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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (04) : 398 -403. doi: 10.3877/cma.j.issn.1672-6448.2023.04.004

心血管超声影像学

心脏血管肉瘤的临床及超声心动图特征
王月丽, 宋砾, 牛宝荣, 陈炎, 张楠, 何怡华()   
  1. 100029 首都医科大学附属北京安贞医院心脏超声医学中心
    100029 首都医科大学附属北京安贞医院影像科
  • 收稿日期:2021-08-03 出版日期:2023-04-01
  • 通信作者: 何怡华
  • 基金资助:
    胎儿心脏病母胎医学研究北京市重点实验室(BZ0308); 国家自然科学基金项目(81501486); 心血管疾病精准医学北京实验室(PXM2020_014226_000054)

Clinical and echocardiographic features of cardiac angiosarcoma

Yueli Wang, Li Song, Baorong Niu, Yan Chen, Nan Zhang, Yihua He()   

  1. Beijing Key Laboratory of Maternal-Fetal Medicine and Fetal Heart Disease, Echocardiographic Medical Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China
    Department of Radiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China
  • Received:2021-08-03 Published:2023-04-01
  • Corresponding author: Yihua He
引用本文:

王月丽, 宋砾, 牛宝荣, 陈炎, 张楠, 何怡华. 心脏血管肉瘤的临床及超声心动图特征[J/OL]. 中华医学超声杂志(电子版), 2023, 20(04): 398-403.

Yueli Wang, Li Song, Baorong Niu, Yan Chen, Nan Zhang, Yihua He. Clinical and echocardiographic features of cardiac angiosarcoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(04): 398-403.

目的

探讨原发性心脏血管肉瘤的临床资料及超声心动图特点,以期为临床诊疗提供策略和依据。

方法

收集首都医科大学附属北京安贞医院2009年1月至2021年1月经病理证实的12例原发性心脏血管肉瘤患者的临床资料和超声心动图表现,包括一般资料、临床症状、超声心动图特点、临床检验结果、病理学特征以及治疗和预后,并进行回顾性分析。

结果

12例心脏血管肉瘤患者,男性8例,女性4例,平均年龄(44±15)岁,6例为局限性血管肉瘤,6例存在远处转移。其中10例超声心动图描述为心脏占位,均位于右心腔,基底较宽;其余2例,诊断为心包血管肉瘤,超声心动图表现为孤立性大量心包积液,未发现明确占位。心包受累是常见并发症,6例(6/12,50%)出现心包积液,1例患者心包积液细胞学检查为阴性。12例左、右心室功能均正常。部分患者血流动力学异常,三尖瓣口梗阻3例(3/12,25%),上腔静脉口阻塞2例(2/12,17%),另2例因肿瘤压迫出现三尖瓣后叶无力;右心室基底部运动不良1例。

结论

超声心动图对心腔内肿物检出较敏感,心脏血管肉瘤好发于右侧心腔,易侵犯邻近结构,以心包积液最常见。心脏血管肉瘤的超声心动图特征仍需进一步探索和明确。

Objective

To investigate the clinical and echocardiographic manifestations of primary cardiac angiosarcoma (CA) in order to provide a basis for its clinical diagnosis and treatment.

Methods

The clinical data and echocardiographic features, including the tumor location and adjacent infiltration, of 12 cases of CA pathologically diagnosed at Anzhen Hospital from 2009 to 2021 were reviewed retrospectively.

Results

Twelve patients with CA were identified, including eight males and four females, with an average age of (44±15) years old. Of the 12 individuals included, six had distant metastases and six had localized CA. Ten of them were described by echocardiography as having cardiac space-occupying lesions, all located in the right heart cavity with a wide base; the remaining two cases were diagnosed with pericardial angiosarcoma, which showed an isolated massive pericardial effusion on echocardiography and no clear space-occupying lesion was found. Pericardial involvement was a common complication; six cases (6/12, 50%) presented with pericardial effusion, and one patient had a negative pericardial effusion cytology. Both the left and right ventricles were functioning normally in all the 12 cases. Some patients had abnormal hemodynamics, three cases (3/12, 25%) had tricuspid orifice obstruction, two (2/12, 17%) had superior vena cava orifice obstruction, and another two had poor motion of posterior leaflet of tricuspid valve due to tumor compression. One case had right ventricular basal dyskinesia.

Conclusion

Echocardiography is sensitive in detecting intra-cardiac masses. CA tends to occur in the right side of the heart chambers and is prone to invade adjacent structures, with pericardial effusion being the most common. The echocardiographic features of CA remain to be further explored and determined.

表1 12例心脏血管肉瘤患者一般临床特点
图1 原发性心脏血管肉瘤超声心动图图像。图1a,1b为病例9,四腔心切面示近房顶右心房侧壁见一偏低回声肿块,附着面基底径广,未累及三尖瓣根部(图a白色箭头所示),肿块内见血流信号进入右心房(图a黄色箭头所示);剑突下切面示右心房内见一偏低回声肿块(图b白色箭头所示),下腔静脉入右心房血流受阻(图b黄色箭头所示)。图1c,1d为病例11,斜四腔心切面示右心房侧壁见一偏中等回声肿块,附着面基底径广,累及三尖瓣根部(图c白色箭头所示),心包腔内见大量液性暗区(图d黄色箭头所示,白色箭头所示为肿块)。图1e,1f为病例8,斜四腔心切面示右心房侧壁见一中等回声肿块,附着于房间隔中上部(图e白色箭头所示);剑突下切面示右心房内房间隔中上部见一等回声肿块(图f白色箭头所示),上腔静脉入右心房血流受阻(图f黄色箭头所示)注:RV为右心室;RA为右心房;LV为左心室;LA为左心房;IVC为下腔静脉;SVC为上腔静脉
表2 12例心脏血管肉瘤患者超声心动图特点
表3 12例心脏血管肉瘤临床检验及病理免疫组化结果
表4 12例心脏血管肉瘤患者临床治疗及预后
1
Patel SD, Peterson A, Bartczak A, et al. Primary cardiac angiosarcoma-a review[J]. Med Sci Monit, 2014, 20: 103-109.
2
Chen TW, Loong HH, Srikanthan A, et al. Primary cardiac sarcomas: A multi-national retrospective review[J]. Cancer Med, 2019, 8(1): 104-110.
3
Yu JF, Cui H, Ji GM, et al. Clinical and imaging manifestations of primary cardiac angiosarcoma[J]. Bmc Medical Imaging, 2019, 19(1): 16.
4
Leduc C, Jenkins SM, Sukov WR, et al. Cardiac angiosarcoma: histopathologic, immunohistochemical, and cytogenetic analysis of 10 cases[J].Hum Pathol, 2017, 60: 199-207.
5
Calvete O, Martinez P, Garcia-Pavia P, et al. A mutation in the POT1 gene is responsible for cardiac angiosarcoma in TP53-negative Li-Fraumeni-like families[J]. Nat Commun, 2015, 6: 8383.
6
Calvete O, Garcia‐Pavia P, Domínguez F, et al. POT1 and Damage Response Malfunction Trigger Acquisition of Somatic Activating Mutations in the VEGF Pathway in Cardiac Angiosarcomas[J].J Am Heart Assoc, 2019, 8(18): e012875.
7
Cao J, Wang J, He C, et al. Angiosarcoma: a review of diagnosis and current treatment [J]. Am J Cancer Res, 2019, 9(11): 2303-2313.
8
Antonuzzo L, Rotella V, Mazzoni F, et al. Primary cardiac angiosarcoma: a fatal disease[J]. Case Rep Med, 2009, 591512.
9
Quintana RA, Yeh YC, Llanos-Chea F. Occult cardiac angiosarcoma presenting as cardiac tamponade[J]. Am J Med Sci, 2017, 354(2): 216.
10
Li Y, Wang B, Zhang L, et al. Rare case of pericardial angiosarcoma[J]. Circ Heart Fail, 2018, 11(10): e005342.
11
Donsbeck AV, Ranchere D, Coindre JM, et al. Primary cardiac sarcomas: An immunohistochemical and grading study with long-term follow-up of 24 cases[J]. Histopathology, 1999, 34(4): 295-304.
12
Simpson L, Kumar SK, Okuno SH, et al. Malignant primary cardiac tumors: Review of a single institution experience [J]. Cancer, 2008, 112(11): 2440-2446.
13
Ay C, Pabinger I, Cohen AT, et al. Cancer-associated venous thromboembolism: Burden, mechanisms, and management[J]. Thromb Haemost, 2017, 117(2): 219-230.
14
Göbölös L, Bhatnagar G. Angiosarcoma of the heart[J]. JACC Case Rep, 2021, 3(6): 950-953.
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