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      Metastatic cardiac tumors: from clinical presentation through diagnosis to treatment

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          Abstract

          Background

          To evaluate the prevalence of metastatic tumors involving the myocardium and study their presentation in order to increase awareness to their existence.

          Methods

          Pathological reports from Sheba Medical Center (Israel, January 1, 2010 through December 31, 2015) and medical records from The Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica (Serbia, 23 years period) were screened for cases of metastatic cardiac tumors. Medical, radiological and pathological data of identified cases was retrieved and reviewed.

          Results

          Out of thousands of registered cardiac surgeries we found less than a dozen cases of metastatic cardiac tumors classified as melanoma, carcinomas of lung, colon and kidney and sarcomas of uterine origin. We found that metastatic cardiac tumors comprised 15.8% of all the cardiac tumors.

          Conclusions

          Metastatic cardiac tumors are extremely rare. As new diagnostic technologies and improved survival of oncological patients may increase the incidence of metastatic cardiac tumors in the future, awareness to their existence and knowledge of their presentation are key factors in their timely recognition.

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          Most cited references21

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          Metastases to the heart.

          K Reynen, U Köckeritz, R.H. Strasser (2004)
          Article 0 comments Cited 114 times – based on 0 reviews     Review now
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            Tumors metastatic to the heart.

            Aaron D Goldberg, Ron Blankstein, Robert F. Padera (2013)
            Article 0 comments Cited 89 times – based on 0 reviews     Review now
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              Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT.

              Lars Stegger, Klaus Tiemann, Kambiz Rahbar … (2012)
              In the diagnostic algorithm of cardiac tumors, the noninvasive determination of malignancy and metastatic spread is of major interest to stratify patients and to select and monitor therapies. In the diagnostic work-up, morphologic imaging modalities such as echocardiography or magnetic resonance tomography offer information on, for example, size, invasiveness, and vascularization. However, preoperative assessment of malignancy may be unsatisfactory. The aim of this study was to evaluate the diagnostic value of (18)F-FDG PET and the incremental diagnostic value of an optimized CT score in this clinical scenario. (18)F-FDG PET/CT scans (whole-body imaging with low-dose CT) of 24 consecutive patients with newly diagnosed cardiac tumors were analyzed (11 men, 13 women; mean age ± SD, 59 ± 13 y). The maximum standardized uptake values (SUV(max)) of the tumors were measured. Patients were divided into 2 groups: benign cardiac tumors (n = 7) and malignant cardiac tumors (n = 17) (cardiac primaries [n = 8] and metastases [n = 9]). SUV(max) was compared between the 2 groups. Results were compared with contrast-enhanced CT, using standardized criteria of malignancy. Histology served as ground truth. Mean SUV(max) was 2.8 ± 0.6 in benign cardiac tumors and significantly higher both in malignant primary and in secondary cardiac tumors (8.0 ± 2.1 and 10.8 ± 4.9, P < 0.01). Malignancy was determined with a sensitivity of 100% and specificity of 86% (accuracy, 96%), after a cutoff with high sensitivity (SUV(max) of 3.5) was chosen to avoid false-negatives. Morphologic imaging reached a sensitivity of 82% and a specificity of 86% (accuracy, 83%). Both false-positive and false-negative decisions in morphology could be corrected in all but 1 case using a metabolic threshold with an SUV(max) of 3.5. In addition, extracardiac tumor manifestations were detected in 4 patients by whole-body (18)F-FDG PET/CT. (18)F-FDG PET/CT can aid the noninvasive preoperative determination of malignancy and may be helpful in detecting metastases of malignant cardiac tumors.
              Article 0 comments Cited 74 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ivana Burazor:
                ORCID: http://orcid.org/0000-0001-7001-8132
                +381-63-8062833 , ivana.burazor@gmail.com
                Sarit Aviel-Ronen: saritaviel@gmail.com
                Massimo Imazio: massimo_imazio@yahoo.it
                Orly Goitein: Orly.Goitein@sheba.health.gov.il
                Marina Perelman: Marina.Perelman@sheba.health.gov.il
                Natalia Shelestovich: shelestovich.nataly@gmail.com
                Ninoslav Radovanovic: radovan@gmail.com
                Vladimir Kanjuh: kanjuh@eunet.rs
                Iris Barshack: Iris.Barshack@sheba.health.gov.il
                Yehuda Adler: Yehuda.Adler@sheba.health.gov.il
                Journal
                Journal ID (nlm-ta): BMC Cancer
                Journal ID (iso-abbrev): BMC Cancer
                Title: BMC Cancer
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2407
                Publication date (Electronic): 20 February 2018
                Publication date PMC-release: 20 February 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 202
                Affiliations
                [1 ]Department of Cardiology, Institute for Rehabilitation, Belgrade, Serbia
                [2 ]ISNI 0000 0001 2166 9385, GRID grid.7149.b, Medical Faculty, , University of Belgrade, ; Belgrade, Serbia
                [3 ]ISNI 0000 0001 2107 2845, GRID grid.413795.d, Department of Pathology, , Sheba Medical Center, ; Ramat-Gan, Israel
                [4 ]ISNI 0000 0001 2107 2845, GRID grid.413795.d, Talpiot Medical Leadership Program, , Sheba Medical Center, ; Ramat-Gan, Israel
                [5 ]ISNI 0000 0004 1757 684X, GRID grid.416419.f, Department of Cardiology, , Maria Vittoria Hospital, ; Torino, Italy
                [6 ]ISNI 0000 0001 2107 2845, GRID grid.413795.d, Department of Diagnostic Imaging, , Sheba Medical Center, ; Ramat-Gan, Israel
                [7 ]ISNI 0000 0004 1937 0546, GRID grid.12136.37, Sackler Faculty of Medicine, , Tel Aviv University, ; Tel Aviv, Israel
                [8 ]Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
                [9 ]ISNI 0000 0001 2146 2771, GRID grid.419269.1, The Board on Cardiovascular Pathology, Department of Medical Sciences, , Serbian Academy of Sciences and Arts, ; Belgrade, Serbia
                Author information
                http://orcid.org/0000-0001-7001-8132
                Article
                Publisher ID: 4070
                DOI: 10.1186/s12885-018-4070-x
                PMC ID: 5819646
                PubMed ID: 29463229
                SO-VID: b7f8c798-e2d6-49e6-a9db-b3c6613dd1a3
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 15 January 2017
                Date accepted : 29 January 2018
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: metastatic cardiac tumors,myocardium,melanoma,metastatic carcinoma,metastatic sarcoma
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: metastatic cardiac tumors, myocardium, melanoma, metastatic carcinoma, metastatic sarcoma

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