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Case 87

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A 44-year-old female was had been diagnosed with endometrial stromal sarcoma metastatic to the lungs and underwent a radical hysterectomy. However, the patient’s disease progressed with fever, dyspnea, orthopnea and fatige. A doppler echocardiogram was then performed and presented the alterations shown in Picture 1. After six cycles of adjuvant chemotherapy with doxorubicin and dacarbazine, there was complete resolution of the echocardiographic abnormal findings.

Based on the clinical history and imaging study, the most likely diagnosis is:

a) Infective endocarditis

25%

b) Cardiac metastasis

25%

c) Intracardiac thrombus

25%

d) Primary cardiac tumor

25%
   

Comments

- Primary cardiac tumors are rare, while metastatic tumors, 20-40 times more frequent, have an incidence from 10 to 20% in necropsies of patients with advanced neoplastic diseases.

- The clinical presentation of cardiac tumors depends more on their size and location than on the histological type. 

- The symptoms may arise from obstruction of blood flow, heart valve involvement, direct myocardial invasion and thromboembolic events.

- The history of advanced neoplastic disease with pulmonary involvement and the complete remission of the mass after chemotherapy support the hypothesis of a cardiac metastasis from the primary tumor.

References

1. Abad C. Tumores cardíacos (I). Generalidades. Tumores primitivos benignos. Rev Esp Cardiol 1998; 51:10-20.

2. Abad C. Tumores cardíacos (II). Tumores primitivos malignos. Tumores metastásicos. Tumor carcinoide. Rev Esp Cardiol 1998; 51:103-14.

3. Braunwald E, Zipes DP, Libby P. Chapter 7: Ecocardiografia. Tratado de medicina cardiovascular. 6th ed. Vol 1. São Paulo: Roca, 2003.

4. Foster E. Echocardiographic evaluation of the atria and appendages. Up to Date, 2012. Avaliable at http://www.uptodate.com/contents/echocardiographic-evaluation-of-the-atria-and-appendages

5. Vieira MLC e cols. Achados ecocardiográficos em pacientes com suspeita diagnóstica de endocardite infecciosa. Arq. Bras. Cardiol. 2004; 83(3):191-196.

6. Koss LG, Spiro RH, Brunschwig A. Endometrial stromal sarcoma. Surg. Gynecol. Obstet., 1965; 121:531-537.

Authors

Bruna Salgado Rabelo, 4th year medical student of UFMG School of Medicine. E-mail: brunasalgadorabelo[at]gmail.com

Diego Pereira Zille, 4th year medical student of UFMG School of Medicine. E-mail: diegozille[at]hotmail.com

Glauber Coutinho Eliazar, 5th year medical student of UFMG School of Medicine. E-mail: glaubereliazar[at]gmail.com

Gustavo de Oliveira Bretas, 4th year medical student of UFMG School of Medicine. E-mail: guhbretas[at]gmail.com

Marina Bernardes Leão, 4th year medical student of UFMG School of Medicine. E-mail: marinableao[at]gmail.com

Supervisors

Dr. Juliano Maia Duarte, Clinical Oncologist at Oncocentro de Minas Gerais, drjuliano_duarte[at]hotmail.com

Dr. Rosália Morais Torres, Cardiologist and member of the Department of Internal Medicine at UFMG School of Medicine. E-mail: rmtorres[at]medicina.ufmg.br

Translated by

Marina Bernardes Leão, 4th year medical student of UFMG School of Medicine

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