Cardiac metastatic malignant melanoma

Introduction to cardiac metastatic malignant melanoma Cardiac malignant metastases were first described in Bonite in 1700. In 1867, Prudhomme first reported a case of malignant melanoma metastases. Due to advances in diagnostic techniques and increased autopsy work, the number of reported cases increased. Cardiac metastases are not extensive and often have no clinical manifestations, and even those with severe myocardial destruction have no clinical manifestations. Difficulty or shortness of breath, tachycardia, systolic murmur, edema, pericardial effusion, etc. are also common symptoms. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: arrhythmia pericarditis heart failure

Causes of cardiac metastatic malignant melanoma

(1) Causes of the disease

Because of the heart metastasis caused by malignant melanoma, melanoma is the most likely to cause heart metastasis in all malignant tumors.

(two) pathogenesis

1. Malignant tumors can be transferred to the heart through four pathways.

(1) The tumor thrombus enters the myocardium through a small coronary blood vessel, which is found in melanoma, lymphoma and the like.

(2) The tumor passes through the mediastinum and trachea, and the bronchial lymphatic tract flows back into the heart. Under the microscope, there are malignant cells in the lymphatic surface of the heart, which is called cancerous lymphangitis.

(3) Tumors can also directly invade the heart from intrathoracic tumors.

(4) A small part is the formation of fibrin on the tumor cells into the vein, maintaining tumor growth, and the tumor plug enters the heart cavity.

2. Metastasis can involve some or all of the heart transfer The heart can be divided into two parts:

(1) Cardiac metastasis: refers to intracardiac (membrane) metastasis, myocardial metastasis and extracardiac (membrane) metastasis.

(2) Pericardial metastasis: refers to the transfer of pericardial wall layer.

Cardiac metastases are more than pericardial metastases in a ratio of 2:1.

Cardiac metastatic malignant melanoma prevention

Malignant melanoma is a highly malignant tumor. Although the incidence rate in China is not high, due to the lack of understanding of the seriousness of doctors and patients, the treatment effect is also extremely unsatisfactory. It must be widely used during surgical resection, and it is 3~5cm away from the original tumor. That is, there may still be recurrence and metastasis, and generally should not be taken for biopsy, such as taking biopsy and radical surgery as short as possible to avoid or reduce recurrence and metastasis.

Metastatic malignant melanoma complications Complications arrhythmia pericarditis heart failure

There may be complications such as arrhythmia, pericarditis, heart failure.

Cardiac metastatic malignant melanoma symptoms Common symptoms Angina palpebral metastasis systolic murmur arrhythmia dyspnea tachycardia edema atrioventricular block obstruction myocardial infarction

Cardiac metastases are not extensive and often have no clinical manifestations, even those with severe myocardial destruction have clinical manifestations, dyspnea or urgency, tachycardia, systolic murmur, edema, pericardial effusion, etc. are also common symptoms, pericardial metastases It is often lighter than the symptoms of cardiac metastasis. It is an important clinical manifestation of pericardial effusion. The following symptoms and signs may appear in the heart with metastases:

1. Tumor invasion into the heart muscle causes congestive heart failure.

2. Tumors inserted into coronary vessels can cause angina or myocardial infarction.

3. Tumor invasion of the heart valve can cause its deformation.

4. Tumors form intracardiac occlusion.

5. Cause arrhythmia and changes in bundle branch block.

6. Pericardial compression symptoms due to pericardial fluid or diffuse lesions in the pericardium.

Examination of cardiac metastatic malignant melanoma

Cytological examination: The discovery of tumor cells in pericardial puncture fluid has important diagnostic significance.

1. Continuously taking chest radiographs

It can be found that the heart shadow gradually increases.

2. CT and MRI examination

Changes in the pericardium or heart can be seen.

3. ECG

Mainly manifested as tachycardia, low voltage, ectopic tachycardia and atrioventricular block.

Diagnosis and differentiation of cardiac metastatic malignant melanoma

Diagnostic criteria

Diagnosis can usually be made before death. When a patient with malignant tumor is not due to anemia, hypoproteinemia or cardiac dysfunction due to lung metastasis, the patient should be suspected of having cardiac metastases. The following performance should be paid attention to: 1 Acute pericarditis or pericardial tamponade. 2X line examination has an increase in heart shadow. 3 paroxysmal tachycardia or severe atrioventricular block, or even heart failure.

Differential diagnosis

1. Identification with primary cardiac tumors

The incidence of the latter is extremely low, only 1/20 of the former, the age of onset is small, and benign cardiac myxoma is more common, and no extracardiac malignant tumor is the main basis for identification.

2. Identification with dilated cardiomyopathy

Both can be characterized as congestive heart failure, the examination showed a heart enlargement and decreased mobility, but the heart metastases developed faster, the effect on digitalis and diuretics was poor, X-ray films showed irregular heart shape, B-ultrasound, Tumor lesions can be found by CT and magnetic resonance.

3. Identification of pericardial effusion with other causes

Cardiac metastatic malignant melanoma is prone to pericardial effusion, but most of it is bloody, rapid development, cancer cells can be found in the effusion, the treatment effect is poor, these characteristics can be identified.

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