原发性心脏肿瘤研究进展
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摘要
原发性心脏肿瘤临床较少见,流行病学统计循环系统较其他系统为最低。由于年龄的特殊性,由心脏超声心动图诊断的婴幼儿和儿童心脏原发性肿瘤发病率最高仅达0. 2%,在人群中的尸检检出率更低。原发性心脏肿瘤包括良性和恶性,原发性心脏肿瘤多为良性,以黏液瘤最常见,其次以横纹肌瘤多见;而恶性肿瘤则以肉瘤常见。其发病率虽低,随着临床辅助检查手段的进步,产前诊断率增加,其心脏损伤的检出率也逐年增加。1995—2005年之间,超声心动图作为一种非创伤性检查手段,其运用最为广泛。2005年CT开始应用于临床,2010年MRI的应用更加有效的检测及评估了心脏肿瘤的预后及疗效。发生于儿童的心脏肿瘤多为原发性或者无明显临床症状,只有少部分患者需要行外科手术治疗。原发性心脏肿瘤患者常表现为呼吸困难、胸痛、心悸、发热、体重减轻等非特异性症状,严重者也可引起心脏破裂、心肾衰竭、神经系统症状等。大多数心脏肿块不适合经皮活检,而手术切除后的病理结果可提示明确诊断。目前,临床诊断主要依靠超声心动图(经胸或经食管超声)和心脏磁共振,快速准确诊断心脏肿瘤尚有一定局限性,一定程度上也限制了诊疗方案的确定,而及时有效的治疗对预后尤其重要。由于其发病率低,目前关于此病的报道多为病例分析,本文就原发心脏性肿瘤的分类、诊断及治疗作一综述。
Primary cardiac tumors are rare,and clinical epidemiological statistics of the circulatory system is the lowest compared with other systems. Due to the particularity of age,primary cardiac tumors in infants and children are extremely rare,with an estimated incidence of 0. 2% according to echocardiographic studies and the autopsy rate in the population is lower. Primary cardiac tumors include benign and malignant: according to statistics,about 90% of primary cardiac tumors are benign,with myxoma the most common and more common with rhabdomyoma; whereas malignant tumors are common with sarcomas. Its incidence is low,but with the progress of clinical auxiliary examination,the prenatal diagnosis rate increases,detection rate of heart damage also increased year by year. Between 1995 and 2005,echocardiography was the most widely used instrument as a non-invasive test. And 2005 CT began to be used in clinical application,while MRI in 2010 can be more effectively detected and assessed of the prognosis and efficacy of cardiac tumors. Occurring in children with heart tumors are mostly primary or no obvious clinical symptoms,but surgery is required only in a minority of cases. Patients with primary cardiac tumors often show as nonspecific symptoms of dyspnea,chest pain,heart palpitations,fever,and weight loss and so on; severe cases can also cause heart rupture,heart and kidney failure,neurological symptoms. Most heart lumps are not suitable for percutaneous biopsy,but pathological findings after surgical resection can prompt a clear diagnosis. At present,the clinical diagnosis mainly depends on echocardiography( transthoracic or transesophageal echocardiography) and cardiac magnetic resonance( MR),and there are some limitations in the rapid and accurate diagnosis of cardiac tumors,which,to some extent also limits the diagnosis of treatment programs,and timely and effective treatment of prognosis is particularly important. However,clinical diagnosis and treatment is still more difficult and timely and effective treatment of prognosis is particularly important. Because of its low incidence,the current reports of the disease are mostly case reports. This article focuses on the classification,diagnosis and treatment of primary cardiac tumors.
Primary cardiac tumors are rare,and clinical epidemiological statistics of the circulatory system is the lowest compared with other systems. Due to the particularity of age,primary cardiac tumors in infants and children are extremely rare,with an estimated incidence of 0. 2% according to echocardiographic studies and the autopsy rate in the population is lower. Primary cardiac tumors include benign and malignant: according to statistics,about 90% of primary cardiac tumors are benign,with myxoma the most common and more common with rhabdomyoma; whereas malignant tumors are common with sarcomas. Its incidence is low,but with the progress of clinical auxiliary examination,the prenatal diagnosis rate increases,detection rate of heart damage also increased year by year. Between 1995 and 2005,echocardiography was the most widely used instrument as a non-invasive test. And 2005 CT began to be used in clinical application,while MRI in 2010 can be more effectively detected and assessed of the prognosis and efficacy of cardiac tumors. Occurring in children with heart tumors are mostly primary or no obvious clinical symptoms,but surgery is required only in a minority of cases. Patients with primary cardiac tumors often show as nonspecific symptoms of dyspnea,chest pain,heart palpitations,fever,and weight loss and so on; severe cases can also cause heart rupture,heart and kidney failure,neurological symptoms. Most heart lumps are not suitable for percutaneous biopsy,but pathological findings after surgical resection can prompt a clear diagnosis. At present,the clinical diagnosis mainly depends on echocardiography( transthoracic or transesophageal echocardiography) and cardiac magnetic resonance( MR),and there are some limitations in the rapid and accurate diagnosis of cardiac tumors,which,to some extent also limits the diagnosis of treatment programs,and timely and effective treatment of prognosis is particularly important. However,clinical diagnosis and treatment is still more difficult and timely and effective treatment of prognosis is particularly important. Because of its low incidence,the current reports of the disease are mostly case reports. This article focuses on the classification,diagnosis and treatment of primary cardiac tumors.
引文
[1]Yin L,Yu SS,Wu HL,et al.An Atypical Right Atrial Myxoma With Spontaneous Rupture[J].Int Heart J,2016,57(2):262.
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[3]Nassr AA,Shazly SA,Morris SA,et al.Prenatal management of fetal intrapericardial teratoma:a systematic review[J].Prenat Diagn,2017,37(9):849-863.
[4]Loukas M.Primary cardiac angiosarcoma-a review[J].Med Sci Monit,2014,20(3):103-109.
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[7]Barnes H,Conaglen P,Russell P,et al.Clinicopathological and surgical experience with primary cardiac tumors[J].Asian Cardiovasc Thorac Ann,2014,22(9):1054-1058.
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[11]Srivastava S,Tewari P.Stroke associated with left atrial mass:Association of cerebral aneurysm with left atrial myxoma[J].Ann Card Anaesth,2014,17(1):56.
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[13]Rose D,Papa A,Tomao S,et al.Cerebral Metastases in Patients with Left Atrial Myxoma[J].J Card Surg,2016,31(5):289-293.
[14]Nguyen A,Awad WI.Cardiac Sarcoma Arising From Malignant Transformation of a Preexisting Atrial Myxoma[J].Ann Thorac Surg,2016,101(4):1571-1573.
[15]杨漪,翁艳,李向利,等.原发性心脏肿瘤34例的临床病理分析[J].首都医科大学学报,2016,37(5):651-656.
[16]Padalino MA,Reffo E,Cerutti A,et al.Medical and surgical management of primary cardiac tumours in infants and children[J].Cardiol Young,2014,24(2):268-274.
[17]Rivero Jiménez N,Ortega Molina M,Bret-Zurita M,et al.Sudden cardiac arrest as first symptom of a benign cardiac tumor growth[J].Revist Colomb Card,2017,25(1).
[18]Heth M,Hajar T,Korcheva V,et al.Spontaneous Involution(Regression)of a Solitary Cutaneous Myofibroma in an adult patient:Case Report[J].J Cutan Pathol,2018,45(2):159-161.
[19]Restrepo CS,Vargas D,Ocazionez D,et al.Primary Pericardial Tumors[J].Radio Graphics,2013,33(6):1613-1630.
[20]Li W,Teng P,Xu H,et al.Cardiac Hemangioma:A Comprehensive Analysis of 200 Cases[J].Ann Thorac Surg,2015,99(6):2246-2252.
[21]Maleszewski JJ,Tavora F,Burke AP.Do“intimal”sarcomas of the heart exist?[J].Am J Surg Pathol,2014,38(8):1158-1159.
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[23]Zhang R,Li L,Li X,et al.Primary cardiac angiosarcoma[J].Medicine,2017,96(42):e7352.
[24]Kupsky DF,Newman DB,Kumar G,et al.Echocardiographic Features of Cardiac Angiosarcomas:The Mayo Clinic Experience(1976-2013)[J].Echocardiography,2016,33(2):186-192.
[25]Wang M,Fu G,Jiang H,et al.Multimodality treatment for cardiac angiosarcoma[J].Intern Med,2014,53(17):1949-1953.
[26]Jang Y,Kim J,Shim JW,et al.Primary cardiac angiosarcoma:a prolonged response to surgical resection followed by concurrent chemoradiotherapy with docetaxel[J].Springer Plus,2016,5(1):1-3.
[27]Park WK,Jung S,Lim JY.Cardiac Angiosarcoma on the Right Atrium:Two Cases[J].Korean J Thorac Cardiovasc Surg,2012,45(2):120-123.
[28]Jin OS,Yoon YS,Kyung-Hwan K.Clinical Implication of Surgical Resection for the Rare Cardiac Tumors Involving Heart and Great Vessels[J].J Korean Med Sci,2013,28(5):717.
[29]Blondeau P.Primary cardiac tumors-French studies of 533 cases[J].Thorac Cardiovasc Surg,1990,38(Suppl 2):192-195.
[30]Grantzau T,Overgaard J.Risk of second non-breast cancer after radiotherapy for breast cancer:A systematic review and meta-analysis of762,468 patients[J].Radiother Oncol,2015,114(1):56-65.
[31]Coulier B,Colin GC,Tourmous H,et al.Imaging features of primary cardiac lymphoma[J].Diagn Interv Imaging,2017,130(17):2123.
[32]Jonavicius K,Salcius K,Meskauskas R,et al.Primary cardiac lymphoma:two cases and a review of literature[J].J Cardiothorac Surg,2015,10(1):138.
[33]Park CK,Cho YA,Kim M,et al.Malignant lymphoma arising in cardiac myxoma,presenting with peripheral arterial emboli[J].Cardiovasc Pathol,2017,32:26-29.
[34]Ciancarella P,Fusco A,Citraro D,et al.Multimodality imaging evaluation of a primary cardiac lymphoma[J].J Saudi Heart Assoc,2017,29(2):128-135.
[35]Gatti G,Maraldo O,Benussi B,et al.Early and Late Survival of OnPump Cardiac Surgery Patients Formerly Affected by Lymphoma[J].Heart Lung Circ,2017.doi:10.1016/j.hlc.2017.11.008.
[36]吕浩,沈振亚.合并非出血性脑梗死的心脏黏液瘤的外科治疗分析[J].浙江临床医学,2015,17(6):941-942.
[37]Abu Saleh WK,Ramlawi B,Shapira OM,et al.Improved Outcomes With the Evolution of a Neoadjuvant Chemotherapy Approach to Right Heart Sarcoma[J].Ann Thorac Surg,2017,104(1):90-96.
[38]Hudzik B,Miszalski-Jamka K,Glowacki J,et al.Malignant tumors of the heart[J].Cancer Epidemiol,2015,39(5):665-672.
[39]Wang J,Wang B,Hu Y,et al.Clinicopathologic features and outcomes of primary cardiac tumors:a 16-year-experience with 212 patients at a Chinese medical center[J].Cardiovasc Pathol,2018,33:45-54.
[40]Leja M,Reardon MJ.Reardon,Cardiac sarcomas:therapeutic options?[J].Future Cardiol,2011,7(5):595-597.
[2]Kwiatkowska J,Waldoch A,Meyer-Szary J,et al.Cardiac tumors in children:A 20-year review of clinical presentation,diagnostics and treatment[J].Adv Clin Exp Med,2017,26(2):319-326.
[3]Nassr AA,Shazly SA,Morris SA,et al.Prenatal management of fetal intrapericardial teratoma:a systematic review[J].Prenat Diagn,2017,37(9):849-863.
[4]Loukas M.Primary cardiac angiosarcoma-a review[J].Med Sci Monit,2014,20(3):103-109.
[5]Habertheuer A,Laufer G,Wiedemann D,et al.Primary cardiac tumors on the verge of oblivion:a European experience over 15 years[J].JCardiothorac Surg,2015,10(1):56.
[6]Barreiro M,Renilla A,Jimenez JM,et al.Primary cardiac tumors:32years of experience from a Spanish tertiary surgical center[J].Cardiovasc Pathol,2013,22(6):424-427.
[7]Barnes H,Conaglen P,Russell P,et al.Clinicopathological and surgical experience with primary cardiac tumors[J].Asian Cardiovasc Thorac Ann,2014,22(9):1054-1058.
[8]Rahbar K,Seifarth H,Fers MS,et al.Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT[J].J Nucl Med,2012,53(6):856-863.
[9]Kayancicek H,Khalil E,Keskin G,et al.Ten years’clinical experience of cardiac myxoma:diagnosis,treatment,and clinical outcomes[J].Anatol J Cardiol,2018,19(2):157-158.
[10]Satish OS,Aditya MS,Rao MA,et al.Sporadic Cardiac Myxoma Involving All the Cardiac Chambers[J].Circulation,2013,127(4):e360-e361.
[11]Srivastava S,Tewari P.Stroke associated with left atrial mass:Association of cerebral aneurysm with left atrial myxoma[J].Ann Card Anaesth,2014,17(1):56.
[12]Saito Y,Aizawa Y,Monno K,et al.Small,smooth,nonmobile cardiac myxoma detected by transesophageal echocardiography following recurrent cerebral infarction:a case report[J].J Med Cas Rep,2017,11(1):131.
[13]Rose D,Papa A,Tomao S,et al.Cerebral Metastases in Patients with Left Atrial Myxoma[J].J Card Surg,2016,31(5):289-293.
[14]Nguyen A,Awad WI.Cardiac Sarcoma Arising From Malignant Transformation of a Preexisting Atrial Myxoma[J].Ann Thorac Surg,2016,101(4):1571-1573.
[15]杨漪,翁艳,李向利,等.原发性心脏肿瘤34例的临床病理分析[J].首都医科大学学报,2016,37(5):651-656.
[16]Padalino MA,Reffo E,Cerutti A,et al.Medical and surgical management of primary cardiac tumours in infants and children[J].Cardiol Young,2014,24(2):268-274.
[17]Rivero Jiménez N,Ortega Molina M,Bret-Zurita M,et al.Sudden cardiac arrest as first symptom of a benign cardiac tumor growth[J].Revist Colomb Card,2017,25(1).
[18]Heth M,Hajar T,Korcheva V,et al.Spontaneous Involution(Regression)of a Solitary Cutaneous Myofibroma in an adult patient:Case Report[J].J Cutan Pathol,2018,45(2):159-161.
[19]Restrepo CS,Vargas D,Ocazionez D,et al.Primary Pericardial Tumors[J].Radio Graphics,2013,33(6):1613-1630.
[20]Li W,Teng P,Xu H,et al.Cardiac Hemangioma:A Comprehensive Analysis of 200 Cases[J].Ann Thorac Surg,2015,99(6):2246-2252.
[21]Maleszewski JJ,Tavora F,Burke AP.Do“intimal”sarcomas of the heart exist?[J].Am J Surg Pathol,2014,38(8):1158-1159.
[22]Neuville A,Collin F,Bruneval P,et al.Intimal Sarcoma Is the Most Frequent Primary Cardiac Sarcoma:clinicopathologic and molecular retrospective analysis of 100 primary cardiac sarcomas[J].Am J Surg Pathol,2014,38(4):461-469.
[23]Zhang R,Li L,Li X,et al.Primary cardiac angiosarcoma[J].Medicine,2017,96(42):e7352.
[24]Kupsky DF,Newman DB,Kumar G,et al.Echocardiographic Features of Cardiac Angiosarcomas:The Mayo Clinic Experience(1976-2013)[J].Echocardiography,2016,33(2):186-192.
[25]Wang M,Fu G,Jiang H,et al.Multimodality treatment for cardiac angiosarcoma[J].Intern Med,2014,53(17):1949-1953.
[26]Jang Y,Kim J,Shim JW,et al.Primary cardiac angiosarcoma:a prolonged response to surgical resection followed by concurrent chemoradiotherapy with docetaxel[J].Springer Plus,2016,5(1):1-3.
[27]Park WK,Jung S,Lim JY.Cardiac Angiosarcoma on the Right Atrium:Two Cases[J].Korean J Thorac Cardiovasc Surg,2012,45(2):120-123.
[28]Jin OS,Yoon YS,Kyung-Hwan K.Clinical Implication of Surgical Resection for the Rare Cardiac Tumors Involving Heart and Great Vessels[J].J Korean Med Sci,2013,28(5):717.
[29]Blondeau P.Primary cardiac tumors-French studies of 533 cases[J].Thorac Cardiovasc Surg,1990,38(Suppl 2):192-195.
[30]Grantzau T,Overgaard J.Risk of second non-breast cancer after radiotherapy for breast cancer:A systematic review and meta-analysis of762,468 patients[J].Radiother Oncol,2015,114(1):56-65.
[31]Coulier B,Colin GC,Tourmous H,et al.Imaging features of primary cardiac lymphoma[J].Diagn Interv Imaging,2017,130(17):2123.
[32]Jonavicius K,Salcius K,Meskauskas R,et al.Primary cardiac lymphoma:two cases and a review of literature[J].J Cardiothorac Surg,2015,10(1):138.
[33]Park CK,Cho YA,Kim M,et al.Malignant lymphoma arising in cardiac myxoma,presenting with peripheral arterial emboli[J].Cardiovasc Pathol,2017,32:26-29.
[34]Ciancarella P,Fusco A,Citraro D,et al.Multimodality imaging evaluation of a primary cardiac lymphoma[J].J Saudi Heart Assoc,2017,29(2):128-135.
[35]Gatti G,Maraldo O,Benussi B,et al.Early and Late Survival of OnPump Cardiac Surgery Patients Formerly Affected by Lymphoma[J].Heart Lung Circ,2017.doi:10.1016/j.hlc.2017.11.008.
[36]吕浩,沈振亚.合并非出血性脑梗死的心脏黏液瘤的外科治疗分析[J].浙江临床医学,2015,17(6):941-942.
[37]Abu Saleh WK,Ramlawi B,Shapira OM,et al.Improved Outcomes With the Evolution of a Neoadjuvant Chemotherapy Approach to Right Heart Sarcoma[J].Ann Thorac Surg,2017,104(1):90-96.
[38]Hudzik B,Miszalski-Jamka K,Glowacki J,et al.Malignant tumors of the heart[J].Cancer Epidemiol,2015,39(5):665-672.
[39]Wang J,Wang B,Hu Y,et al.Clinicopathologic features and outcomes of primary cardiac tumors:a 16-year-experience with 212 patients at a Chinese medical center[J].Cardiovasc Pathol,2018,33:45-54.
[40]Leja M,Reardon MJ.Reardon,Cardiac sarcomas:therapeutic options?[J].Future Cardiol,2011,7(5):595-597.