Legoux B, Jegou B, Litoux P, Dreno B
Clinique Dermatologique, CHU, Nantes.
Ann Dermatol Venereol. 1996;123(6-7):393-4.
Melanoma is the most frequent cause of neoplastic metastasis to the heart. The diagnosis is however usually made after the patient's death as clinical signs are discrete, non-specific or masked by other visceral metastases.
A 50-year-old man who was given chemotherapy for metastatic melanoma limited to the mediastinal lymph nodes suddenly developed acute dyspnea due to cardiac tamponnade. Puncture biopsy of the pericardium revealed melanoma cells and nodular infiltration of the pericardium. A pleuro-percardial window gave functional relief. The patient died 5 months later due to a recurrent episode of cardiac tamponnade.
The diagnosis of metastasis to the heart of a malignant melanoma may be suspected in patients developing heart failure, rhythm or conduction disorders or pericardial effusion. The diagnosis can usually be confirmed with transthoracic sonography. Endocavitary or transmural tumors may require transesophageal echography or magnetic resonance imaging before surgery to determine extension and myocardial infiltration. Despite the severe prognosis, in case of immediate life-threatening emergencies or isolated cardiac metastases, a surgical treatment may be considered.
黑色素瘤是肿瘤转移至心脏最常见的原因。然而，由于临床症状不明显、不具特异性或被其他内脏转移所掩盖，诊断通常在患者死后才得以做出。
一名50岁男性因局限于纵隔淋巴结的转移性黑色素瘤接受化疗，突然因心脏压塞出现急性呼吸困难。心包穿刺活检发现黑色素瘤细胞及心包结节状浸润。胸膜心包开窗术缓解了功能障碍。患者5个月后因复发性心脏压塞死亡。
对于出现心力衰竭、心律或传导障碍或心包积液的患者，可能怀疑恶性黑色素瘤转移至心脏。诊断通常可通过经胸超声心动图得以证实。腔内或透壁肿瘤在手术前可能需要经食管超声心动图或磁共振成像来确定病变范围及心肌浸润情况。尽管预后严重，但在出现危及生命的紧急情况或孤立性心脏转移时，可考虑手术治疗。
