Artioli Grazia, Borgato Lucia, Calamelli Sara, Azzarello Giuseppe
Oncohematology Unit, Medical Science Department, ULSS 13, Mirano (Venice) - Italy.
Cardiology Department, ULSS 13, Mirano (Venice) - Italy.
Tumori. 2016 Nov 11;102(Suppl. 2):766D193F-C36D-401A-8CF1-D09F9F47B4A4. doi: 10.5301/tj.5000498.
Uterine leiomyosarcoma (LMS) is a rare malignancy of mesenchymal tissues and in advanced stages its prognosis is very poor. Surgery followed by radiotherapy and/or chemotherapy is the treatment of choice for advanced disease. Cardiac metastases are very uncommon and only a few cases have been described to date.
A 55-year-old woman was referred to our center for a uterine LMS with lung metastases at diagnosis. After 3 lines of chemotherapy for persistent lung disease, CT scan showed suspected thrombosis in the right pulmonary vein, along with disease progression in the lungs. The patient started treatment with low-molecular-weight heparin and a fourth line of chemotherapy. After 3 months of therapy, a new CT scan showed a larger thrombus and she underwent a cardiology visit that revealed an intracardiac mass. Submitting the patient to palliative surgery or radiation therapy was not possible because of the aggressiveness of the lung metastases, so she continued chemotherapy, resulting in disease stabilization.
Surgery is the best option for intracardiac dissemination of uterine LMS, but when this is not possible based on the performance status of the patient and spread of the disease, the combination of chemotherapy and radiotherapy seems to be the best option according to the literature. In our case we treated the patient only with chemotherapy.
子宫平滑肌肉瘤（LMS）是一种罕见的间叶组织恶性肿瘤，晚期预后很差。手术联合放疗和/或化疗是晚期疾病的首选治疗方法。心脏转移非常罕见，迄今为止仅有少数病例报道。
一名55岁女性因诊断为子宫LMS伴肺转移被转诊至我院。在针对持续性肺部疾病进行3线化疗后，CT扫描显示右肺静脉疑似血栓形成，同时肺部疾病进展。患者开始接受低分子量肝素治疗及第4线化疗。治疗3个月后，新的CT扫描显示血栓增大，她接受了心脏科会诊，结果发现心内肿物。由于肺转移灶具有侵袭性，无法对患者进行姑息性手术或放疗，因此她继续接受化疗，病情得以稳定。
手术是子宫LMS心脏转移的最佳选择，但根据患者的身体状况和疾病扩散情况无法进行手术时，根据文献，化疗和放疗联合似乎是最佳选择。在我们的病例中，我们仅对患者进行了化疗。
