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Published in: General Thoracic and Cardiovascular Surgery 4/2021

Open Access 01-04-2021 | Endarterectomy | Original Article

Surgical treatment of primary pulmonary artery sarcoma

Authors: Yongxin Han, Yanan Zhen, Xiaopeng Liu, Xia Zheng, Jianbin Zhang, Zhenguo Zhai, Jun Duan, Yajun Zhang, Peng Liu

Published in: General Thoracic and Cardiovascular Surgery | Issue 4/2021

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Abstract

Objective

Primary pulmonary artery sarcoma (PAS) is a rare tumor that originates from the intimal layer of the pulmonary artery or pulmonary valve and has a poor prognosis. The standard treatment for this devastating disease remains unclear. This study aimed to summarize the current standard treatments for PAS.

Methods

From September 2015 to January 2020, six patients were diagnosed with PAS and underwent pulmonary endarterectomy (PEA) at our department. Their medical records were retrospectively reviewed to analyze the clinical characteristics, histopathological features, and postoperative outcomes. Fourteen articles, each reporting at least 6 cases, identified 201 patients diagnosed with PAS, and 158 patients had detailed treatments and follow-up data.

Results

All of the patients who successfully underwent PEA were alive at follow-up, with a mean survival duration of 11.6 months (7–28 months), and one patient developed recurrence in the right upper lobe lung. Two patients received postoperative chemotherapy. In one patient, the tumor invaded the pulmonary valve.

Conclusions

PAS resection combined with PEA via the aid of cardiopulmonary bypass and deep hypothermic circulatory arrest could achieve maximal tumor resection in patients without metastatic lesions. An individualized surgery strategy relies on a precise preoperative imaging examination. Moreover, postoperative adjuvant therapy could yield improved survival outcomes.
Literature
1.
go back to reference Coons JC, Pogue K, Kolodziej AR, Hirsch GA, George MP. Pulmonary arterial hypertension: a pharmacotherapeutic update. Curr Cardiol Rep. 2019;21(11):141.CrossRef Coons JC, Pogue K, Kolodziej AR, Hirsch GA, George MP. Pulmonary arterial hypertension: a pharmacotherapeutic update. Curr Cardiol Rep. 2019;21(11):141.CrossRef
2.
go back to reference Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Rev Esp Cardiol (Engl Ed). 2016;69(2):177.CrossRef Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Rev Esp Cardiol (Engl Ed). 2016;69(2):177.CrossRef
3.
go back to reference Barmpas A, Giannakidis D, Fyntanidou V, Koulouris C, Mantalobas S, Pavlidis E, et al. Intimal sarcoma of the pulmonary artery, a diagnostic enigma. AME Case Rep. 2019;3:32.CrossRef Barmpas A, Giannakidis D, Fyntanidou V, Koulouris C, Mantalobas S, Pavlidis E, et al. Intimal sarcoma of the pulmonary artery, a diagnostic enigma. AME Case Rep. 2019;3:32.CrossRef
4.
go back to reference Kim C, Kim MY, Kang JW, Song JS, Lee KY, Kim SS. Pulmonary artery intimal sarcoma versus pulmonary artery thromboembolism: CT and clinical findings. Korean J Radiol. 2018;19(4):792–802.CrossRef Kim C, Kim MY, Kang JW, Song JS, Lee KY, Kim SS. Pulmonary artery intimal sarcoma versus pulmonary artery thromboembolism: CT and clinical findings. Korean J Radiol. 2018;19(4):792–802.CrossRef
5.
go back to reference Tachihara M, Tanaka Y, Zen Y, Nishimura Y. The notable appearance of pulmonary artery intimal sarcoma on positron emission tomography (PET)/CT. Intern Med. 2017;56(21):2953–4.CrossRef Tachihara M, Tanaka Y, Zen Y, Nishimura Y. The notable appearance of pulmonary artery intimal sarcoma on positron emission tomography (PET)/CT. Intern Med. 2017;56(21):2953–4.CrossRef
6.
go back to reference Schuler PK, Weber A, Bode PK, Neuhaus M, Pretre R, Jenni R, et al. MRI of intimal sarcoma of the pulmonary arteries. Circ Cardiovasc Imaging. 2009;2(5):e37–e3939.CrossRef Schuler PK, Weber A, Bode PK, Neuhaus M, Pretre R, Jenni R, et al. MRI of intimal sarcoma of the pulmonary arteries. Circ Cardiovasc Imaging. 2009;2(5):e37–e3939.CrossRef
7.
go back to reference Deng L, Zhu J, Xu J, Guo S, Liu S, Song Y. Clinical presentation and surgical treatment of primary pulmonary artery sarcoma. Interact Cardiovasc Thorac Surg. 2018;26(2):243–7.CrossRef Deng L, Zhu J, Xu J, Guo S, Liu S, Song Y. Clinical presentation and surgical treatment of primary pulmonary artery sarcoma. Interact Cardiovasc Thorac Surg. 2018;26(2):243–7.CrossRef
8.
go back to reference Yin K, Zhang Z, Luo R, Ji Y, Zheng D, Lin Y, et al. Clinical features and surgical outcomes of pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2018;155(3):1109–15.e1.CrossRef Yin K, Zhang Z, Luo R, Ji Y, Zheng D, Lin Y, et al. Clinical features and surgical outcomes of pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2018;155(3):1109–15.e1.CrossRef
9.
go back to reference Pu X, Song M, Huang X, Zhu G, Chen D, Gan H, et al. Clinical and radiological features of pulmonary artery sarcoma: a report of nine cases. Clin Respir J. 2018;12(5):1820–9.CrossRef Pu X, Song M, Huang X, Zhu G, Chen D, Gan H, et al. Clinical and radiological features of pulmonary artery sarcoma: a report of nine cases. Clin Respir J. 2018;12(5):1820–9.CrossRef
10.
go back to reference Srivali N, Yi ES, Ryu JH. Pulmonary artery sarcoma mimicking pulmonary embolism: a case series. QJM. 2017;110(5):283–6.PubMed Srivali N, Yi ES, Ryu JH. Pulmonary artery sarcoma mimicking pulmonary embolism: a case series. QJM. 2017;110(5):283–6.PubMed
11.
go back to reference Wong HH, Gounaris I, McCormack A, Berman M, Davidson D, Horan G, et al. Presentation and management of pulmonary artery sarcoma. Clin Sarcoma Res. 2015;5(1):3.CrossRef Wong HH, Gounaris I, McCormack A, Berman M, Davidson D, Horan G, et al. Presentation and management of pulmonary artery sarcoma. Clin Sarcoma Res. 2015;5(1):3.CrossRef
12.
go back to reference Grazioli V, Vistarini N, Morsolini M, Klersy C, Orlandoni G, Dore R, et al. Surgical treatment of primary pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2014;148(1):113–8.CrossRef Grazioli V, Vistarini N, Morsolini M, Klersy C, Orlandoni G, Dore R, et al. Surgical treatment of primary pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2014;148(1):113–8.CrossRef
13.
go back to reference Mussot S, Ghigna MR, Mercier O, Fabre D, Fadel E, Le Cesne A, et al. Retrospective institutional study of 31 patients treated for pulmonary artery sarcoma. Eur J Cardiothorac Surg. 2013;43(4):787–93.CrossRef Mussot S, Ghigna MR, Mercier O, Fabre D, Fadel E, Le Cesne A, et al. Retrospective institutional study of 31 patients treated for pulmonary artery sarcoma. Eur J Cardiothorac Surg. 2013;43(4):787–93.CrossRef
14.
go back to reference Gan HL, Zhang JQ, Zhou QW, Xiao W, Gao YM, Liu S, et al. Surgical treatment of pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2011;142(6):1469–72.CrossRef Gan HL, Zhang JQ, Zhou QW, Xiao W, Gao YM, Liu S, et al. Surgical treatment of pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2011;142(6):1469–72.CrossRef
15.
go back to reference Blackmon SH, Rice DC, Correa AM, Mehran R, Putnam JB, Smythe WR, et al. Management of primary pulmonary artery sarcomas. Ann Thorac Surg. 2009;87(3):977–84.CrossRef Blackmon SH, Rice DC, Correa AM, Mehran R, Putnam JB, Smythe WR, et al. Management of primary pulmonary artery sarcomas. Ann Thorac Surg. 2009;87(3):977–84.CrossRef
16.
go back to reference Tavora F, Miettinen M, Fanburg-Smith J, Franks TJ, Burke A. Pulmonary artery sarcoma: a histologic and follow-up study with emphasis on a subset of low-grade myofibroblastic sarcomas with a good long-term follow-up. Am J Surg Pathol. 2008;32(12):1751–61.CrossRef Tavora F, Miettinen M, Fanburg-Smith J, Franks TJ, Burke A. Pulmonary artery sarcoma: a histologic and follow-up study with emphasis on a subset of low-grade myofibroblastic sarcomas with a good long-term follow-up. Am J Surg Pathol. 2008;32(12):1751–61.CrossRef
17.
go back to reference Kim HK, Choi YS, Kim K, Shim YM, Sung K, Lee YT, et al. Surgical treatment for pulmonary artery sarcoma. Eur J Cardiothorac Surg. 2008;33(4):712–6.CrossRef Kim HK, Choi YS, Kim K, Shim YM, Sung K, Lee YT, et al. Surgical treatment for pulmonary artery sarcoma. Eur J Cardiothorac Surg. 2008;33(4):712–6.CrossRef
18.
go back to reference Huo L, Moran CA, Fuller GN, Gladish G, Suster S. Pulmonary artery sarcoma: a clinicopathologic and immunohistochemical study of 12 cases. Am J Clin Pathol. 2006;125(3):419–24.CrossRef Huo L, Moran CA, Fuller GN, Gladish G, Suster S. Pulmonary artery sarcoma: a clinicopathologic and immunohistochemical study of 12 cases. Am J Clin Pathol. 2006;125(3):419–24.CrossRef
19.
go back to reference Mayer E, Kriegsmann J, Gaumann A, Kauczor HU, Dahm M, Hake U, et al. Surgical treatment of pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2001;121(1):77–82.CrossRef Mayer E, Kriegsmann J, Gaumann A, Kauczor HU, Dahm M, Hake U, et al. Surgical treatment of pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2001;121(1):77–82.CrossRef
20.
go back to reference Anderson MB, Kriett JM, Kapelanski DP, Tarazi R, Jamieson SW. Primary pulmonary artery sarcoma: a report of six cases. Ann Thorac Surg. 1995;59(6):1487–90.CrossRef Anderson MB, Kriett JM, Kapelanski DP, Tarazi R, Jamieson SW. Primary pulmonary artery sarcoma: a report of six cases. Ann Thorac Surg. 1995;59(6):1487–90.CrossRef
21.
go back to reference Miura S, Meirmanov S, Nakashima M, Hayashi T, Abe K, Tamaru N, et al. Intimal sarcoma of the pulmonary artery: report of an autopsy case. Pathol Res Pract. 2005;201(6):469–74.CrossRef Miura S, Meirmanov S, Nakashima M, Hayashi T, Abe K, Tamaru N, et al. Intimal sarcoma of the pulmonary artery: report of an autopsy case. Pathol Res Pract. 2005;201(6):469–74.CrossRef
22.
go back to reference Kaminaga T, Takeshita T, Kimura I. Role of magnetic resonance imaging for evaluation of tumors in the cardiac region. Eur Radiol. 2003;13(Suppl 6):L1–.CrossRef Kaminaga T, Takeshita T, Kimura I. Role of magnetic resonance imaging for evaluation of tumors in the cardiac region. Eur Radiol. 2003;13(Suppl 6):L1–.CrossRef
23.
go back to reference Wyler von Ballmoos MC, Chan EY, Reardon MJ. Imaging and surgical treatment of primary pulmonary artery sarcoma. Int J Cardiovasc Imaging. 2019;35(8):1429–33.CrossRef Wyler von Ballmoos MC, Chan EY, Reardon MJ. Imaging and surgical treatment of primary pulmonary artery sarcoma. Int J Cardiovasc Imaging. 2019;35(8):1429–33.CrossRef
24.
go back to reference Liu MX, Ma ZH, Jiang T, Guo XJ, Yu FF, Yang YH, et al. Differential diagnosis of pulmonary artery sarcoma and central chronic pulmonary thromboembolism using CT and MR images. Heart Lung Circ. 2018;27(7):819–27.CrossRef Liu MX, Ma ZH, Jiang T, Guo XJ, Yu FF, Yang YH, et al. Differential diagnosis of pulmonary artery sarcoma and central chronic pulmonary thromboembolism using CT and MR images. Heart Lung Circ. 2018;27(7):819–27.CrossRef
25.
go back to reference Lee EJ, Moon SH, Choi JY, Lee KS, Choi YS, Choe YS, et al. Usefulness of fluorodeoxyglucose positron emission tomography in malignancy of pulmonary artery mimicking pulmonary embolism. ANZ J Surg. 2013;83(5):342–7.CrossRef Lee EJ, Moon SH, Choi JY, Lee KS, Choi YS, Choe YS, et al. Usefulness of fluorodeoxyglucose positron emission tomography in malignancy of pulmonary artery mimicking pulmonary embolism. ANZ J Surg. 2013;83(5):342–7.CrossRef
26.
go back to reference Ito K, Kubota K, Morooka M, Shida Y, Hasuo K, Endo H, et al. Diagnostic usefulness of 18F-FDG PET/CT in the differentiation of pulmonary artery sarcoma and pulmonary embolism. Ann Nucl Med. 2009;23(7):671–6.CrossRef Ito K, Kubota K, Morooka M, Shida Y, Hasuo K, Endo H, et al. Diagnostic usefulness of 18F-FDG PET/CT in the differentiation of pulmonary artery sarcoma and pulmonary embolism. Ann Nucl Med. 2009;23(7):671–6.CrossRef
27.
go back to reference Kruger I, Borowski A, Horst M, de Vivie ER, Theissen P, Gross-Fengels W. Symptoms, diagnosis, and therapy of primary sarcomas of the pulmonary artery. Thorac Cardiovasc Surg. 1990;38(2):91–5.CrossRef Kruger I, Borowski A, Horst M, de Vivie ER, Theissen P, Gross-Fengels W. Symptoms, diagnosis, and therapy of primary sarcomas of the pulmonary artery. Thorac Cardiovasc Surg. 1990;38(2):91–5.CrossRef
28.
go back to reference Bleisch VR, Kraus FT. Polypoid sarcoma of the pulmonary trunk: analysis of the literature and report of a case with leptomeric organelles and ultrastructural features of rhabdomyosarcoma. Cancer. 1980;46(2):314–24.CrossRef Bleisch VR, Kraus FT. Polypoid sarcoma of the pulmonary trunk: analysis of the literature and report of a case with leptomeric organelles and ultrastructural features of rhabdomyosarcoma. Cancer. 1980;46(2):314–24.CrossRef
29.
go back to reference Ramp U, Gerharz CD, Iversen S, Schweden F, Steppling H, Gabbert HE. Sarcoma of the pulmonary artery: report of two cases and a review of the literature. J Cancer Res Clin Oncol. 1992;118(7):551–6.CrossRef Ramp U, Gerharz CD, Iversen S, Schweden F, Steppling H, Gabbert HE. Sarcoma of the pulmonary artery: report of two cases and a review of the literature. J Cancer Res Clin Oncol. 1992;118(7):551–6.CrossRef
30.
go back to reference Nakahira A, Ogino H, Sasaki H, Katakami N. Long-term survival of a pulmonary artery sarcoma produced by aggressive surgical resection and adjuvant chemoradiotherapy. Eur J Cardiothorac Surg. 2007;32(2):388–90.CrossRef Nakahira A, Ogino H, Sasaki H, Katakami N. Long-term survival of a pulmonary artery sarcoma produced by aggressive surgical resection and adjuvant chemoradiotherapy. Eur J Cardiothorac Surg. 2007;32(2):388–90.CrossRef
Metadata
Title
Surgical treatment of primary pulmonary artery sarcoma
Authors
Yongxin Han
Yanan Zhen
Xiaopeng Liu
Xia Zheng
Jianbin Zhang
Zhenguo Zhai
Jun Duan
Yajun Zhang
Peng Liu
Publication date
01-04-2021
Publisher
Springer Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 4/2021
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-020-01476-2

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