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Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction

Received: 3 November 2021    Accepted: 19 November 2021    Published: 25 November 2021
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Abstract

Background: Metastatic tumors to the heart include lymphomas, sarcoma, leukemia, and melanoma. Of these, metastatic melanoma is the most common, and are usually hematogenous, where metastatic lesions can be present in the left ventricle, right atrium, and/ or the right ventricle. Objective: We present an atypical metastatic melanoma pattern, where cardiac metastasis originated by direct extension from the adjacent gastric mesentery. We also present our trans-cardiac resection approach, which was the safest way to access the cardiac metastasis intra-operatively without disrupting the tumor. Method: This was an incidental intraoperative finding, and no formal study methods were employed. During the operation, the atrium was opened via standard procedures. The point of tumor adherence to the posterior atrial wall was identified and resected. The tumor was found to extend by a pedicle into the mesentery of the gastric pull-up. Result: The outcome of this procedure was favorable. The tumor was completely resected, along with the adjacent heart and mesenteric tissues. The edges of the atrial tissues were cryoablated to eliminate any micro-invasion, and at 2-week follow-up, patient indicated significant improvement in pre-operative symptoms. Conclusion: Our patient’s metastatic melanoma presented as a solitary metastasis to the right atrial caval junction. Trans-cardiac resection of the tumor was affected with deep hypothermic circulatory arrest without complications. We recommend this as the safest way to access the tumor at the atrial caval junction.

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 7, Issue 6)
DOI 10.11648/j.ijcts.20210706.14
Page(s) 75-77
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Cardiovascular Surgery, Metastatic Melanoma, Atrial Caval Junction, Recommended Surgical Resection, Case Report, Cardiac Metastasis

References
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[2] Zitzelsberger, T. et al. Imaging Characteristics of Cardiac Metastases in patients with Malignant Melanoma. Cancer Imaging. 2017: 19 (17).
[3] Damsky, WE, et al. Decoding Melanoma Metastasis. Cancers. 2011: 3 (1); 126–163.
[4] Goldberg, AD, et al. Tumors Metastatic to the Heart. Circulation. 2013; 128: 1790–1794.
[5] Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic Pattern of Malignant Melanoma. A Study of 216 Autopsy Cases. American Journal of Surgery. 1978; 135: 807-810.
[6] Maleszewski JJ, Bois MC, Bois JP, Young PM, Stulak JM, Klarich KW. Neoplasia and the Heart: Pathological Review of Effects with Clinical and Radiological Correlation. Journal of the American College of Cardiology. 2018; 72: 202–227.
[7] Shapiro, LM, et al. Cardiac Diagnosis and Management. Heart. 2001; 85: 218–222.
[8] Tesolin M, Lapierre C, Oligny L, Bigras JL, Champagne M. Cardiac Metastasis from Melanoma. Radiographics. 2005; 25 (1): 249-253.
[9] Balinski AM, Kerndt CC, Parry NP, Rehman RA, Yeow RY, Hayek SS. Metastatic Melanoma of the Heart: A Systemic Review. Journal of Clinical Oncology. 2020; 38 (15): 22017.
[10] Chuk MK, Chang JT, Theoret MR, Sampene E, He K, Weis SL, et al. FDA Approval Summary: Accelerated Approval of Pembrolizumab for Second-line Treatment of Metastatic Melanoma. Clinical Cancer Research. 2017; 23 (19): 5666-5670.
[11] Aerts BRJ, Kock MCJM, Kofflard MJM, Plaisier PW. Cardiac Metastasis of Malignant Melanoma: A Case Report. Netherlands Heart Journal: Monthly Journal of the Netherlands Society of Cardiology and Netherlands Heart Foundation. 2014; 22 (1): 39-41.
[12] Lee JH, Lyle M, Menzies AM, Chan MM, Lo S, Clements A, et al. Metastasis-specific Patterns of Response and Progression with anti-PD-1 Treatment in Metastatic Melanoma. Pigment Cell and Melanoma Research. 2018; 31 (3): 404–410.
[13] Biteghe FAN, Chalomie NET, Mungra N, Vignaux G, Gao N, Vergeade A, et al. Antibody-based Immunotherapy: Alternative Approaches for the treatment of Metastatic Melanoma. Biomedicines. 2020; 8 (9): 327.
[14] Sondak V., Gibney G. Surgical Management of Melanoma. Hematologics/ Oncologics Clinics of North America. 2014; 28: 455–470.
[15] Forschner A, Eichner F, Amaral T, Keim U, Garbe C, Eigentler TK. Improvement of Overall Survival in Stage IV Melanoma patients during 2011-2014: Analysis of real-world data in 441 patients of the German Central Malignant Melanoma Registry (CMMR). Journal of Cancer Research and Clinical Oncology. 2017; 143 (3): 533-540.
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  • APA Style

    Vitalis Chukwuebuka Osuji, Maha Mohammed Alkhuziem, Daniel John Beckman. (2021). Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction. International Journal of Cardiovascular and Thoracic Surgery, 7(6), 75-77. https://doi.org/10.11648/j.ijcts.20210706.14

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    ACS Style

    Vitalis Chukwuebuka Osuji; Maha Mohammed Alkhuziem; Daniel John Beckman. Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction. Int. J. Cardiovasc. Thorac. Surg. 2021, 7(6), 75-77. doi: 10.11648/j.ijcts.20210706.14

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    AMA Style

    Vitalis Chukwuebuka Osuji, Maha Mohammed Alkhuziem, Daniel John Beckman. Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction. Int J Cardiovasc Thorac Surg. 2021;7(6):75-77. doi: 10.11648/j.ijcts.20210706.14

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  • @article{10.11648/j.ijcts.20210706.14,
      author = {Vitalis Chukwuebuka Osuji and Maha Mohammed Alkhuziem and Daniel John Beckman},
      title = {Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {7},
      number = {6},
      pages = {75-77},
      doi = {10.11648/j.ijcts.20210706.14},
      url = {https://doi.org/10.11648/j.ijcts.20210706.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20210706.14},
      abstract = {Background: Metastatic tumors to the heart include lymphomas, sarcoma, leukemia, and melanoma. Of these, metastatic melanoma is the most common, and are usually hematogenous, where metastatic lesions can be present in the left ventricle, right atrium, and/ or the right ventricle. Objective: We present an atypical metastatic melanoma pattern, where cardiac metastasis originated by direct extension from the adjacent gastric mesentery. We also present our trans-cardiac resection approach, which was the safest way to access the cardiac metastasis intra-operatively without disrupting the tumor. Method: This was an incidental intraoperative finding, and no formal study methods were employed. During the operation, the atrium was opened via standard procedures. The point of tumor adherence to the posterior atrial wall was identified and resected. The tumor was found to extend by a pedicle into the mesentery of the gastric pull-up. Result: The outcome of this procedure was favorable. The tumor was completely resected, along with the adjacent heart and mesenteric tissues. The edges of the atrial tissues were cryoablated to eliminate any micro-invasion, and at 2-week follow-up, patient indicated significant improvement in pre-operative symptoms. Conclusion: Our patient’s metastatic melanoma presented as a solitary metastasis to the right atrial caval junction. Trans-cardiac resection of the tumor was affected with deep hypothermic circulatory arrest without complications. We recommend this as the safest way to access the tumor at the atrial caval junction.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction
    AU  - Vitalis Chukwuebuka Osuji
    AU  - Maha Mohammed Alkhuziem
    AU  - Daniel John Beckman
    Y1  - 2021/11/25
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijcts.20210706.14
    DO  - 10.11648/j.ijcts.20210706.14
    T2  - International Journal of Cardiovascular and Thoracic Surgery
    JF  - International Journal of Cardiovascular and Thoracic Surgery
    JO  - International Journal of Cardiovascular and Thoracic Surgery
    SP  - 75
    EP  - 77
    PB  - Science Publishing Group
    SN  - 2575-4882
    UR  - https://doi.org/10.11648/j.ijcts.20210706.14
    AB  - Background: Metastatic tumors to the heart include lymphomas, sarcoma, leukemia, and melanoma. Of these, metastatic melanoma is the most common, and are usually hematogenous, where metastatic lesions can be present in the left ventricle, right atrium, and/ or the right ventricle. Objective: We present an atypical metastatic melanoma pattern, where cardiac metastasis originated by direct extension from the adjacent gastric mesentery. We also present our trans-cardiac resection approach, which was the safest way to access the cardiac metastasis intra-operatively without disrupting the tumor. Method: This was an incidental intraoperative finding, and no formal study methods were employed. During the operation, the atrium was opened via standard procedures. The point of tumor adherence to the posterior atrial wall was identified and resected. The tumor was found to extend by a pedicle into the mesentery of the gastric pull-up. Result: The outcome of this procedure was favorable. The tumor was completely resected, along with the adjacent heart and mesenteric tissues. The edges of the atrial tissues were cryoablated to eliminate any micro-invasion, and at 2-week follow-up, patient indicated significant improvement in pre-operative symptoms. Conclusion: Our patient’s metastatic melanoma presented as a solitary metastasis to the right atrial caval junction. Trans-cardiac resection of the tumor was affected with deep hypothermic circulatory arrest without complications. We recommend this as the safest way to access the tumor at the atrial caval junction.
    VL  - 7
    IS  - 6
    ER  - 

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Author Information
  • Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, USA

  • Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, USA

  • Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, USA

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