転移性心臓腫瘍に対する外科的治療

Surgical Resection of Metastatic Cardiac Tumors

転移性心臓腫瘍は診断時にはすでに進行期であることが多い．また種類，発生部位，転移様式によりさまざまな形態を呈するために，治療方針の決定がむずかしい疾患である．しかしながら，心不全症状を呈する場合にはすみやかな外科治療介入が必要である．腫瘍減量術（mass reduction）は腫瘍塞栓に対するリスク軽減とともに，生存期間延長に寄与する可能性が示唆される．本稿では手術介入を行ったまれな転移性心臓腫瘍2例について，文献的考察を加えて報告する．

We report two cases of metastatic cardiac tumors managed surgically. Case 1 involved a 52-year-old man with colorectal cancer and pulmonary metastases who developed respiratory distress during chemoradiotherapy. Imaging revealed a right atrial mass extending into the right ventricle. Mass reduction of the intracardiac tumor was surgically performed to reduce embolic risk and to enable subsequent chemotherapy. Postoperative chemotherapy resulted in complete remission without recurrence. Case 2 involved a 50-year-old woman with cervical cancer who experienced worsening dyspnea during treatment. Positron emission tomography （PET） and echocardiography identified a tumor extending from the right atrium to the pulmonary artery. As complete resection was unfeasible, mass reduction with tricuspid valve replacement was performed, followed by chemotherapy. The patient remains alive. Pathology confirmed metastatic cardiac tumors in both cases. These tumors present variably depending on the primary cancer and metastatic pattern, making diagnosis and treatment challenging. In symptomatic cases, especially with heart failure or embolism, prompt surgical intervention is critical. Mass reduction can relieve symptoms and improve survival. A focused literature review is also included to support clinical decision-making.