Myojin K, Murakami T, Ishii K, Kunihara T
Division of Cardiovascular Surgery, National Sapporo Hospital, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Feb;46(2):202-6. doi: 10.1007/BF03250619.
A 47-year-old woman was transferred to our hospital under endotracheal intubation with severe hemodynamic deterioration. A left mastectomy had been performed 8 months earlier and histology of the specimen showed malignant cystosarcoma phyllodes. An angiography and echocardiography suggested massive mass of the right ventricle extending to the pulmonary artery. An emergent life-saving operation was required using cardiopulmonary bypass. A huge multilobular tumor was resected from the right ventricle through the pulmonary artery as much as possible and a tricuspid valvuloplasty was also performed. The patient was weaned from cardiopulmonary bypass, then satisfactorily recovered from hemodynamic disturbances. Nevertheless, she died 15 days later due to multiple organ failure. Microscopic examination of resected specimen showed the neoplastic stromal cells that increase mitotic activity and have sarcomatous characteristics, consistent with a metastatic cystosarcoma phyllodes. This is a second case of operation for cardiac metastasis of cystosarcoma phyllodes using cardiopulmonary bypass, so far presented in the literature of the world reviewed by the authors.
一名47岁女性在气管插管状态下因严重血流动力学恶化被转送至我院。8个月前她接受了左侧乳房切除术,标本组织学检查显示为恶性叶状囊肉瘤。血管造影和超声心动图提示右心室有巨大肿物延伸至肺动脉。需要进行体外循环下的紧急挽救生命手术。通过肺动脉尽可能多地从右心室切除了一个巨大的多叶肿瘤,并进行了三尖瓣成形术。患者成功脱离体外循环,随后血流动力学紊乱得到满意恢复。然而,她15天后因多器官衰竭死亡。切除标本的显微镜检查显示肿瘤性间质细胞有丝分裂活性增加且具有肉瘤特征,符合转移性叶状囊肉瘤。这是世界文献中迄今报道的第二例采用体外循环进行叶状囊肉瘤心脏转移手术的病例,由作者回顾。