Heart Metastases: Detection & Treatment

[Yosef Landesman]

Discuss here metastatic alveolar soft part sarcoma in the heart and treatment options

[Karen Imm]

Hi there,
I wanted to comment on heart mets. Although, it is rare, APSP can travel to the heart. I have had 2 open heart surgeries to remove tumors. The first one was the size of a lime and the second was slightly smaller. They have had to rebuild my heart and have let it be known that they cannot do anymore heart surgeries. I have also had thoracic surgery and several surgeries on my primary tumor. Currently, I have an inoperable tumor close to the heart (right hilum). I also have lung mets ( I have had several removed via surgery) but those are not the biggest concern at this point. We tried IMRT and it was helpful. The tumor has not grown since radiation ended.(Sept. 2006) In the past I have also had Interferon, Ifosfamide and Adriamyacin, along with other "chemo cocktails" and many rounds of radiation.
We just returned from TX where I was being considered for a clinical trial. However, because my inoperable tumor had not grown in recent months, I do not qualify. However, I will return on a regular basis so that when it does start to grow again, I can start the trail right away.
Thank you all for your continued support and information.
God Bless,
Karen Imm

[D.ap]

Discuss here metastatic alveolar soft part sarcoma in the heart and treatment options

As I understand it the heart tumor can be seen only by an echocardiogram?
True or false
If true ,what are the symtoms of heart tumors if any?



Thanks in advance

Debbie

[Olga]

Debbie - we had another patient with the heart metastasis found by the MUGA scan - (Multi Gated Acquisition Scan) is a nuclear medicine test designed to evaluate the function of the right and left ventricles of the heart, the patient is given a tracer in order to visualize the heart by this scan. She had this scan as a part of her pre-screening for eligibility for the clinical trial, to see if heart function is normal - that's when it was found. I am not sure if the ECG shows anything in case of the small heart met.
About Karen Imm, the poster above. I have received an e-mail from her recently and I am waiting for her to post here or to update her record in the patients Personal stories and Updates.

[D.ap]

Olga
Just trying to be as pro active as possible. Has there been any pattern or rym or reason as in maybe tumors being close to or in a particular area of the lung that would warrant an echo to make sure those little devils aren't lurking in the heart?

Thanks so much good night

Debbie

[Olga]

Debbie, in the case I mentioned already the cardio met was a direct invasion trough the blood vessel wall so prob. close proximity to the major blood vessels is a concern. But these cases are very rare and we do not really have enough information to figure out a pattern.

[D.ap]

With the diagnosis of ASPS in the lungs comes the possibility of heart invasion by the existing lung tumors.

I am of the opinion that an echocardiogram can be a tool to help establish whether our ASPS friends are having a breathing problem and/or a heart problem.

http://www.webmd.com/heart-disease/echocardiogram


Echocardiogram


An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen.

The different types of echocardiograms are:
• Transthoracic echocardiogram (TTE). This is the most common type. Views of the heart are obtained by moving the transducer to different locations on your chest or abdominal wall.
• Stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart (coronary artery disease).
• Doppler echocardiogram. This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.
• Transesophageal echocardiogram (TEE). For this test, the probe is passed down the esophagus instead of being moved over the outside of the chest wall. TEE shows clearer pictures of your heart, because the probe is located closer to the heart and because the lungs and bones of the chest wall do not block the sound waves produced by the probe. A sedative and an anesthetic applied to the throat are used to make you comfortable during this test.

Echo can be used as part of a stress test and with an electrocardiogram camera.gif (EKG or ECG) to help your doctor learn more about your heart.

[D.ap]

Metastases to the heart

http://m.annonc.oxfordjournals.org/cont ... 3/375.full

The chosen method of diagnosis


The method of choice to detect cardiac metastases and their complications, however, is two-dimensional echocardiography [27, 29, 31, 37, 81, 82]. Echocardiography can show dense pericardial bands reflecting the pericardium being thickened by inflammation or tumor infiltration. Pericardial effusion can be proven quickly, with high sensitivity. Pericardial metastases may project in a cauliflower-like pattern into the fluid-filled pericardial space [83]. Pericardiocentesis can be performed under ultrasound guidance, and thereby more safely and accurately. Tumor cells within the pericardial fluid may verify diagnosis of metastatic pericardial involvement [10, 29, 68–71]. Negative cytologic findings, however, do not exclude a malignant origin of the effusion, and pericardial biopsy might then be necessary. Because sonographic examination is comfortable for the patient and inexpensive, it is appropriate for the follow-up of pericardial effusions. In cases of larger myocardial metastases, regional wall motion abnormalities can be revealed by ultrasound. Intracavitary lesions can also be detected with high sensitivity. In cases of peri- or paracardial lesions, the transesophageal approach is superior to the transthoracic approach [81, 84].

Supplemental diagnostic imaging methods are computer tomography and magnetic resonance imaging. These two methods provide sections of cardiac, mediastinal, pulmonic and thoracic structures in any desired plane, without overlapping. Thus, size and extension of paracardial or transpericardial tumor growth can be determined more precisely than by sonography. In addition, and in contrast to ultrasound, tissue differentiation is partly possible between solid, liquid, hemorrhagic or fatty lesions [64, 81, 82, 85, 86], and myocardial metastases can be better demarcated.

[D.ap]

In reading up on heart metastasis in general with other sarcomas/carcinomas they are rare and most times benign.
Melanomas are notorious for heart mets.

The common sites of metastasis are lung, bone, and brain.
5
The coexistence of ASPS and cardiac metastasis is very
rare
6
; however, because ASPS might metastasize to the
heart and induce severe heart failure, a cardiac examination
should be performed in patients with ASPS.

I was able to find a case report from a German research center specific to a 50 year old ASPS patient, a woman and her surgical resection of a large heart met--41mmx 31mm x4mm.
asymptomatic like most of our tumors are as they grow and SLOWLY move tissue away.


http://www.researchgate.net/profile/Abb ... iewer=true

[D.ap]

Abstract

Cardiac tumors represent a relatively rare, yet challenging diagnosis. Secondary tumors are far more frequent than primary tumors of the heart. The majority of primary cardiac tumors is benign in origin, with primary malignant tumors accounting for 25% of cases. Metastatic tumors usually arise from lung, breast, renal cancer, melanomas, and lymphomas. Clinical manifestations of cardiac tumors depend on the size and location of the mass and the infiltration of adjacent tissues rather than the type of the tumor itself. Echocardiography is the main diagnostic tool for the detection of a cardiac mass. Other imaging modalities (C-MRI, C-CT, 3D Echo) may offer further diagnostic information and the establishment of the diagnosis is made with histological examination. Management depends on the type of the tumor and the symptomatology of the patient.


https://www.hindawi.com/journals/isrn/2011/208929/

3.2.1. Echocardiography

Echocardiography represents a substantial imaging technique for the detection of cardiac tumors with a high sensitivity and specificity (90% and 95%, resp.), and it can be easily performed at the patient’s bedside [14]. Transthoracic echocardiography (TTE) can depict the shape, the size, the extent, and the mobility of the tumor, as well as, its location and its relation to adjacent cardiac structures, the width of adherence to the cardiac wall, and the hemodynamic consequences that it may confer to cardiac function [15]. Transesophageal echocardiography (TEE) is superior to TTE, since one can avoid transducer contact with the thoracic wall and the lungs and achieve a better visualization and identification of small tumors (<5 mm) and tumors localized at the posterior cardiac segments [16]. It should be performed when there is a low quality of TTE image due to poor acoustic window or when serious clinical questions regarding the nature of a mass remain unanswered. However, the echo field remains narrow and no information regarding the composition and the perfusion of a mass is given.

Of interest are newer echocardiographic techniques that may aid in the differential diagnosis of cardiac tumors from other cardiac masses. Contrast echocardiography helps in the differential diagnosis between tumor and thrombus by examining tissue perfusion [17]. In contrast to thrombi, malignant tumors or tumors rich in vascularity, in general, appear with an intense enhancement of the echocardiographic image when contrast medium is administered, and therefore, contrast echo leads to an accurate diagnosis. Benign cardiac tumors (i.e., myxomas) exhibit sparse vascularity, and medium enhancement of the echocardiographic signal appears sometimes even lower to that of proximal myocardium. Therefore, because of their sparse vascularity, the differential diagnosis between myxomas and thrombi, with the use of contrast echocardiography, is less reliable in comparison to malignant tumors [18].

Three-dimensional echocardiography (3D Echo) contributes mainly to an improved assessment of the shape, the size, the mobility of a tumor and its relationship regarding adjacent structures, by making use of the wider imaging range that this technique provides [19]. Improvement of this technique in order to provide better temporal and spatial resolution is expected in the near future.

[Olga]

Ivan's heart metastases were found coincidentally, during the work out in preparation for the possible pancreatic surgery - they found an abnormality on the cardiogram, then an echo was ordered and reinforced the suspicion and the dedicated cardiac MRI confirmed this dreadful suspicion. It was not seen on the periodic CT scans with the contrast he had. He had no specific symptoms that would alert him. In retrospect, reviewing the old CT scans, they can see some septal thickening. Even the cardiogram only became abnormal on the pretty big size. We had to go to ER at some point, and they performed an express blood work test, that showed normal troponin (not elevated) - heart damage associated parameters.