignant (3). In previous reports, an intracardiac or pericardial mass was the most specific indicator of cardiac metastasis. The cardiac metastasis is common in the right chamber of the heart, but occurs on the left side when accompanied by lung metastasis.
The prognosis of most cardiac metastases is extremely poor. Previous literatures describe perioperative mortality rate to be 40% and average survival time to be 5 months (2, 3). Radiation therapy is recommended and surgical resection is limited.
References
1. Hallahan DE, Vogelzang NJ, Borow KM, Bostwick DG, Simon MA, Cardiac Metastases From Soft-Tissue Sarcomas, J Clin Oncol. 1986 Nov;4(11):1662-9.
2. Takenaka S, Hashimoto N, Araki N, Hamada K, Naka N, Joyama S et al., Eleven Cases of Cardiac Metastases from Soft-tissue Sarcomas, Jpn J Clin Oncol. 2011 Apr;41(4):514-8
3. Lichtenberger JP 3rd, Reynolds DA, Keung J, Keung E, Carter BW, Metastasis to the Heart: A Radiologic Approach to Diagnosis With Pathologic Correlation, AJR Am J Roentgenol. 2016 Oct;207(4):764-772
Keywords
heart, Intracardiac metastasis of leiomyosarcoma,

No. of Applicants : 63

▶ Correct Answer : 44/63,  69.8%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Korea University Guro Hospital , Korea (South) LEE SEOKYOUNG
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - , France LE GUEN RAPHAEL
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Korea (South) JIN YOUNG LEE
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) EUNJIN LEE
  • - Mayo Clinic , Japan HIROAKI TAKAHASHI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Japan NAOMI YUASA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - , Japan HIROAKI ARAKAWA
  • - Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Tokyo Metropolitan Bokutoh Hospital , Japan TOMOKI WADA
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 13/63,  20.6%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Lilavati Hospital , India DHRUV UMESH SHARMA
  • - GEMS, Srikakulam, Andhra Pradesh , India RAMU C
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 3/63,  4.8%
  • - NIMS, HYDERABAD , India BHASKAR K
  • - All India Institute of Medical Sciences, Rishikesh , India ROSHNI A
  • - , Senegal AXEL MBUYU KAYEMBE
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