Eleven cases of cardiac metastases from soft-tissue sarcomas.
OBJECTIVE
Cardiac metastasis is a highly life-threatening condition because it leads to cardiac failure. However, it is difficult to diagnose because its precise clinical features are unknown. Here, we report 11 cases of cardiac metastasis from soft-tissue sarcoma, and discuss its diagnosis and treatment.


METHODS
Of 641 patients with soft-tissue sarcoma treated in our institute between 1996 and 2009, we retrospectively reviewed the medical records of 11 patients whose cardiac metastases were diagnosed while they were alive.


RESULTS
The most common primary tumor was leiomyosarcoma (n= 5), followed by clear cell sarcoma (n= 2). In all cases, metastases to other organs, including lungs (n= 10), soft tissues (n= 5) and bones (n= 4) were found along with cardiac metastases. Cardiac metastasis was diagnosed by echocardiography in six cases and by computed tomography in four cases. In four patients, cardiac metastasis was not detected by chest computed tomography as follow-up to lung metastases and echocardiography was required to make the diagnosis. Although five patients complained of exertional dyspnea, four were asymptomatic. Seven cases were treated with radiotherapy. No patient had surgery for their cardiac metastasis. The median survival of patients who received radiation therapy was 10.5 months; that of those who did not was 3.5 months.


CONCLUSIONS
Cardiac metastasis is often asymptomatic. Echocardiography is better than computed tomography for diagnosing cardiac metastasis, and should be considered in all patients presenting with soft-tissue metastases. Owing to the highly life-threatening nature of cardiac metastases and the possibility of soft-tissue dissemination, treatment with radiation therapy is recommended immediately on diagnosis.
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. s.takenaka.0816@gmail.com
Satoshi
S
Takenaka
Nobuyuki
N
Hashimoto
Nobuhito
N
Araki
Kenichiro
K
Hamada
Norifumi
N
Naka
Susumu
S
Joyama
Shigeki
S
Kakunaga
Takafumi
T
Ueda
Akira
A
Myoui
Hideki
H
Yoshikawa
D000328:Adult; D000368:Aged; D002305:Cardiac Tamponade / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D017809:Fatal Outcome; D005221:Fatigue / Q000209:etiology; D005260:Female; D006338:Heart Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary*; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D010534:Peritoneal Neoplasms / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary*; D018227:Sarcoma, Clear Cell / Q000175:diagnosis / Q000556:secondary