Trends in cardiac metastasis

Our plain-English summary of Trends in cardiac metastasis, by B. Karwinski, E. Svendsen (APMIS, 1989).

The study

• Authors: B. Karwinski, E. Svendsen
• Journal: APMIS
• Published: 1989;97(11):1018-24
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A review of 8571 autopsies disclosed 2833 patients with malignant tumours from 1975 to 1984 at the Department of Pathology, The Gade Institute. Cardiac metastases were found in 130 cases. An increase of cardiac involvement was shown in the autopsy material from 1.2% in 1975-1979 to 1.8% in 1980-1984. The same trend was seen if cardiac metastases were related to malignant tumours. Numerically, lung cancer accounted for most of the metastases seen, but the increase was made up by other tumours than lung cancer. especially malignant melanoma, mesothelioma, breast cancer and sarcomas. These tumours have a high frequency of heart metastases and the increased incidence of these cancers in the material explains the rise of cardiac metastases. Cardiac metastases increased with rising number of distant metastases. This study shows that mesotheliomas have the highest percentage of cardiac spread. The importance of autopsy for detecting metastatic spread in sites that are difficult to detect clinically is emphasized.

In plain English

This study reviewed autopsy records from the Department of Pathology, The Gade Institute, University of Bergen, Norway, for 1975 to 1984. Of 8571 autopsies, 2833 showed malignant tumours. After leukaemia and other cancers of lymphatic and blood-forming tissue were excluded, 2564 cases remained. Cancer that had spread to the heart was found in 130 cases: 1.5% of all autopsies and 5.1% of the cancer cases. Lung cancer accounted for the most cases, 60 of 559 (10.7%). Mesothelioma had the highest rate, with 6 of 17 cases (35.3% in the table) spreading to the heart. The article does not say whether these mesotheliomas were pleural or peritoneal, and it did not study asbestos exposure. The authors suggested mesotheliomas are frequent in Bergen probably because of the shipyard industry. Among all autopsies, heart spread rose from 1.2% in 1975-1979 to 1.8% in 1980-1984, and cancers other than lung cancer accounted for the rise. For mesothelioma the counts went from 2 of 7 to 4 of 10. The authors said numbers for individual cancers were too small for statistical evaluation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of autopsy records from a single pathology department
• Who was studied: 8571 autopsies performed 1975 to 1984 at the Department of Pathology, The Gade Institute, University of Bergen, Norway. Malignant tumours were found in 2833 cases. Leukaemia (130 cases) and other lymphatic and haematopoietic neoplasms (139 cases) were excluded, leaving 2564 cases.
• Exposure: No asbestos or other exposure was studied, and asbestos is not mentioned. The study looked at spread of cancers, including mesothelioma, to the heart. In the discussion the authors suggested that mesotheliomas are frequent in Bergen probably because of the shipyard industry.
• Main results:
  • Heart metastases were found in 130 patients: 130 of 8571 autopsies (1.5%) and 130 of 2564 cancer cases (5.1%).
  • Lung cancer spread to the heart in 60 of 559 cases (10.7%). Other tumours did so in 70 of 2005 cases (3.5%). This difference was statistically significant (p less than 0.0005).
  • Mesothelioma had the highest frequency of heart involvement, 6 of 17 cases (35.3% in Table 2; the text prints 35.5%). Mesothelioma also had the highest frequency of spread to the pericardium (4 of 17, 23.5%).
  • Among all autopsies, heart metastases rose from 53 of 4380 (1.2%) in 1975-1979 to 77 of 4191 (1.8%) in 1980-1984 (p less than 0.03). Among cancer cases the rise was from 53 of 1171 (4.5%) to 77 of 1393 (5.5%), which was not statistically significant. Tumours other than lung cancer accounted for the increase.
  • Among mesotheliomas, heart involvement went from 2 of 7 (28.6%) in 1975-1979 to 4 of 10 (40.0%) in 1980-1984. The authors said these numbers were too small for statistical evaluation.
  • Heart metastases became more frequent as the number of distant metastatic sites increased. The heart was the only site of spread in just 1 of 60 lung cancer cases and in none of the other tumours.
• The authors' conclusion: The authors concluded that the rise in heart metastases was explained by increased incidence of malignant melanoma, breast cancer, mesothelioma and sarcoma, all of which often spread to the heart. They also emphasized the autopsy as a way to detect spread to sites that are hard to assess during life.
• Limitations the authors state:
  • Numbers for individual cancer types were too small for statistical evaluation of trends over time.
  • Figures for several other cancer types were small.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pathology, Autopsy, Lung Cancer, Mesothelioma, Sarcoma.

Related studies

• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Cardiac masses: assessment by MR imaging — J.T. Lund, R.L. Ehman, et al. (1989)
• Primary cardiac tumors: experience at the University of Minnesota — J.E. Molina, J.E. Edwards, et al. (1990)
• Malignant primary cardiac tumors. The Cleveland Clinic experience, 1956 to 1986 — P.A. Bear, D.S. Moodie (1987)
• Cardiac tumors that cause arrhythmias — K.F. Kusano, T. Ohe (2002)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)

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