Management of device-related malignant sarcoma

Khamooshian, Arash; Klinkenberg, Theo J.; Maass, Alexander H.; Mariani, Massimo A.

doi:10.1016/j.hrcr.2017.04.002

Cited by 5 publications

(26 citation statements)

References 11 publications

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“…Based on the tissue sampling and the PET-CT images, the multidisciplinary oncology team decided that the most likely primary origin of the metastasis was the tumour in the left lung. There are case reports and small case series describing metastatic lesions of melanoma, 3 malignant lesions in the proximity of breast carcinoma, 4–6 sarcoma, 7 , 8 rhabdomyosarcoma, 9 cutaneous leiomyosarcoma , 10 squamous cell and basocellular carcinoma of the skin, 11 , 12 non-Hodgkin lymphoma, 13 plasmablastic lymphoma , 14 plasmacytoma, 15 and multiple myeloma. 16…”

Section: Discussionmentioning

confidence: 99%

An unexpected cause of a swollen pacemaker pocket: a case report

Popelier

Vanheste

Cuypers

et al. 2022

European Heart Journal - Case Reports

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Background A complication originating from the pacemaker pocket after device implantation can most often be explained by a post-operative pocket haematoma, or, less frequently, by a pocket infection. Both conditions need immediate assessment, dedicated treatment, and specialized follow-up. In rare cases, however, a swollen pacemaker pocket has an alternative diagnosis, which is exemplified by the following case. Case summary A 70-year-old male patient had a-specific symptoms of fatigue, dyspnoea, and coughing for some weeks. He also noted an evident, new swelling of his pacemaker pocket several months after pacemaker implantation, a procedure that was performed in a high-volume center and without any complication. Ultrasound imaging of the pocket suggested the presence of a soft tissue mass with increased vascularity, rather than a fluid collection or a late organized haematoma. Ultrasound-guided biopsy of the mass was obtained for histopathology analysis and revealed a well-differentiated invasive squamous cell carcinoma. Additional PET-CT imaging demonstrated multiple fluorodeoxyglucose-avid hotspots: a voluminous lesion in the left lung hilum, smaller lesions in the liver, some mediastinal lymph nodes, several bone lesions, and a large mass surrounding the pacemaker. The multidisciplinary oncologic specialty team concluded that the patient had an aggressive metastatic lung carcinoma. The patient refused to undergo further treatment and died 1.5 months after diagnosis. Discussion To the best of our knowledge, we did not find any earlier reports of a squamous cell carcinoma of the lung spreading to a pacemaker pocket. Presentation of a primary tumour or a metastasis in a pacemaker pocket is extremely rare. Ultrasound imaging with ultrasound-guided biopsy is a fast and reliable method to sample the tissue and to obtain a reliable diagnosis.

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Section: Discussionmentioning

confidence: 99%

An unexpected cause of a swollen pacemaker pocket: a case report

Popelier

Vanheste

Cuypers

et al. 2022

European Heart Journal - Case Reports

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“…While no cause and effect relationship has been identified between CF-LVAD implantation and malignancy development, there is some evidence for transitory immunologic changes after CF-LVAD implantation including an initial pronounced apoptosis-specific immune alteration by increased annexin V binding to CD3 T cells and death-inducing receptors soluble CD95/tumor necrosis factor-R1 (11). Additionally, correlations between device implantation, end-stage cardiomyopathies and implications for malignancy development have been identified in the past (12)(13)(14)(15). Further, large-scale studies investigating the immunologic alterations after CF-LVAD implantation in end-stage heart failure patients are warranted.…”

Section: Discussionmentioning

confidence: 99%

Development of malignancies and their outcomes in patients supported on continuous-flow left ventricular assist devices—a systematic review

Maynes¹,

Gordon²,

Weber³

et al. 2021

Ann Cardiothorac Surg

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Background: With increased use of continuous-flow left ventricular assist devices (CF-LVAD), development of malignant tumors in this population is not uncommon. We sought to evaluate malignancies in CF-LVAD patients and evaluate the outcomes of treatment strategies.Methods: Overall, 18 articles consisting of 28 patients were identified who developed malignancies after CF-LVAD placement. Patient-level data were extracted for systematic review.Results: Median patient age was 60 years [59-67] and 85.7% (24/28) were male. CF-LVAD was placed as bridge-to-transplant (BTT) in 60.9% (14/23) of patients. The three most common malignancy types were GI in 35.7% (10/28) of patients, lung in 21.4% (6/28) and skin in 10.7% (3/28). Median time from CF-LVAD implant to malignancy diagnosis was 6.9 [2.5-12.8] months. Metastatic disease occurred in 17.9%(5/28) over a median time of 5.0 [1.0-82.0] months from the diagnosis. Surgical resection of the malignancy was performed in 57.1% (16/28) of patients. Our results showed that while there was a significantly higher probability of survival among patients who underwent surgery versus those who did not, when only stage I and II patients were included in the analysis, this difference was no longer statistically significant. Three patients were relisted for heart transplant after surgical treatment, and two received the transplant.Conclusions: Surgical management of malignancies in patients on CF-LVADs may improve survival and transplant eligibility status, therefore, a CF-LVAD should not always preclude surgical treatment.

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“…In fact, numerous cases of malignant tumors over the pocket area have been described in the literature. These include melanomas, sarcomas, squamous cell carcinomas, breast carcinomas, plasmacytomas, non‐Hodgkin's lymphomas, and fibroxanthomas . Treatment should be tailored to the underlying neoplastic disorder and prognosis depends on the specific malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…These include melanomas, sarcomas, squamous cell carcinomas, breast carcinomas, plasmacytomas, non-Hodgkin's lymphomas, and fibroxanthomas. [17][18][19][20][21][22][23][24][25][26][27] Treatment should be tailored to the underlying neoplastic disorder and prognosis depends on the specific malignancy. Titanium is the main material used for manufacturing CIED generator case and is considered an inert material with excellent in vivo tolerance and no clinical evidence of carcinogenic action.…”

Section: Discussionmentioning

confidence: 99%