CANCER BIOLOGY & THERAPY 2016, VOL. 17, NO. 1, 11–13 http://dx.doi.org/10.1080/15384047.2015.1109391
CLINICAL CASE REPORT
A case report of primary cardiac capillary hemangioma Jidan Fana, Xiaobo Liaob, and Xinmin Zhoub a Department of Cardiothoracic Surgery, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu Province 225001, China; bDepartment of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
ABSTRACT
ARTICLE HISTORY
Background: Hemangioma of the heart, presenting as a primary cardiac tumor is extremely rare. Methods: We present a 20-year-old male with a cardiac tumor which was incidentally discovered during routine clinical examination. Results: Echocardiography showed a large intramyocardial mass attached to the left ventricle, close to the apex. A tumor was shown near the apex of the left ventricle by Cardiac CT. We performed a total resection surgery of the tumor one week after admission and the patient recovered well and discharged from hospital 7 d after surgery. Conclusion: The pathological diagnosis was primary cardiac capillary hemangioma. No tumor recurrence was shown by echocardiography after 20 months follow-up visits.
Received 7 August 2015 Revised 2 December 2015 Accepted 11 October 2015
Introduction Cardiac primary tumors are not common and they are often diagnosed postmortem because they are frequently asymptomatic. The incidence of primary cardiac tumors found at autopsy is about 0.02%, of which capillary haemangiomas form a small proportion. Three quarters of cardiac tumors can be categorized a benign tumor on histology. Here we present a case of primary cardiac capillary hemangioma.
Case report A 20-year-old male patient was sent to our heart center because a cardiac tumor was incidentally found at routine examination prior to college entry. The patient was asymptomatic. The patient was asymptomatic. The pulse and blood pressure of him was 85/min and 120/80mmHg, respectively on the physical examination. No murmurs or extra sounds were audible on cardiac examination. Other system exams and lab results were reported as normal. And he had no particular medical histories. An incomplete right bundle branch block was shown in the resting electrocardiogram. Echocardiography showed a large intra-myocardium mass (4.2 £ 5.0 cm) attached to the left ventricle, near the apex. The aortic and mitral valve function was intact and a little pericardial effusion was noted (Fig. 1A), which could also be proved by Cardiac CT (Fig. 1B). The tumor was resected with the patient on cardiopulmonary bypass was removed by a total resection surgery one week after admission. Macroscopically, the surface of the tumor (4.5£5.8 cm) was dark red which was covered with plenty of capillaries and rooted in the posterolateral border and the apex of the left ventricle, presented with expansive growth. We took a median incision of the tumor into the left ventricular chamber and then resected it extensively of which total included. CONTACT Xinmin Zhou © 2016 Taylor & Francis Group, LLC
[email protected]
KEYWORDS
Cardiac capillary hemangioma; no recurrence; resection surgery
The ’sandwich’ method with 2 sheets of felt and 3–0 prolene was used in order to close the incision after repeated flush of the left ventricular chamber. CPB and aortic cross-clamp times were 55 and 30 minutes, respectively. The patient was sent to intensive care unit (ICU) with inotropic and breath support and he had recovered well after surgery. Macroscopically, the mass was round and dark red, which had a smooth outer surface with a core like the flesh of fish (Fig. 2). Histologically, abundant capillaries were tufted distribution, filled with atrophic or hypertrophic cardiomyocytes. (Fig. 3). Some mall blood vessels with thick walls were found in some parts. And the neoplasm we mentioned above was diagnosed as primary cardiac capillary hemangioma.
Discussion Primary cardiac hemangiomas are benign neoplasms deriving from vascular endothelial cells and extremely rare,1 generally can be divided into capillary hemangioma, angiocavernoma, arteriovenous hemangioma. Kojima et al.2 evaluated 56 patients with cardiac hemangiomas, and most frequently observed these tumors in the cardiac ventricle (right ventricle, 35 %; left ventricle, 34 %), followed in order by the right atrium (23 %), interatrial septum (11 %), interventricular septum (11 %), and left atrium (7 %). Different clinical symptoms such as chest congestion, polypnea, cardiac failure, pericardial effusion, and arrhythmia were occurred due to the different sites results in cardiac hemangiomas. However, there were no symptoms in the patient we presented. Echocardiography is usually the first choice to assistant diagnosis of cardiac hemangioma,3 which can exactly and clearly show the size, location, modality, amount and the pericardical structure. The blood flow inside the tumor was
12
J. FAN ET AL.
Figure 1. A. Echocardiography showed a large intra-myocardium mass (4.2 £ 5.0 cm) attached to the left ventricle, near the apex. 1B Cardiac CT showed a tumor near the left ventricle apex.
clearly detected using MRI which can support the diagnosis of hemangioma. Beside this, vaporous shadows presented in coronary arteriography can also support the diagnosis. In spite of
Figure 2. Macroscopically the tumor (4.5£5.8 cm) was rooted in the posterolateral border and the apex of the left ventricle, which had a dark red, smooth outer surface with a core like the flesh of fish.
all the methods above, the final diagnoses was depending on the results of pathology. The natural history of hemangioas is quite unpredictable and diffferent. They may regress, cease growing or proliferate over time.4,5 Most of times, surgical resection is the first choice, which usually has a favorable outcomes in the treatment process.4,5,6 Follow-up is recommended to identify any recurrence, even though the rate of recurrence is unknown.3,4 Our patient coordinated the procedure quite well and no tumor recurrence was shown by echocardiography after 20 months follow-up visits. In short, the primary cardiac hemangiomas have no specific clinical manifestations and unpredictable natural histories. It’s of great importance to diagnose and treat cardiac hemangiomas patients effectively as early as possible. Although most of the patients recovered well after the surgery by the follow-up of echocardiography, there was still a case of recurrence after 10 y being reported.7 Therefore, we will continue to follow-up this patient.
Figure 3. Histological aspect of the tissue showing the cardiac capillary hemangioma.
CANCER BIOLOGY & THERAPY
Disclosure of potential conflicts of interest No potential conflicts of interest were disclosed.
References 1. Amano J, Nakayama J, Yoshimura Y, Ikeda U. Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences. Gen Thorac Cardiovasc Surg 2013; 61(8):435-47; PMID:23460447; http:// dx.doi.org/10.1007/s11748-013-0214-8. 2. Kojima S, Sumiyoshi M, Suwa S, Tamura H, Sasaki A, Kojima T, Mineda Y, Ohta H, Matsumoto M, Nakata Y. Cardiac hemangioma: a report of two cases and review of the literature. Heart Vessels 2003; 18(3):153-6; PMID:12955432; http://dx.doi.org/10.1007/s00380-003-0699-7. 3. Tseng JJ, Chou MM, Lee YH, Ho ES. In utero diagnosis of cardiac hemangioma. Ultrasound Obstet Gynecol 1999; 13(5):363; PMID:10380304; http://dx.doi.org/10.1046/j.1469-0705.1999.13050363.x.
13
4. Tse TS, Tsui KL, Ling LC, Chui WH, Choi MC, Li SK, Chiu CS. Necrotic cardiac hemangioma masquerading as sepsis with disseminated intravascular coagulation. Hong Kong Med J 2005; 11(4):308; PMID:16085950. 5. Eftychiou C, Antoniades L. Cardiac hemangioma in the left ventricle and brief review of the literature. J Cardiovasc Med 2009; 10(7):565; PMID:19424078; http://dx.doi.org/10.2459/JCM.0b013e32832cafc2. 6. Thung KH, Wan IY, Yip G, Underwood MJ. Cardiac tumor masquerading as obstructive sleep apnea syndrome. Interact Cardiovasc Thorac Surg 2008; 7(2):358; PMID:18227122; http://dx.doi.org/ 10.1510/icvts.2007.166728. 7. Colli A, Budillon AM, DeCicco G, Agostinelli A, Nicolini F, Tzialtas D, Zoffoli G, Corradi D, Maestri R, Beghi C, Gherli T. Recurrence of a right ventricular hemangioma. J Thorac Cardiovasc Surg. 2003; 126 (3):881-3; PMID:14502179; http://dx.doi.org/10.1016/S0022-5223(03) 00720-7.
CLINICAL CASE REPORT
A case report of primary cardiac capillary hemangioma Jidan Fana, Xiaobo Liaob, and Xinmin Zhoub a Department of Cardiothoracic Surgery, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu Province 225001, China; bDepartment of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
ABSTRACT
ARTICLE HISTORY
Background: Hemangioma of the heart, presenting as a primary cardiac tumor is extremely rare. Methods: We present a 20-year-old male with a cardiac tumor which was incidentally discovered during routine clinical examination. Results: Echocardiography showed a large intramyocardial mass attached to the left ventricle, close to the apex. A tumor was shown near the apex of the left ventricle by Cardiac CT. We performed a total resection surgery of the tumor one week after admission and the patient recovered well and discharged from hospital 7 d after surgery. Conclusion: The pathological diagnosis was primary cardiac capillary hemangioma. No tumor recurrence was shown by echocardiography after 20 months follow-up visits.
Received 7 August 2015 Revised 2 December 2015 Accepted 11 October 2015
Introduction Cardiac primary tumors are not common and they are often diagnosed postmortem because they are frequently asymptomatic. The incidence of primary cardiac tumors found at autopsy is about 0.02%, of which capillary haemangiomas form a small proportion. Three quarters of cardiac tumors can be categorized a benign tumor on histology. Here we present a case of primary cardiac capillary hemangioma.
Case report A 20-year-old male patient was sent to our heart center because a cardiac tumor was incidentally found at routine examination prior to college entry. The patient was asymptomatic. The patient was asymptomatic. The pulse and blood pressure of him was 85/min and 120/80mmHg, respectively on the physical examination. No murmurs or extra sounds were audible on cardiac examination. Other system exams and lab results were reported as normal. And he had no particular medical histories. An incomplete right bundle branch block was shown in the resting electrocardiogram. Echocardiography showed a large intra-myocardium mass (4.2 £ 5.0 cm) attached to the left ventricle, near the apex. The aortic and mitral valve function was intact and a little pericardial effusion was noted (Fig. 1A), which could also be proved by Cardiac CT (Fig. 1B). The tumor was resected with the patient on cardiopulmonary bypass was removed by a total resection surgery one week after admission. Macroscopically, the surface of the tumor (4.5£5.8 cm) was dark red which was covered with plenty of capillaries and rooted in the posterolateral border and the apex of the left ventricle, presented with expansive growth. We took a median incision of the tumor into the left ventricular chamber and then resected it extensively of which total included. CONTACT Xinmin Zhou © 2016 Taylor & Francis Group, LLC
[email protected]
KEYWORDS
Cardiac capillary hemangioma; no recurrence; resection surgery
The ’sandwich’ method with 2 sheets of felt and 3–0 prolene was used in order to close the incision after repeated flush of the left ventricular chamber. CPB and aortic cross-clamp times were 55 and 30 minutes, respectively. The patient was sent to intensive care unit (ICU) with inotropic and breath support and he had recovered well after surgery. Macroscopically, the mass was round and dark red, which had a smooth outer surface with a core like the flesh of fish (Fig. 2). Histologically, abundant capillaries were tufted distribution, filled with atrophic or hypertrophic cardiomyocytes. (Fig. 3). Some mall blood vessels with thick walls were found in some parts. And the neoplasm we mentioned above was diagnosed as primary cardiac capillary hemangioma.
Discussion Primary cardiac hemangiomas are benign neoplasms deriving from vascular endothelial cells and extremely rare,1 generally can be divided into capillary hemangioma, angiocavernoma, arteriovenous hemangioma. Kojima et al.2 evaluated 56 patients with cardiac hemangiomas, and most frequently observed these tumors in the cardiac ventricle (right ventricle, 35 %; left ventricle, 34 %), followed in order by the right atrium (23 %), interatrial septum (11 %), interventricular septum (11 %), and left atrium (7 %). Different clinical symptoms such as chest congestion, polypnea, cardiac failure, pericardial effusion, and arrhythmia were occurred due to the different sites results in cardiac hemangiomas. However, there were no symptoms in the patient we presented. Echocardiography is usually the first choice to assistant diagnosis of cardiac hemangioma,3 which can exactly and clearly show the size, location, modality, amount and the pericardical structure. The blood flow inside the tumor was
12
J. FAN ET AL.
Figure 1. A. Echocardiography showed a large intra-myocardium mass (4.2 £ 5.0 cm) attached to the left ventricle, near the apex. 1B Cardiac CT showed a tumor near the left ventricle apex.
clearly detected using MRI which can support the diagnosis of hemangioma. Beside this, vaporous shadows presented in coronary arteriography can also support the diagnosis. In spite of
Figure 2. Macroscopically the tumor (4.5£5.8 cm) was rooted in the posterolateral border and the apex of the left ventricle, which had a dark red, smooth outer surface with a core like the flesh of fish.
all the methods above, the final diagnoses was depending on the results of pathology. The natural history of hemangioas is quite unpredictable and diffferent. They may regress, cease growing or proliferate over time.4,5 Most of times, surgical resection is the first choice, which usually has a favorable outcomes in the treatment process.4,5,6 Follow-up is recommended to identify any recurrence, even though the rate of recurrence is unknown.3,4 Our patient coordinated the procedure quite well and no tumor recurrence was shown by echocardiography after 20 months follow-up visits. In short, the primary cardiac hemangiomas have no specific clinical manifestations and unpredictable natural histories. It’s of great importance to diagnose and treat cardiac hemangiomas patients effectively as early as possible. Although most of the patients recovered well after the surgery by the follow-up of echocardiography, there was still a case of recurrence after 10 y being reported.7 Therefore, we will continue to follow-up this patient.
Figure 3. Histological aspect of the tissue showing the cardiac capillary hemangioma.
CANCER BIOLOGY & THERAPY
Disclosure of potential conflicts of interest No potential conflicts of interest were disclosed.
References 1. Amano J, Nakayama J, Yoshimura Y, Ikeda U. Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences. Gen Thorac Cardiovasc Surg 2013; 61(8):435-47; PMID:23460447; http:// dx.doi.org/10.1007/s11748-013-0214-8. 2. Kojima S, Sumiyoshi M, Suwa S, Tamura H, Sasaki A, Kojima T, Mineda Y, Ohta H, Matsumoto M, Nakata Y. Cardiac hemangioma: a report of two cases and review of the literature. Heart Vessels 2003; 18(3):153-6; PMID:12955432; http://dx.doi.org/10.1007/s00380-003-0699-7. 3. Tseng JJ, Chou MM, Lee YH, Ho ES. In utero diagnosis of cardiac hemangioma. Ultrasound Obstet Gynecol 1999; 13(5):363; PMID:10380304; http://dx.doi.org/10.1046/j.1469-0705.1999.13050363.x.
13
4. Tse TS, Tsui KL, Ling LC, Chui WH, Choi MC, Li SK, Chiu CS. Necrotic cardiac hemangioma masquerading as sepsis with disseminated intravascular coagulation. Hong Kong Med J 2005; 11(4):308; PMID:16085950. 5. Eftychiou C, Antoniades L. Cardiac hemangioma in the left ventricle and brief review of the literature. J Cardiovasc Med 2009; 10(7):565; PMID:19424078; http://dx.doi.org/10.2459/JCM.0b013e32832cafc2. 6. Thung KH, Wan IY, Yip G, Underwood MJ. Cardiac tumor masquerading as obstructive sleep apnea syndrome. Interact Cardiovasc Thorac Surg 2008; 7(2):358; PMID:18227122; http://dx.doi.org/ 10.1510/icvts.2007.166728. 7. Colli A, Budillon AM, DeCicco G, Agostinelli A, Nicolini F, Tzialtas D, Zoffoli G, Corradi D, Maestri R, Beghi C, Gherli T. Recurrence of a right ventricular hemangioma. J Thorac Cardiovasc Surg. 2003; 126 (3):881-3; PMID:14502179; http://dx.doi.org/10.1016/S0022-5223(03) 00720-7.
