[心脏转移性肿瘤的发生率]

Rafajlovski Saso, Tatić Vujadin, Ilić Srbislav, Kanjuh Vladimir

Vojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd.

Vojnosanit Pregl. 2005 Dec;62(12):915-20. doi: 10.2298/vsp0512915r.

INTRODUCTION

Secondary or metastatic tumors in the heart occur more frequently than primary ones, and, according to the published series, their frequency found in autopsic material ranges from 1.6% to 20.6%. Metastatic tumors in the heart are rarely clinically symptomatic, and, therefore, they are rarely diagnosed within the lifetime. They are mostly diagnosed at autopsy. The aim of this study was to analyze the frequency of metastatic tumors of the heart, their primary localization, as well as the localization of the metastases found in the autopsic material within the period 1972-2004.

METHODS

During the autopsy of the patients died of metastatic tumors, we microscopically and macroscopically analyzed all the organs and tissues to determine the metastases of primary tumors in other organs, especially in the heart and pericardium.

RESULTS

Within the period from 1972-2004, 11 403 autopsies were performed. In 2 928 (25.6%) out of 11 403 autopsies, the presence of malignant tumor was diagnosed, and in 79 (2.7%) of these cases, metastasis of the heart was found out. Only in 5 of the cases, the presence of metastasis in the heart was diagnosed during the lifetime. The most frequent metastases in the heart were caused by pulmonary carcinoma (18 cases), leukemia and malignant lymphoma (8 cases, each), then pancreatic and breast carcinoma, while the metastases of other carcinomas were rather rare. In 40 (60.76%) cases, the metastasis was localized in the myocardium, but more often in the left ventricle, in 24 (30.38%) cases in the pericardium, in 4 cases in the epicardium and in the 3 of them in the mitral and tricuspid valve. Only in one case of renal carcionoma, metastasis was found in the right atrium and it occurred by spreading (dissemination) through the lumen of the inferior vena cava.

CONCLUSION

Metastatic tumors of the heart are rather rare, and rarely clinically symptomatic, and, thus, rarely diagnosed during life. The methods of choice for the diagnosis of the metastasis in the heart are echocardiography, computerized tomography, magnetic resonance imaging, cytological analysis of the pericardial effusion and biopsy. The treatment includes surgery, chemotherapy and radiotherapy.

引言

心脏的继发性或转移性肿瘤比原发性肿瘤更为常见，根据已发表的系列研究，在尸检材料中发现其发生率在1.6%至20.6%之间。心脏转移性肿瘤很少有临床症状，因此，在患者生前很少被诊断出来。它们大多是在尸检时被诊断出来的。本研究的目的是分析1972年至2004年期间尸检材料中心脏转移性肿瘤的发生率、其原发部位以及转移灶的位置。

方法

在对死于转移性肿瘤的患者进行尸检时，我们对所有器官和组织进行了微观和宏观分析，以确定原发性肿瘤在其他器官中的转移情况，特别是在心脏和心包中的转移情况。

结果

在1972年至2004年期间，共进行了11403例尸检。在11403例尸检中，有2928例（25.6%）被诊断出存在恶性肿瘤，其中79例（2.7%）发现有心脏转移。只有5例在生前被诊断出心脏有转移。心脏最常见的转移瘤是由肺癌引起的（18例），白血病和恶性淋巴瘤（各8例），其次是胰腺癌和乳腺癌，而其他癌症的转移则较为罕见。在40例（60.76%）中，转移灶位于心肌，但更多见于左心室，24例（30.38%）位于心包，4例位于心外膜，其中3例位于二尖瓣和三尖瓣。只有1例肾癌患者，转移灶位于右心房，是通过下腔静脉管腔扩散（播散）形成的。