Clinical recognition and management of cardiac metastatic disease. Observations in a unique case of alveolar soft-part sarcoma

Alveolar Soft Part Sarcoma with Unusual Cardiac Metastasis: A Case Report and Review of the Literature

Alveolar soft part sarcoma is a very uncommon soft tissue malignancy which accounts for <1% of soft tissue sarcoma. It is a malignant and highly vascular tumor arising most commonly in the musculature of the lower extremities, with metastasis primarily to the lungs, bones, and brain. Cardiac metastasis is very rare and only 5 cases have been reported in the literature so far. We report a case of a young woman with a history of surgically resected alveolar soft part sarcoma of left thigh who presented with persistent dry cough and was found to have a cardiac mass, which on biopsy proved to be alveolar soft part sarcoma.

Primary cardiac alveolar soft part sarcoma. A report of the first observed case with molecular diagnostics corroboration

A case of primary alveolar soft part sarcoma (ASPS) of the heart is reported in an 11-year-old female as 1 of 16 cases of ASPS presenting in the first 2 decades of life in our institutional 17-year review period. The classic alveolar or organoid pattern was inconspicuous as compared to a more diffuse or formless pattern consisting of a population of uniform round cells with abundant eosinophilic cytoplasm, but in addition there was a second, minor population of gigantiform tumor cells with a variety of unusual shapes. Scattered tumor cells contained dense eosinophilic condensations in the cytoplasm. Other unusual features for ASPS in our case included a lymphohistocytic reaction and zonal necrosis. Immunohistochemistry revealed nuclear reactivity for TFE3, and the ASPL-TFE3 fusion transcript was identified by reverse-transcriptase polymerase chain reaction. The only other examples of ASPS involving the heart were 3 cases in the literature of metastatic disease from tumors arising in the soft tissues. This initial case of primary cardiac ASPS joins the list of other types of sarcomas in children that have been reported as primary neoplasms of the heart.

An Unusual Cause of New-onset Atrial Flutter: Primary Cardiac Lymphoma

Primary cardiac lymphoma is a rare disease with a high mortality rate due to the advanced stage of myocardial involvement at presentation. The diagnosis is extremely difficult to make because of the rarity of the disease, variability of clinical manifestations, limited noninvasive diagnostic techniques available, and difficulties and/or delays in the use of invasive measures. The incidence of the disease is increasing, especially among immunocompromised patients, with those suffering from acquired immunodeficiency syndrome accounting for the greatest increase. We report the case of an immunocompetent 76-year-old black woman who presented with near-syncopal episodes. Transthoracic echocardiogram revealed a right atrial mass. Surgical resection was performed, and a diagnosis of large B-cell non-Hodgkin's lymphoma was made. Primary cardiac lymphoma should be considered in any patient with a cardiac mass. Prompt diagnosis and treatment of primary cardiac lymphoma is imperative for survival.

Acute vascular embolus resulting from metastatic endocardial involvement with synovial sarcoma: report of a case and review of the literature

A rare case of metastatic soft tissue sarcoma (STS) involving the endocardium of the left ventricle of the heart is described. A 57-year-old man with a previously resected synovial sarcoma of the anterior abdominal wall presented 5 years later with an acute ischaemic arm resulting from tumour embolus. The treatment and outcome of the patient are outlined. Metastatic STS cardiac involvement and management of this complication are reviewed.

Acute cor pulmonale secondary to metastatic tumor to the heart: a case report and literature review

Metastatic tumors to the heart are becoming more common due to improved survival afforded by advanced treatment of malignancies. Their presence should be sought in a cancer patient who develops new primary cardiac symptoms. We present a case of a 50-year-old woman who succumbed to acute cor pulmonale secondary to metastatic laryngeal carcinoma to the right ventricle with subsequent tumor emboli to the pulmonary vasculature.

Cardiac manifestations of noncardiac tumors. Part II: Direct effects

Cardiac manifestations of secondary tumors of the heart exert their effects directly by endocardial, myocardial, epicardial or cavitary deposits (metastatic lesions); indirectly via tumor products such as carcinoma; or mediated by therapy (chemotherapy, radiation) to treat the primary neoplasm. Part II of this review summarizes certain direct effects of noncardiac tumors on the heart including superior and inferior vena cava syndromes, pulmonary artery and vein obstruction or compression, myocardial implants, and intracavitary metastases. Many of these direct effects may be noninvasively diagnosed by computed tomography, magnetic resonance imaging and/or two-dimensional echocardiography.

Metastatic periosteal osteosarcoma causing cardiac and renal failure

The case of a 25-year-old man who had periosteal osteogenic sarcoma with intravascular metastases in unusual locations is reported. The patient presented with acute renal failure, unilateral pulmonary edema, functional mitral stenosis, and low cardiac output. After successful surgical removal of a left atrial metastasis with subsequent improvement in cardiac output, renal function improved only transiently and urinary output varied markedly. At autopsy, metastatic osteogenic sarcoma was discovered within the lumen of the abdominal aorta obstructing both renal arteries. The case is the first report of a neoplasm metastatic to the aorta causing intermittent bilateral renal arterial obstruction; it illustrates the diagnostic difficulties presented by intravascular metastatic disease.

Right ventricular obstruction secondary to intracardiac metastatic osteosarcoma

A 30-year-old female with a history of surgically treated osteosarcoma 2 years prior to admission presented with progressive dyspnea and cyanosis. Physical examination was otherwise negative. Cardiac catheterization demonstrated a right ventricular mass lesion. At surgery, a metastatic osteosarcoma filling the entire right ventricle and extending from the pulmonary valve across the tricuspid valve and into the right atrial cavity was partially excised. Despite marked improvement postoperatively, she did 33 d after surgery. Postmortem findings were unusual in that the heart represented the sole site of metastasis. The diagnostic approach to cardiac symptoms from malignancy is discussed in relation to this patient.