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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giovanni Battista Luciani Alessandro Mazzucco Jules E. Dussek Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Luciani, G. B. Articles by Akomea-Agyin, C. Search for Related Content PubMed PubMed Citation Articles by Luciani, G. B. Articles by Akomea-Agyin, C.

Ann Thorac Surg 1997;63:601-602
© 1997 The Society of Thoracic Surgeons

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Correspondence

Surgical Management of Primary Pulmonary Artery Sarcoma

Division of Cardiac Surgery, University of Verona, O.C.M. Piazzale Stefani 1, Verona, 37126, Italy

To the Editor:

We read with interest the article by Akomea-Agyin and associates [1], on a case of primary pulmonary artery sarcoma presenting in a young woman with signs and symptoms of pulmonary embolism. A strikingly similar case was recently described in the pages of this journal by our group [2], and our closing remark suggested an increased level of awareness toward cases of pulmonary embolism in healthy, young women without apparent risk factors for embolism at history or physical examination. It is somewhat discouraging to register that this invitation has not been received in the very same auditorium of surgeons caring for these patients, as the woman reported in the article by Akomea-Agyin and associates was managed for 3 years as if suffering from recurrent pulmonary embolism [1]. The price paid for a late diagnosis was in the present case the need for a left pneumonectomy, which can sometimes be avoided if the tumor is promptly diagnosed. Radical excision of primary pulmonary artery sarcoma combined with adjuvant radiation and chemotherapy is justified as the experience of several authors [3, 4], as well as our own [2], has proved prolonged tumor-free survival. Unfortunately, the overall outlook continues to be poor, and survival beyond 4 or 5 years remains unlikely. Therefore, we continue to believe the problem to be primarily a diagnostic one and would like to reemphasize the need for an increased level of suspicion, particularly in the presence of "atypical" cases of pulmonary embolism. The possibility of offering a truly lasting therapy for these aggressive tumors only relies on the ability of the physicians caring for these patients to spread the knowledge to colleagues, also through the specialized medical literature. We hope that the unfortunate coincidence of two identical cases in the same journal will be seen less often in the future.

References

1. Akomea-Agyin C, Dussek JE, Anderson DR, Hartley RB. Pulmonary artery sarcoma mimicking pulmonary embolism: successful surgical intervention. Ann Thorac Surg 1996;61:1536–8.[Abstract/Free Full Text]
2. Mazzucco A, Luciani GB, Bertolini P, Faggian G, Morando G, Ghimenton C. Primary sarcoma of the pulmonary artery: diagnostic and surgical implications. Ann Thorac Surg 1994;57:222–5.[Abstract]
3. Head HD, Flam MS, John MJ, Lipnik SS, Slater DL, Stewart RD. Long-term palliation of pulmonary artery sarcoma by radical excision and adjuvant therapy. Ann Thorac Surg 1992;53:332–4.[Abstract]
4. Anderson MB, Kriett JM, Kapelanski DP, Tarazi R, Jamieson SW. Primary pulmonary artery sarcoma: a report of six cases. Ann Thorac Surg 1995;59:1487–90.

Reply

Department of Cardiothoracic Surgery, Guy's Hospital, St. Thomas' St, London SE1 9RT, England

To the Editor:

We entirely agree with Drs Luciani and Mazzucco that we should have a high index of suspicion in cases of atypical pulmonary embolism, cf, "all that wheezes is not asthma."

The problem in our case [1] is that the patient had been under the care of general physicians, not surgeons, for the 3 years before referral. Our working diagnosis from the first mention of the patient was that this was likely to be a tumor and not pulmonary embolism. Perhaps we are all publishing (dare I say it?) in the wrong journal, and these articles ought to be appearing in journals read by pulmonologists. I am happy to report that our patient remains disease free 3 years after the original resection.

We regret that the limitation on the number of references in a case report prevented us from quoting the articles by Mazzucco and colleagues [2] and Anderson and associates [3].

References

1. Akomea-Agyin C, Dussek JE, Anderson DR, Hartley RB. Pulmonary artery sarcoma mimicking pulmonary embolism: successful surgical intervention. Ann Thorac Surg 1996;61:1536–8.
2. Mazzucco A, Luciani GB, Bertolini P, Faggian G, Morando G, Ghimenton C. Primary sarcoma of the pulmonary artery: diagnostic and surgical implications. Ann Thorac Surg 1994;57:222–5.
3. Anderson MB, Kriett JM, Kapelanski DP, Tarazi R, Jamieson SW. Primary pulmonary artery sarcoma: a report of six cases. Ann Thorac Surg 1995;59:1487–90.[Abstract/Free Full Text]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giovanni Battista Luciani Alessandro Mazzucco Jules E. Dussek Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Luciani, G. B. Articles by Akomea-Agyin, C. Search for Related Content PubMed PubMed Citation Articles by Luciani, G. B. Articles by Akomea-Agyin, C.