Journal of the New Zealand Medical Association, 23-June-2006, Vol 119 No 1236
Seminoma with extensive metastases to the right atrium
Constantin Marcu, Kristen Andresen, Richard Salzano, Thomas Donohue
A 43-year-old Caucasian male presented with mild dyspnoea on exertion 2 years after treatment for stage IB testicular seminoma. Chest radiography demonstrated multiple, bilateral lung nodules. Computed tomographic (CT) imaging showed pulmonary nodules and a filling defect, measuring 5×4 cm, in the right atrium extending through the atrial wall into the anterior mediastinum (Figure 1AB).
PA=pulmonary artery; RA=right atrium; Ao=aorta.
No periaortic or intrathoracic adenopathy was demonstrated. Percutaneous lung nodule biopsy was nondiagnostic. Mediastinotomy under cardiopulmonary bypass was planned because of concerns of possible right ventricular inflow obstruction from the right atrial mass. Presurgical coronary angiography demonstrated normal coronary arteries and a large “tumour blush” in the region of the right atrium (Figure 1CD).
An intraoperative transoesophageal echocardiogram (TOE) showed a mobile echogenic structure in the right atrium extending through the atrial wall, into the mediastinum (Figure 2ABC).
The specimen was excised from the anterior mediastinum and recurrent seminoma was confirmed on pathology. Surgical debulking was not indicated, and chemotherapy with cisplatin, bleomycin, and etoposide was started. After one course of chemotherapy, a follow-up TOE revealed a ~50% reduction in the right atrial mass size without further evidence of extracardiac extension (Figure 3ABC).
The patient will undergo three additional courses of the same chemotherapy regimen.
LA=left atrium; RV=right ventricle; RA=right atrium; Ao=aorta.
RV=right ventricle; RA=right atrium; LA=left atrium;. Ao=aorta.
Author information: Constantin B Marcu, Consultant Cardiologist, Vrije University Medical Center, Amsterdam, The Netherlands; Kristen M Andresen, Consultant Cardiologist, Hospital of Saint Raphael – Yale University, New Haven, CT, USA; Richard Salzano, Consultant Cardiothoracic Surgeon, Hospital of Saint Raphael – Yale University, New Haven, CT, USA; Thomas J Donohue, Consultant Cardiologist, Hospital of Saint Raphael – Yale University, New Haven, CT, USA
Correspondence: Constantin B Marcu, MD, Vrije University Medical Center, Department of Cardiology 6D 120, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Fax: +31 20 4442446; email: firstname.lastname@example.org
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