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Subroto Paul
Daniel M. Cohen
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J Thorac Cardiovasc Surg 2007;133:1667-1669
© 2007 The American Association for Thoracic Surgery

Brief Communication

Primary Ewing sarcoma invading the heart: Resection and reconstruction

Subroto Paul, MDa, Tharumenthiran Ramanathan, MD, PhD, FRACSb, Daniel M. Cohen, MDa, Abraham Lebenthal, MDa, Lambros Zellos, MDa, Sary F. Aranki, MDb, David J. Sugarbaker, MDa,*

a Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Mass
b Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Mass.

Received for publication January 6, 2007; accepted for publication February 7, 2007.

* Address for reprints: David J. Sugarbaker, MD, Brigham and Women’s Hospital, Division of Thoracic Surgery, 75 Francis St, Boston, MA 02115. (Email: dsugarbaker@partners.org).

The first 20% of the full text of this article appears below.

Clinical Summary

We describe the case history of a 14-year-old boy who came to his pediatrician with a cough. Chest radiograph revealed a large mediastinal mass. Workup with chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed that the mass had invaded the right pulmonary parenchyma, both atria, and the superior vena cava (SVC) (Figure 1, A). CT-guided biopsy revealed the tumor to be Ewing sarcoma/primitive neuroectodermal tumor. The patient underwent sarcoma-based chemotherapy with 18 weeks of vincristine, ifosafamide, doxorubicin (Adriamycin), and etoposide followed by 2 additional weeks of vincristine, doxorubicin, and isofamide. Repeat imaging revealed the mass to be downsized by chemotherapy (Figure 1, B). Bone scan, abdominal CT, and positron emission tomography–CT did not reveal any metastases. The patient was referred for surgery. Preoperative workup included pulmonary function tests (forced expiratory volume in 1 second = 2.59 [67%], forced vital capacity = 3.00 [67%]), a quantitative ventilation/perfusion scan (quantitative perfusion [left lung] = 81%; quantitative perfusion [right lung] = 19%), and an echocardiogram (ejection . . . [Full Text of this Article]




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