1 / 20

HEAPHY 1 & 2 CASE RACE 1 – DIAG Delia DEPHOFF

WAIKATO / BAY OF PLENTY ABSTRACT This case study is of a patient with leimyosarcoma in their lower leg, who had a CT scan which showed a metastasis which is rarely seen. . Sat 31 st Aug 2013 Session 3 / CR1-7 13:31 – 13:35. HEAPHY 1 & 2 CASE RACE 1 – DIAG Delia DEPHOFF.

candra
Download Presentation

HEAPHY 1 & 2 CASE RACE 1 – DIAG Delia DEPHOFF

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. WAIKATO / BAY OF PLENTY ABSTRACT This case study is of a patient with leimyosarcoma in their lower leg, who had a CT scan which showed a metastasis which is rarely seen. Sat 31stAug 2013 Session 3/ CR1-7 13:31 – 13:35 HEAPHY 1 & 2 CASE RACE 1 – DIAG Delia DEPHOFF

  2. Rare Metastasis Case Race NZIMRT Annual Conference Hamilton 2013 Delia Dephoff

  3. Patient • 50 year old • Male • CT chest abdomen and pelvis

  4. Previous Imaging Initial US of right leg • showed abnormal mass within anterior musculature in right leg 3 days later MRI right lower leg pre and post contrast • large enhancing soft tissue mass, appearance suggestive of a soft tissue sarcoma

  5. Previous imaging Next day CT chest, abdo, pelvis for staging. • multiple pulmonary nodules concerning for metastases. No additional evidence of metastatic disease elsewhere within the abdomen or pelvis 2 weeks later MRI Brain • no evidence of intracranial metastatic disease Then 8 weeks later:

  6. Request : CT Chest, Abdo/Pelvis Indication: Metastatic sarcoma (leiomyosarcoma), Baseline CT prior to chemotherapy

  7. Leiomyosarcoma • Malignant tumour arising from smooth muscle tissue • Blood vessels, heart, liver, pancreas, genitourinary and gastrointestinal tracts, retroperitoneum, uterus (most common) and skin (WebMD, 2012)

  8. Imaging Protocol: CT CAP Contrast: oral and intravenous Pre-contrast: liver Arterial: chest and liver, Portal venous: abdomen and pelvis Delayed: liver Recons: 5mm axial, sagittal and coronal Windows: lung, mediastinum and abdomen

  9. Findings – Abdomen and Pelvis • Multiple hypoattenuating lesions in liver developed since prior scan consistent with metastases. • A 31mm right adrenal mass is also seen which has developed since the prior examination and is consistent with metastatic disease.

  10. Adrenal Metastases • Often found at autopsy • Commonly asymptomatic • Detected as one of multiorganmets (Lam & Lo, 2002) • Common site of metastatic desease • CT and MRI shows it to be more prevalent than previously thought. • Diagnosis is important as invariably influences choice of treatment • Melanoma, lung cancer, breast cancer (Goh, 2011)

  11. Findings - Thorax “Numerous pulmonary nodules are seen significantly increased in number and size since prior chest CT. No significant mediastinal lymphadenopathy seen. Left hilar lymphadenopathy is seen. No pleural effusions or pneumothorax are seen.” But what else can be seen?

  12. Findings “A 2.2 x 1.8cm enhancing mass is seen in the left ventricle arising from the interventricular septum. This has developed since the prior examination and in this patient with known leiomyosarcoma this most likely represents a metastatic deposit. No pericardial effusion is seen.”

  13. Cardiac Metastases • Occur more frequently than primary tumours • Intracavity growth is unusual (more common with a primary tumour) • Rarely gain clinical attention • Cardiac metastasis symptoms often overlooked because symptoms of disseminated tumor prevail (Reynen, Köckeritz & Strasser, 2004)

  14. Cardiac Metastases • Secondary may not be as rare as it appears • Often undiagnosed and found on post mortem • Can be asymptomatic, • Symptoms can include: SOB, hypotension, tachycardia, clinical findings suggestive of tamponade • Neoplastic pericardial effusions (Bussani, De-Georgio, Abbate& Silvestri, 2007)

  15. Summary • Cardiac metastases are rarely found • Probably occur more often than thought • Often go undetected because overshadowed by symptoms from other metastases Sadly this patient passed away earlier this year.

  16. References • Bussani, R., De-Georgio, F., Abate, A., & Silvestri, F. (2007). Cardiac metastases. In Journal of Clinical Pathology. January, 60(1): 27-34 doi: 10.1136/jcp.2005.035105 • Reynen, K., Köckeritz, U., & Strasser, R.H. (2004). Metastases to the heart. In Annals of Oncology 15: 375-381 DOI: 10.1093/annonc/mdh086 downloaded from http://amnoc.oxfordjournals.org May 1, 2013 • Goh, J. (2011) Imaging in adrenal metastases. In Medscape reference Drugs, diseases and procedures. Downloaded from http://emedicine.medscape.com/article/376585-overview on May 10 2013 • Lam, K.Y., Lo, C.Y. (2002). Metastatic tumours of the adrenal glands: a 30 year experience in a teaching hospital. In Clinical endocrinology Jan;56(1):95-101. Downloaded from http://www.ncbi.nlm.nih.gov/pubmed/11849252 • WebMD (2012). Cancer Health Centre, Leiomyosarcoma, General. Updated May 16 2012. Downloaded July 24th 2013 from http://www.webmed.com/cancer/leiomyosarcoma-general

More Related