Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
J Thorac Oncol. 2013 Feb;8(2):246-9. doi: 10.1097/JTO.0b013e31827bd931.
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.
A single-institution retrospective review of cardiac involvement among patients with TETs from 2008 to 2012.
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.
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.
尽管胸腺瘤（TET）通常会浸润纵隔结构，但心脏受累并不常见，也尚未得到系统研究。本研究旨在描述我们在 2008 年至 2012 年间，对单一机构中 TET 患者心脏受累的临床表现、治疗和随访的经验。
对 2008 年至 2012 年间，单一机构中 TET 患者的心脏受累情况进行回顾性分析。
心脏受累的频率为 4%。所有 5 例确诊为心脏疾病的患者均有左心受累。仅有 1 例患者有症状。心肌侵犯是最常见的受累方式，其次是经静脉传播。3 例患者尝试行受累区域的手术切除：1 例因广泛心肌侵犯而中止手术；另外 2 例患者的切除不完全。手术避免了 1 例患者潜在的灾难性血流动力学并发症。然而，行不完全切除的 2 例患者的心脏肿瘤均复发。1 例患者接受了放疗，主动脉根部肿块完全消退。
本研究是对 TET 患者心脏受累情况的最全面综述。与以往的单一病例报告不同，我们发现多数患者表现为无症状、左心受累和心肌侵犯。怀疑有心脏受累时，应考虑行动态心血管磁共振成像检查。尽管对于即将出现血流动力学障碍的患者应立即行手术切除，但对于心肌受累的长期姑息性治疗似乎效果不佳，尤其是当无法行完全切除时。对于某些患者，应考虑放疗。
