Lege Artis Medicinae

[INTRAVASCULAR LEIOMYOMATOSIS PRESENTING AS A RIGHT ATRIAL MASS]

MAGYAR Éva, SALAMON Ferenc, TOMCSÁNYI István

OCTOBER 21, 2007

Lege Artis Medicinae - 2007;17(10)

[INTRODUCTION - Intravenous leiomyoma is a peculiar, rare tumour that originates from the myomatous uterus, grows into the lumina of veins and, through the inferior vena cava, may extend to the right heart cavity. The intracardial tumour causes severe cardiovascular symptoms and may be fatal. CASE REPORT - The symptoms of the 45-yearold woman consisted of chest discomfort, dizziness, and short periods of unconsciousness, which occurred during vacuum-cleaning when she bent forward. Imaging showed a growth that filled the lumen of the vena cava and extended to the right atrium, swinging between the atrium and ventricle. The patient underwent surgery with cardiopulmonary bypass and the intracardial tumour was removed together with its extensions filling the veins. The histological examination verified intravenous leiomyomatosis. Although the patient refused the recommended hysterectomy, she is well after six years the operation. CONCLUSION - In cases of unspecific cardiac symptoms, the possibility of intravenous leiomyomatosis should be considered. The diagnosis can be set up by echocardiography, MR or CT scan. If the diagnosis is confirmed, the tumour should be surgically removed.]

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[CARCINOMATOUS MENINGITIS]

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[INTRODUCTION - Carcinomatous meningitis is a serious complication of advanced stage solid tumours, which may become more common with improved survival. CASE REPORTS - A 53-year-old woman with a recent history of breast cancer (pT2pN2M0) had been treated by mastectomy and adjuvant chemotherapy and radiotherapy. She presented with weakness, diplopia and vertigo raising the possibility of vertebrobasilar ischaemia or an intracranial mass. In another patient, a 62-year-old man with hypertension, a stenotic common bile duct had been diagnosed when examined for abdominal complaints. When he presented with a high blood pressure value accompanied by intensive headache, vomiting and bilateral hearing loss, he was thought to have a hypertensive crisis. The rapidly progressive neurological symptoms and the history of breast cancer and findings suggesting pancreatic head tumour, respectively, led to the clinical diagnosis of carcinomatous meningitis in both cases, despite any evidence on CT scans or a negative MR scan, though of limited value, in the first case. This diagnosis was confirmed by the laboratory and cytological findings of the cerebrospinal fluid, and also by the post mortem examination, since both patients died within a month after the onset of the symptoms. The primary tumour in the second patient proved to be a widely metastasizing diffuse type gastric cancer. CONCLUSION - Carcinomatous meningitis has a varying but characteristic presentation which generally makes it easy to diagnose, but it can sometimes present differential diagnostic problems. What we can learn from these two cases may help in recognizing this complication.]

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[The author’s response to the comment on “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

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