Chondrosarcoma metastatic to the heart

Metastasectomy of left atrial mesenchymal chondrosarcoma

Metastasis of chondrosarcoma of skeletal origin to the heart is uncommonly reported in the literature, with the majority of cases involving right atrial metastases. Surgical resection remains the mainstay of treatment, and the literature has shown improved median survival with this form of therapy, possibly by reducing thromboembolic risk in this patient population. We report the case of a patient with metastatic mesenchymal chondrosarcoma of the left atrium who underwent resection, following a lack of response to anticoagulation therapy. This is the first report of surgical resection of left atrial metastatic disease prior to the onset of thromboembolic sequelae.

An Unusual Cardiac Metastasis: Right Atrial Chondrosarcoma Diagnosed With Multimodality Cardiac Imaging

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Metastatic cardiac tumors are about 20 times more common than primary cardiac tumors.

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Metastatic CS to the myocardium has only rarely been described in case reports.

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Cardiac masses are differentiated by clinical context, location, and imaging appearance.

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CMR is considered the gold standard in cardiac imaging, but TEE was key in this case.

CNS Metastases from Bone and Soft Tissue Sarcomas in Children, Adolescents, and Young Adults: Are They Really So Rare?

Purpose. To check whether primary involvement of brain/spinal cord by bone/soft tissue sarcomas' metastases in children is as rare as described and to present various morphological forms of bone/soft tissue sarcomas' CNS metastases. Methods. Patients with first diagnosis in 1999–2014 treated at single center were included with whole course of disease evaluation. Brain/spinal canal magnetic resonance imaging (MRI)/computed tomography were performed in cases suspicious for CNS metastases. Extension from skull/vertebral column metastases was excluded. Results. 550 patients were included. MRI revealed CNS metastases in 19 patients (incidence 3.45%), 14 boys, aged 5–22 years. There were 12/250 osteosarcoma cases, 2/200 Ewing's sarcoma, 1/50 chondrosarcoma, 3/49 rhabdomyosarcoma (RMS), and 1/1 malignant mesenchymoma. There were 10 single metastases and 7 cases of multiple ones; in 2 RMS cases only leptomeningeal spread in brain and spinal cord was found. Calcified metastases were found in 3 patients and hemorrhagic in 4. In one RMS patient there were numerous solid, cystic, hemorrhagic lesions and leptomeningeal spread. Conclusions. CNS metastases are rare and late in children with bone/soft tissue sarcomas, although in our material more frequent (3.45%) than in other reports (0.7%). Hematogenous spread to brain and hemorrhagic and calcified lesions dominated in osteosarcoma. Ewing sarcoma tended to metastasize to skull bones. Soft tissue sarcomas presented various morphological forms.

Radiofrequency ablation of metastatic chondrosarcoma-associated refractory ventricular tachycardia originating from the right ventricular outflow tract: A case report and literature review

Ventricular tachycardia (VT) and premature contraction originating from the right ventricular outflow tract (RVOT) usually appear in healthy individuals. Radiofrequency ablation (RFA) is highly effective at resolving this type of arrhythmia. Refractory VT of RVOT is uncommon and occasionally results from cardiac metastasis of extraskeletal mesenchymal chondrosarcomas (ESMC). ESMC is a rare malignant tumor arising from soft tissues. The current study presents the case of a 25-year-old male with severe VT arising from RVOT due to metastasis of an ESMC that originally occurred in the retroperitoneum. The diagnosis was confirmed following echocardiography and cardiac magnetic resonance. VT was eventually eliminated by RFA, and during the 8-month follow-up period the patient did not complain of any palpitations. Holter monitoring confirmed the absence of recurrence.

An unusual myocardial infarction

We present a 74-year-old male with a chondrosarcoma, who presented with chest pain. The history, electrocardiogram (ECG), and biomarkers established the diagnosis of myocardial infarction (MI); angiography did not show coronary atherosclerosis and, both initial transthoracic echocardiogram and chest computed tomography (CT), did not demonstrate any cardiac abnormalities. A second echocardiogram following a routine ECG showed presence of a mass involving the right ventricle and the cardiac apex that was confirmed by chest CT scan. We underline the importance of considering cardiac tumors in the clinical arena of MI management.

LEARNING POINTS

Cardiac tumors cause ECG changes similar to ischemic heart diseases.Keep in mind cardiac tumors when performing transthoracic echocardiogram (TTE) in the setting of suspected MI.TTE is the technique of choice in detecting cardiac tumors.

Pulmonary metastatic chondrosarcoma with massive extension into left atrium and left ventricle: outcome of surgical management in emergency

We report a case of metastatic chondrosarcoma to the lung that invaded the right inferior pulmonary vein with massive cardiac extension and presented with an acute heart failure. CT scan showed a large mass of the right lower lobe which invaded and filled almost all the left atrium with an extension into left ventricle through the mitral valve. Surgical resection was performed in emergency. The patient is still alive 4 months after development of cardiac symptoms and surgery.

A case of cerebral embolism with metastatic chondrosarcoma in the left atrium

Cardiac tumor is a rare, but clinically important source of cerebral embolism. We report a case of metastatic chondrosarcoma in the left atrium with multiple cerebral emboli. A computed tomography scan of the chest revealed a large mass in the left atrium and pulmonary vein. The patient underwent heart surgery to remove the metastatic chondrosarcoma in the left atrium, to prevent the formation of further systemic emboli and possible sudden death. The cardiac tumor resection was successful, and the patient was discharged from the hospital without any handicap. This is a rare case of metastatic cardiac tumor that was a source of emboli into the brain and was eradicated.

A rare case of primary chondrosarcoma of the heart

We describe a case of a rare primary chondrosarcoma of the heart in a 62-year-old woman who was referred to our institution with a diagnosis of left atrial undetermined mass. Despite utilization of transesophageal echocardiography and multislice computed tomography imaging, the definitive diagnosis of chondrosarcoma was achieved only with histology of the operative specimen. The tumor was extending from the left atrium to the left pulmonary veins causing obstruction of the venous drainage and a clinical and radiological picture of persistent respiratory infection. Surgery achieved only partial resection of the mass, including the removal of the obstruction to the pulmonary venous drainage. After surgery, a rapid healing of the respiratory infection was observed; however, 3 months later, the tumor was already regrowing rapidly.

Resection of right atrial metastatic large-cell neuroendocrine carcinoma

The incidence of cardiac metastases is rising due to increasingly sensitive diagnostic investigations and longer patient survival as a result of improved treatment for malignancies. We report a rare case of right atrial metastasis from a large cell neuroendocrine carcinoma successfully resected with cardiopulmonary bypass. The surgical management of advanced cardiac malignancy is discussed. In appropriately selected cases surgical resection of cardiac metastases can be beneficial, allowing improvement in quality of life, and prolongation of life.

Massive cardiac chondroma presenting with heart failure and superior vena cava obstruction in a teenage boy

Histologically benign soft-tissue chondromas have been reported at many anatomical sites but are an uncommon cause of soft tissue mass lesions in childhood, accounting for less than 1% of cases. The most frequent sites for extraosseous soft-tissue chondromas are the hands and feet. For the extremely rare visceral chondromas, the site can be lung, where they may represent a component of Carney's syndrome of extra-adrenal paraganglioma, pulmonary chondroma, and epithelioid leiomyosarcoma of the gastrointestinal tract. Primary cardiac chondromas are exceptionally rare in patients of any age although cardiac chondrosarcoma, both primary and metastatic, is well reported. We present a case of a teenage boy with a fatal cardiac chondroma

Cardiac Chondrosarcoma Producing Parathyroid Hormone-Related Protein

Chondrosarcoma is a malignant tumor characterized by the formation of cartilage. A case of primary cardiac chondrosarcoma of the left atrium developed in a middle-aged male. The preoperative serum concentrations of C-parathyroid hormone-related protein (PTHrP) and calcium were high (413.2 pmol/L and 12.2 mg/dl, respectively), but normalized after resection of the tumor, which measured 7 x 5 x 3.5 cm. The tumor was histopathologically diagnosed as chondrosarcoma, composed of outer atypical chondroid cells and inner pleomorphic and spindle mesenchymal cells mimicking malignant fibrous histiocytoma. Half of the cartilaginous tumor cells and a few pleomorphic cells showed cytoplasmic immunoreactivity for PTHrP. The tumor is a possible example of the functional pleiotropy of chondrosarcoma.

Pelvic girdle chondrosarcoma and inferior vena cava thrombosis

Pelvic girdle chondrosarcomas in children and adolescents are extremely rare. These high grade malignant chondrosarcomas with a locally aggressive growth pattern have a high tendency for thrombus formations in the afferent tumour vessels, associated with an increased risk of inferior vena cava thrombosis, pulmonary embolism and metastatic spread to the lungs. This tumour location is generally non-resectable for cure and, since adjuvant chemotherapy is ineffective, patients die from the tumour thrombus formation causing tumour emboli and metastatic disease to the lungs. Effective local tumour control can be achieved with high-dose hyperfractionated radiation therapy.

Primary cardiac chondrosarcoma--a case report

We report a case of chondrosarcoma of the heart that was managed surgically. As chondrosarcoma of cardiac origin is extremely rare, this case is described with a brief comment.

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.

Sudden death associated with solitary intracavitary right atrial metastatic tumour deposit

We report a case of cardiac metastasis of primary adrenal cortical carcinoma to the endocardium of the right atrium resulting in an intracavitary mass which we believe caused sudden death by blocking the tricuspid valve orifice. We have been unable to find a similar case previously reported although primary atrial myxoma is well known to be a rare cause of sudden cardiac death by the same mechanism. Modern non-invasive imaging techniques have facilitated recognition of intracavitary cardiac metastases, and with surgical intervention, when feasible, the risk of sudden cardiac death can be reduced.

Inferior vena cava--right atrial tumor thrombus in malignant pelvic bone tumors in children

Two patients with IVC and right atrial tumor thrombus associated with malignant bone tumors are described. Other tumors such as Wilms', renal cell CA, testicular adrenal and hepatic neoplasms have also been reported to invade the IVC. Ultrasound, CT and MRI are helpful in evaluating the presence of vascular thrombosis as well as its longitudinal extent, and intracardiac involvement.