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      Left atrial myxoma: the importance of cardiovascular imaging in the long-term follow-up of breast cancer survivors Translated title: Mixoma auricular izquierdo: importancia de la imagen cardiovascular en el seguimiento a largo plazo de las sobrevivientes de cáncer de mama

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          Abstract

          Abstract: The incidence of cancer patients with cardiac diseases requiring surgery is rising as the population ages, and early detection of cancer and the use of new therapies are increasing survival rates. Cardiac tumors, despite their rarity, are an integral part of the cardio-oncology practice and require diagnosis and treatment. In recent years, the incidence of cardiac tumors has risen due to advancements in multimodality imaging, which have become more accessible and widespread. The association between treated breast cancer and myxoma could be considered a mere coincidence, but a few documented cases exist. We report the case of a patient with a history of breast cancer who presented, upon follow-up, a left atrial cardiac mass on cardiovascular imaging and underwent immediate surgery. This case illustrates the importance of Cardio-Oncology Clinics during the follow-up of breast cancer survivors.

          Translated abstract

          Resumen: La incidencia de pacientes con cáncer y enfermedades cardiacas que requieren cirugía aumenta a medida que la población envejece. La detección temprana del cáncer y el uso de nuevas terapias aumentan las tasas de supervivencia. Los tumores cardiacos, a pesar de su rareza, son una parte integral de la cardio-oncología, requiriendo diagnóstico y tratamiento. En los últimos años, la incidencia de tumores cardiacos ha aumentado debido a los avances en los estudios de imagen, que se han vuelto más accesibles. La asociación entre el cáncer de mama y el mixoma podría considerarse una mera coincidencia, pero hay pocos casos documentados. Presentamos el caso de una paciente con antecedente de cáncer de mama que, durante el seguimiento, presentó una masa cardiaca en la aurícula izquierda en estudios de imagen cardiovascular y, de inmediato, fue intervenida quirúrgicamente. Este caso ilustra la importancia de las Clínicas de Cardio-Oncología durante el seguimiento de las sobrevivientes de cáncer de mama.

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          2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)

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            Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases.

            We analyzed a series of 112 consecutive cases of left atrial myxoma diagnosed in a single French hospital (72 women and 40 men; age range, 5-84 yr) over 40 years, from 1959 to 1998. Symptoms of mitral valve obstruction, the first arm of the classic triad of myxoma presentation, were present in 75 patients (67%), with mostly cardiac failure or malaise. Symptoms of embolism, the second frequent presentation in the classic triad, were observed in 33 cases (29%) with 1 or several locations, essentially cerebral emboli with stroke. Males are statistically at greater risk than females of developing embolic complications. The third arm of the classic triad consists of constitutional symptoms (34%) with fever, weight loss, or symptoms resembling connective tissue disease, due to cytokine (interleukin-6) secretion. Younger and male patients have more neurologic symptoms, and female patients have more systemic symptoms. Seventy-two patients (64%) had cardiac auscultation abnormalities, essentially pseudo-mitral valve disease (53.5%) and more rarely the suggestive tumor plop (15%). The most frequent electrocardiographic sign was left atrial hypertrophy (35%), whereas arrhythmias were uncommon. The greater number of myxoma patients (98) diagnosed preoperatively after 1977 reflects the introduction of echocardiography as a noninvasive diagnostic procedure. However, there was no significant reduction in the average time from onset of symptoms to operation between patients seen in the periods before and after 1977. The tumor diameter ranged from 1 to 15 cm with a weight of between 15 and 180 g (mean, 37 g). The myxoma surface was friable or villous in 35% of the cases, and smooth in the other 65% cases. Myxomas in patients presenting with embolism have a friable surface; those in patients with cardiac symptoms, pseudo-mitral auscultation signs, tumor plop, and electrocardiogram or radiologic signs of left atrium hypertrophy and dilatation are significantly the larger tumors. The long-term prognosis is excellent, and only 4 deaths occurred among our 112 cases over a median follow-up of 3 years. The recurrence rate is low (5%), but long-term follow-up and serial echocardiography are advisable especially for young patients.
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              Long-term cause-specific mortality among survivors of childhood cancer.

              Survivors of childhood cancer are at increased risk of premature mortality compared with the general population, but little is known about the long-term risks of specific causes of death, particularly beyond 25 years from diagnosis at ages when background mortality in the general population starts to increase substantially. To investigate long-term cause-specific mortality among 5-year survivors of childhood cancer in a large-scale population-based cohort. British Childhood Cancer Survivor Study, a population-based cohort of 17,981 5-year survivors of childhood cancer diagnosed with cancer before age 15 years between 1940 and 1991 in Britain and followed up until the end of 2006. Cause-specific standardized mortality ratios (SMRs) and absolute excess risks (AERs). Overall, 3049 deaths were observed, which was 11 times the number expected (SMR, 10.7; 95% confidence interval [CI], 10.3-11.1). The SMR declined with follow-up but was still 3-fold higher than expected (95% CI, 2.5-3.9) 45 years from diagnosis. The AER for deaths from recurrence declined from 97 extra deaths (95% CI, 92-101) per 10,000 person-years at 5 to 14 years from diagnosis, to 8 extra deaths (95% CI, 3-22) beyond 45 years from diagnosis. In contrast, during the same periods of follow-up, the AER for deaths from second primary cancers and circulatory causes increased from 8 extra deaths (95% CI, 7-10) and 2 extra deaths (95% CI, 2-3) to 58 extra deaths (95% CI, 38-90) and 29 extra deaths (95% CI, 16-56), respectively. Beyond 45 years from diagnosis, recurrence accounted for 7% of the excess number of deaths observed while second primary cancers and circulatory deaths together accounted for 77%. Among a cohort of British survivors of childhood cancer, excess mortality from second primary cancers and circulatory diseases continued to occur beyond 25 years from diagnosis.
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                Author and article information

                Journal
                cms
                Cardiovascular and metabolic science
                Cardiovasc. metab. sci
                Asociación Nacional de Cardiólogos de México A.C. (Ciudad de México, Ciudad de México, Mexico )
                2683-2828
                2954-3835
                June 2023
                : 34
                : 2
                : 66-71
                Affiliations
                [4] Mexico City orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional 1° de Octubre Mexico
                [5] Mexico City orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional 1° de Octubre Mexico
                [3] Mexico City orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional 1° de Octubre Mexico
                [2] Mexico City orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional 1° de Octubre Mexico
                [1] Mexico City orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional 1° de Octubre Mexico
                [6] Mexico City orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional 1° de Octubre Mexico
                Article
                S2954-38352023000200066 S2954-3835(23)03400200066
                10.35366/111549
                c3a577de-4913-401f-9305-d44120117fa1

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 09 March 2023
                : 08 June 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 6
                Product

                SciELO Mexico

                Categories
                Clinical cases

                segundo tumor primario,cardio-oncología,seguimiento oncológico,imagen cardiovascular,cáncer de mama,mixoma auricular,cardio-oncology,oncologic follow-up,second primary tumor,cardiovascular imaging,breast cancer,myxoma

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