title: Characterization and management of cardiac involvement of thymic epithelial tumors.
abstract: BACKGROUND
  Although thymic epithelial tumors (TETs) commonly infiltrate mediastinal structures, cardiac involvement is uncommon and has not been systematically studied. The purpose of this study was to describe our single-institution experience of the clinical presentation, treatment, and follow-up of cardiac involvement in patients with TETs.
  
  
  METHODS
  A single-institution retrospective review of cardiac involvement among patients with TETs from 2008 to 2012.
  
  
  RESULTS
  The frequency of cardiac involvement was 4%. All five patients with confirmed cardiac disease had left heart involvement. Only one patient was symptomatic. Myocardial invasion was the most common mode of involvement followed by transvenous spread. Surgical resection of the involved area was attempted in three patients: in one, surgery was aborted because of extensive myocardial involvement; in the other two patients, resection was incomplete. Surgery averted a potentially catastrophic hemodynamic complication in one patient. However, cardiac tumor recurred in both patients who underwent incomplete resection. One patient underwent radiation therapy resulting in complete regression of an aortic root mass.
  
  
  CONCLUSIONS
  This study represents the most comprehensive review of cardiac involvement in patients with TETs. In contrast to previous single-case reports, we found a preponderance of asymptomatic presentation, left heart involvement, and myocardial invasion. Dynamic cardiovascular magnetic resonance imaging should be considered in cases when cardiac involvement is suspected. Although immediate surgical resection is indicated for impending hemodynamic compromise, long-term palliation with surgery for myocardial involvement seems poor, especially when complete resection cannot be performed. Radiation therapy should be considered in selected patients.
authors: Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
authors: Anish
authors: A
authors: Thomas
authors: Sujata
authors: S
authors: Shanbhag
authors: Karl
authors: K
authors: Haglund
authors: Arlene
authors: A
authors: Berman
authors: Marko
authors: M
authors: Jakopovic
authors: Eva
authors: E
authors: Szabo
authors: Andrew
authors: A
authors: Arai
authors: David S
authors: DS
authors: Schrump
authors: King F
authors: KF
authors: Kwong
authors: Arun
authors: A
authors: Rajan
authors: Giuseppe
authors: G
authors: Giaccone
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D013953:Thymus Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery