Percutaneous intravenous catheter forceps biopsy in right atrial mass: two case reports and literature review

Abstract

Background Primary malignant tumors of the heart are rare. Although preoperative histological diagnosis is difficult, it has paramount value in therapeutic strategy development and prognostic estimation. Herein, we reported 2 cases of intracardiac tumors. Cases presentation Both patients presented to the hospital with heart-related symptoms. Echocardiography showed massive masses in the atrium and positron emission tomography–computed tomography (PET/CT) revealed hypermetabolism and invasiveness. One patient cannot take surgery due to extensive metastasis and poor condition. The other patient was primarily diagnosed with lymphoma, and surgery was not recommended. They successfully underwent intravenous atrial biopsy, and histological samples confirmed intimal sarcoma and diffuse large B cell lymphoma. Based on immunohistochemical and molecular assessments, targeted chemotherapy was administered, resulting in clinical and imaging remission at discharge. Conclusions Percutaneous intravenous catheter biopsy as a safe invasive test provides an accurate pathological diagnosis after imaging evaluation, and offers a therapeutic direction. Nonmalignant masses and some chemo-radiosensitive malignant tumors in the atrium could have good prognosis after targeted therapy.

Cardiac intima sarcoma: a rapid review of case reports

“…Through a backward citation search, 24 additional articles were retrieved, bringing the total to 74 articles included in this study. Figure 1 shows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart and screening methods, while Table 1 displays the general characteristics of the patient population [18–85] .…”

“…Pyo and Kim [53] F Dyspnea and circulatory shock NA Died Pomp et al [54] M Symptoms of stroke None Alive with stable disease Rehman et al [55] M Dyspnea on exertion, lightheadedness, midsternal chest tightness, and chest pressure/ heaviness Liver and kidney Alive with controlled disease Ho et al [56] F Paroxysmal atrial fibrillation Thoracolumbar vertebra Alive as at data cutoff Chang et al [57] M Palpitation and dyspnea on exertion, chest tightness, wheezing, sitting breathing, lower limb edema, and bilateral bloody pleural effusion Pericardium, mediastinum lymph nodes, and left lung nodules Alive as at data cutoff Diamond et al [7] F Fatigue, subjective fever, headache, and dyspnea None Alive as at data cutoff Hwang [58] F Dyspnea on exertion and orthopnea None Alive as at data cutoff Ku et al [59] F Cough None Alive as at data cutoff Al-Hajri et al [60] M Dizziness on exertion None Alive as at data cutoff Clemens et al [61] M Dyspnea on exertion None Alive as at data cutoff Kuurstra et al [62] M Sudden onset of severe fatigue, shortness of breath, non-productive cough, and general malaise None Alive as at data cutoff Al-Azzam et al [63] F Dyspnea and progressive exercise intolerance None Alive as at data cutoff Vinod et al [8] F Progressive exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND) and exercise intolerance NA Alive as at data cutoff Li et al [1] M Shortness of breath and diminished exercise tolerance NA Alive as at data cutoff Modi et al [2] M Multiple recurrences of left atrial mass NA Alive as at data cutoff Shah et al [64] M Worsening shortness of breath, chills, night sweats, and weight loss NA Alive as at data cutoff Al Umairi et al [65] 55 M Dizziness NA Alive as at data cutoff Dotsenko et al [66] 47 M Shortness of breath NA Alive as at data cutoff Fu et al [67] 70 F Cough and nocturnal orthopnea NA Alive as at data cutoff Sugiyama et al [68] 60 M Fever, limb arthralgia, and progressive bilateral leg edema NA Alive as at data cutoff Durieux et al [69] 37 M Exertional dyspnea, anorexia and epigastric pain Left adrenal gland Alive as at data cutoff Ye et al [70] 52 F Progressive cough and shortness of breath Femur Alive as at data cutoff Valecha et al [71] 70 F Routine follow-up visits Lungs, axillary and thoracic adenopathy, thoracic and lumbar spine, peritoneum, liver, kidneys, and the adrenal Alive and wide spread metastasis Romanowska et al…”

Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach

“…(Video clips 1 and 2). Also other pedunculated masses may be considered for primary surgery if they appear at embolic risk and can be completely resected with a wide margin. In the presence of a large mass invading the atria or the ventricles (with typical features suggesting its malignancy) and causing a hemodynamic impairment, a transvenous biopsy should be obtained first, to start timely chemotherapy, even if a CT scan, MRI and PET/CT will be relevant in the staging process 116–119 . If the mass is in continuity with a cava or pulmonary vein, suggesting an extension of an extracardiac tumor, the biopsy might more easily obtained from the primary mass, if identified (Figure 1, video clip 9).…”

“… In the presence of a large mass invading the atria or the ventricles (with typical features suggesting its malignancy) and causing a hemodynamic impairment, a transvenous biopsy should be obtained first, to start timely chemotherapy, even if a CT scan, MRI and PET/CT will be relevant in the staging process. 116 , 117 , 118 , 119 If the mass is in continuity with a cava or pulmonary vein, suggesting an extension of an extracardiac tumor, the biopsy might more easily obtained from the primary mass, if identified (Figure 1 , video clip 9 ). Whenever a malignant nature of the mass is suspected, the diagnostic workout should be planned from the beginning by a multidisciplinary team with expertise in oncology, including cardio‐oncologists, cardiac surgeons, imaging specialists, and sarcoma oncologists.…”