Letter to the Editor
Pulmonary Embolism as a First Manifestation of Intracardiac Extension of an Endometrial Stromal Sarcoma
Embolismo pulmonar como primera manifestación de extensión intracardiaca de un sarcoma del estroma endometrial
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AD, right atrium; AI, left atrium; Tr, thrombus; VD, right ventricle; VI, left ventricle. (B) Abdominal magnetic resonance image of inferior vena cava thrombosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 47-year-old patient with iodinated contrast allergy and hypertension, diagnosed 2 years previously with low-grade malignant endometrial stromal sarcoma (ESS) treated with hysterectomy, double adnexectomy and bilateral pelvic lymphadenectomy. One year later she presented left retrosupravesical tumor recurrence that could only be partially resected, and received neoadjuvant radiation therapy and hormone therapy in the form of tamoxifen.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented with a one-week history of dyspnea on minimal effort. No significant findings were seen on chest X-ray. Significantly, a rapid ELISA test showed D-dimer of 1.141<span class="elsevierStyleHsp" style=""></span>ng/ml, so lung scintigraphy was performed that confirmed bilateral pulmonary thromboembolism. Furthermore, a large mass in the right atrium that prolapsed into the ventricle during diastole with extension into the inferior vena cava (IVC) was observed on transthoracic echocardiogram (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Magnetic resonance imaging (MRI) of the chest and abdomen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) confirmed thrombosis occupying almost the entire lumen of the common iliac veins and the IVC, extending up to the right atrium. Gadolinium uptake was observed on inferior vena cava imaging, supporting the diagnosis of tumor thrombosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Surgical intervention was ruled out in view of the partial resection of the pelvic tumor performed one year previously at the time of disease recurrence and because of her concomitant pulmonary thromboembolism. Enoxaparin 60<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h and chronic oral anticoagulation were administered. Subsequent clinical progress was favorable, and after 30 months of follow-up the patient remains asymptomatic with an excellent performance status. Resolution of the thrombus in the right atrium and almost complete recovery of IVC patency have been observed on follow-up ultrasound and MRI.</p><p id="par0020" class="elsevierStylePara elsevierViewall">ESS is a rare malignancy that accounts for only 0.2% of cancerous uterine tumors. The 5-year survival rate is 80%–100%. However, 30%–50% of patients present disease recurrence, generally after a long period of latency.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Metastases most commonly occur in the vagina, the pelvis and in the peritoneal cavity. IVC tumor thrombosis and intracardiac tumor metastasis are extremely rare.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Thus, although the prognosis of these tumors is good, they can appear to behave in a more aggressive manner.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Inferior vena cava tumor thrombosis is relatively common in renal carcinoma, and in these cases MRI is usually performed to confirm anatomical continuity between the tumor and the renal vein and the vena cava. Treatment of choice is surgery, and outcome in the absence of intervention is poor. In the case reported here, it was difficult to confirm anatomical continuity since the patient had undergone hysterectomy and double adnexectomy 2 years previously. The prognosis of endometrial stromal sarcoma is good, and its evolution and behavior cannot be compared to the considerably more aggressive renal cancer.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the case of IVC and intracardiac thrombi, surgery is recommended for excision of the tumor thrombosis, with or without IVC resection, in order to prevent sudden death due to pulmonary embolism or the development of congestive heart failure or death due to acute valvular obstruction.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We did not find any published cases of patients treated with anticoagulation only.</p><p id="par0035" class="elsevierStylePara elsevierViewall">To conclude, it is safe to say that although surgery is the treatment of choice for IVC and/or intracardiac tumor thrombosis, for patients with advanced or inoperable disease or those who refuse surgery, chronic anticoagulation may also be a valid treatment option. In our view, there are probably many cases in which tumor thrombosis coexists with non-tumor thrombosis: it is easy to imagine that a lumen occupied by a tumor will favor the development of non-tumor thrombosis. This would explain the almost complete resolution of our case with anticoagulant treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garcipérez de Vargas FJ, Marcos G, Moyano Calvente SL. Embolismo pulmonar como primera manifestación de extensión intracardiaca de un sarcoma del estroma endometrial. 2014;50:498–499.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 521 "Ancho" => 1301 "Tamanyo" => 99466 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Transthoracic four-chamber ultrasound, apical view, showing large thrombus in the right atrium shifting toward the right ventricle during diastole. AD, right atrium; AI, left atrium; Tr, thrombus; VD, right ventricle; VI, left ventricle. (B) Abdominal magnetic resonance image of inferior vena cava thrombosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endometrial stromal sarcoma: analysis of treatment failures and survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Gadducci" 1 => "E. Sartori" 2 => "F. Landoni" 3 => "P. Zola" 4 => "T. Maggino" 5 => "A. Urgesi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1006/gyno.1996.0314" "Revista" => array:6 [ "tituloSerie" => "Gynecol Oncol" "fecha" => "1996" "volumen" => "63" "paginaInicial" => "247" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8910635" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endolymphatic stromal myosis: surgical and hormonal therapy for extensive venous recurrence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.W. Montag" 1 => "F.D. Manart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gynecol Oncol" "fecha" => "1989" "volumen" => "33" "paginaInicial" => "255" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2539319" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low-grade endometrial stromal sarcoma with inferior vena cava tumor thrombus and intracardiac extension: radical resection may improve recurrence free survival" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Renzulli" 1 => "R. Weimann" 2 => "J.P. Barras" 3 => "T.P. Carrel" 4 => "D. Candinas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.suronc.2008.07.003" "Revista" => array:6 [ "tituloSerie" => "Surg Oncol" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "57" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18708288" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor thrombectomy without bypass for low-grade malignant tumors extending into the inferior vena cava: report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Jibiki" 1 => "Y. Inoue" 2 => "N. Sugano" 3 => "T. Iwai" 4 => "T. Katou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00595-005-3175-4" "Revista" => array:6 [ "tituloSerie" => "Surg Today" "fecha" => "2006" "volumen" => "36" "paginaInicial" => "465" "paginaFinal" => "469" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16633754" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000011/v1_201410310135/S1579212914002778/v1_201410310135/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000011/v1_201410310135/S1579212914002778/v1_201410310135/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914002778?idApp=UINPBA00003Z" ]
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| 2020 May | 32 | 10 | 42 |
| 2020 April | 25 | 23 | 48 |
| 2020 March | 17 | 10 | 27 |
| 2020 February | 38 | 13 | 51 |
| 2020 January | 31 | 17 | 48 |
| 2019 December | 29 | 24 | 53 |
| 2019 November | 30 | 23 | 53 |
| 2019 October | 18 | 10 | 28 |
| 2019 September | 22 | 8 | 30 |
| 2019 August | 28 | 12 | 40 |
| 2019 July | 32 | 16 | 48 |
| 2019 June | 24 | 7 | 31 |
| 2019 May | 29 | 13 | 42 |
| 2019 April | 32 | 17 | 49 |
| 2019 March | 48 | 25 | 73 |
| 2019 February | 33 | 14 | 47 |
| 2019 January | 29 | 11 | 40 |
| 2018 December | 35 | 13 | 48 |
| 2018 November | 41 | 21 | 62 |
| 2018 October | 81 | 16 | 97 |
| 2018 September | 30 | 10 | 40 |
| 2018 May | 26 | 1 | 27 |
| 2018 April | 33 | 4 | 37 |
| 2018 March | 45 | 3 | 48 |
| 2018 February | 38 | 7 | 45 |
| 2018 January | 136 | 6 | 142 |
| 2017 December | 132 | 3 | 135 |
| 2017 November | 34 | 1 | 35 |
| 2017 October | 18 | 9 | 27 |
| 2017 September | 22 | 12 | 34 |
| 2017 August | 30 | 8 | 38 |
| 2017 July | 31 | 2 | 33 |
| 2017 June | 41 | 6 | 47 |
| 2017 May | 42 | 5 | 47 |
| 2017 April | 34 | 8 | 42 |
| 2017 March | 25 | 2 | 27 |
| 2017 February | 14 | 3 | 17 |
| 2017 January | 21 | 3 | 24 |
| 2016 December | 24 | 4 | 28 |
| 2016 November | 37 | 8 | 45 |
| 2016 October | 29 | 14 | 43 |
| 2016 September | 31 | 8 | 39 |
| 2016 August | 43 | 10 | 53 |
| 2016 July | 20 | 9 | 29 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 43 | 2 | 45 |
| 2015 September | 48 | 11 | 59 |
| 2015 August | 41 | 13 | 54 |
| 2015 July | 32 | 8 | 40 |
| 2015 June | 30 | 7 | 37 |
| 2015 May | 36 | 7 | 43 |
| 2015 April | 28 | 8 | 36 |
| 2015 March | 19 | 5 | 24 |
| 2015 February | 17 | 12 | 29 |
| 2015 January | 2 | 3 | 5 |
| 2014 November | 0 | 2 | 2 |
Show all
