[The heart: bystander or participant in neoplasms? The Hedinger syndrome (carcinoid cardiopathy)]. / Cordul: spectator sau participant în neoplazii? Sindromul Hedinger (cardiopatia carcinoida).

A case of a 38-years-old patient with carcinoid syndrome (paroxysmal skin flush, diarrhoea, abdominal pain) is documented although the search of the primary tumor was not able to localise it (possibly an intestinal one). Confirmatory diagnosis had a biochemical support in 262 mg/24 h urinary elimination of 5 HIAA (metabolic of serotonine). Particular aspects of the case are illustrated through intravitam documentation of the liver metastases (via portal vein) and the damage of the right heart (Hedinger syndrome) resulting from the involvement of the tricuspid valve apparatus (with clinical, phonomechanographic and echocardiographic abnormalities). The fatal evolution of the patient was due to uncontrolled aggravation of the portal high blood pressure syndrome (refractory ascites to diuretic treatment). It was impossible to us to obtain the morphopathological data. The specific elements of the carcinoid syndrome (including a convincing indirect illustration) with right cardiac involvement (known as Hedinger syndrome) are discussed, as well as the hypothetical place in pancreas of the primary carcinoid tumor.

[The heart: a spectator or participant in neoplasms? Neoplastic subacute cor pulmonale]. / Cordul: spectator sau participant în neoplazii? Cordul pulmonar subacut neoplazic.

Neoplastic subacute cor pulmonale is a distinct clinical syndrome that is often not too easily diagnosed. Such rapid development of cor pulmonale is observed in a patient with lymphangitis carcinomatosa of the lung consecutive to a cancer of the stomach with splenic, pancreatic and lymph nodes invasion. Diagnosis was established on transition of the normal ECG to a typical pattern of cor pulmonale and was revealed by chest roentgenographic examination (interstitial syndrome finding) and fatal evolution of severe respiratory failure. Necroptic and pathological studies confirmed histologic lung involvement by tumoral emboli and lymphangitic carcinoma the tosis and documented neoplasm in the stomach.