Clinical Topics & News
In Rare Case Colorectal Cancer Causes Thrombus
A unique case of a tumor thrombus in a patient with colorectal cancer leaves clinicians with no clear plan of treatment.
Cardiac tumors are rare and usually benign. An exception is the primary cardiac schwannoma. Only 17 cases have been reported, and most of those were malignant, say a team of doctors from McMaster University and Hamilton General Hospital, both in Ontario, Canada. Schwannomas, composed of Schwann cells, are tumors of nerve sheaths commonly found in cranial and peripheral nerves. The clinicians’ account of an “interesting case” of a patient with a benign schwannoma was unusual—and the fact that it was in the heart makes it “exceedingly rare.”
Their patient, a 47-year-old woman who had been treated for ovarian cancer, had no symptoms of a cardiac schwannoma. During the workup for the ovarian cancer, the clinicians discovered a large mass between the right atrium and right ventricle. Because she was asymptomatic, her physicians decided to closely monitor the tumor’s growth.
The chemotherapy for ovarian cancer did not reduce the cardiac schwannoma. As the disease progressed and the tumor grew, the patient developed symptoms, including sharp chest pain, shortness of breath, and palpitations.
Related: Rare Cancer Gets Timely Right Treatment
The prognosis of benign cardiac tumor depends on resectability, the clinicians say. After complete resection the prognosis is excellent, and adjuvant therapy is not needed. If surgery is not indicated, chemotherapy is an option. The patient chose to have surgery to remove the tumor. During the operation, the surgeons found that the blood supply of the tumor came from a branch of the right coronary artery and the posterior descending artery (PDA).
The surgery, which included resection, ligation of the PDA , and a saphenous vein graft for a coronary bypass to the distal PDA, was successful. A definite diagnosis of cardiac tumors can be completed only after histologic examination of samples taken at autopsy or surgical resection, the clinicians note. The gross and microscopic evidence confirmed diagnosis of benign schwannoma of the heart.
Related: In Rare Case Colorectal Cancer Causes Thrombus
Source:
Koujanian S, Pawlowicz B, Landry D, Alexopoulou I, Nair V. Hum Pathol. 2017;(8):24-26
