Pulmonary artery obstruction due to a metastatic malignant phyllodes tumor of the breast

Abstract

A 65-year-old woman with a 9-year surgical history of a left breast phyllodes tumor was admitted with progressive chest pain on effort. Computed tomography showed severe stenosis of the main pulmonary artery, with the mass originating from the ventricular septum. We planned to resect the tumor the next day. However, the next morning a pulmonary artery embolism occurred, and she developed dyspnea and lost consciousness. After carrying out cardiopulmonary resuscitation, we performed a life-saving operation. We successfully resected the huge tumor as far as possible from the right ventricle via a right atrial (RA)-tomy. However, her consciousness did not improve to better than Glasgow Coma Scale grade 7. She died from suffocation caused by metastasis invading her airway despite undergoing tracheotomy on the 77 th postoperative day.

Cardiopulmonary thromboembolism of epithelioid angiosarcoma arising from malignant phyllodes tumour of the breast

“…Some similarity can be drawn to the case described by Arlen, where the pulmonary component decreased in size following initial chemotherapy while the left atrial component continued to enlarge 3. It is also noted that following surgical removal of the cardiac metastasis the patients in Arlen and Taro's cases developed further metastases shortly after,3 5 as seen in our patient. It is possible that surgical manipulation of the intracardiac mass prompted the dissemination of minute tumour fragments that seeded systemically.…”

“…Of the two patients who survived the initial surgery, one remained unconscious due to cerebral ischaemia secondary to pulmonary embolism from the cardiac tumour, which developed hours before her surgery. These two patients developed further metastases within 6 months postoperatively and succumbed to their disease without adjuvant therapy 3 5. In general, the outcome of metastatic phyllodes tumour to the heart has been dismal.…”

Atypical Distant Metastasis of Breast Malignant Phyllodes Tumors: A Case Report and Literature Review

“…We finally retrieved 17 articles reporting 17 cases. Three patients suffered of cardiac localizations [ 16 – 18 ]. Four patients had gastrointestinal localizations [ 19 – 22 ].…”

Endobronchial/Tracheal Metastasis and Sudden Death

“…Tumors are also capable of acutely occluding the upper airway, again by a variety of mechanisms which include external pressure, internal growth, and so‐called “embolism”. Both primary and secondary tumor growth within the mediastinum can directly compress the trachea and other nearby structures such as the heart, superior vena cava, and pulmonary artery . Such tumors are most often lymphomas, bronchogenic carcinomas, and breast carcinoma but may also include adrenocortical carcinoma, rhabdomyosarcoma, and neuroblastoma, the latter two occurring predominantly in children .…”