Primary pulmonary artery sarcoma: surgical management and differential diagnosis with pulmonary embolism and pulmonary valve stenosis.
OBJECTIVE
Primary pulmonary artery sarcomas are rare and lethal tumors that are usually diagnosed during surgery or autopsy. We present six cases of primary pulmonary artery sarcomas and discuss clinical features, differential diagnosis, surgical treatment, and outcome of the tumors.


METHODS
Between January 1994 and July 2008, six patients were identified with the disease during operation. Three patients were initially diagnosed with pulmonary valve stenosis, and two patients had a presumptive diagnosis of chronic pulmonary embolism. Two patients had simple or partial tumor resection. Four patients had radical tumor resection and homograft reconstruction of the pulmonary arteries.


RESULTS
Histological examinations showed five malignant mesenchymomas and one fibrosarcoma. One patient died of refractory pulmonary hypertension during operation. Two patients died 4 months postoperatively because of brain metastases. Two patients were alive for 3 and 9 months, respectively after the operation with recurrent tumor. One patient is alive even 2 years after resection with no signs of recurrence or metastasis.


CONCLUSIONS
Because of similar clinical features, pulmonary artery sarcomas are often confused with other pulmonary vascular obstructive diseases. Computed tomography scanning and gadolinium-enhanced magnetic resonance imaging could be useful methods for differential diagnosis. The prognosis is very poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis. Early diagnosis and radical surgical resection presents the only opportunity for a potential cure.
Hu
Xiao-Peng
XP
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China. huxp21@sohu.com
Xu
Jian-Ping
JP
Liu
Ning-Ning
NN
D000328:Adult; D002315:Cardiopulmonary Bypass; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005354:Fibrosarcoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008637:Mesenchymoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000175:diagnosis*; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis*; D012086:Reoperation; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D019043:Vascular Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*