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Shu H, Xiao D, Han S, Du Y, Lin J, Li Q. A case of left atrial intimal sarcoma with rhabdomyosarcoma differentiation: a case report and literature review. Front Oncol 2024; 14:1340115. [PMID: 38835391 PMCID: PMC11148456 DOI: 10.3389/fonc.2024.1340115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
Primary cardiac malignancies are rare, with cardiac sarcomas being the main type. Among these, intimal sarcomas are the most common. However, they tend to occur in the great vessels and are rare in the heart, with only a few isolated cases reported. We report a challenging case of a patient with left atrial intimal sarcoma with rhabdomyosarcoma differentiation. The patient was admitted after a physical examination detected left heart occupancy, and initial imaging suspected a left atrial thrombus. The patient then underwent extracorporeal circulation-assisted open cardiac surgery with resection of an atrial mass. The postoperative pathological findings were suggestive of an arterial intimal sarcoma, which included areas of rhabdomyosarcoma differentiation within the tumor tissue. Unfortunately, the patient's tumor recurred 4 months later, and she died due to treatment failure. This case highlights the rarity and risk of misdiagnosis of cardiac intimal sarcoma. Additionally, we aim to improve the understanding of intimal sarcoma through a review of immunohistochemistry and gene amplification techniques.
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Affiliation(s)
- Hongyun Shu
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Duan Xiao
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sisi Han
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Yongkang Du
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Jinduan Lin
- Department of Laboratory Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Qiaowen Li
- Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China
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Ullah M, Waidyanatha S, Stamos K, Tsanaxidis N. Left ventricular intimal sarcoma: a case report. Eur Heart J Case Rep 2024; 8:ytae072. [PMID: 38770404 PMCID: PMC11104662 DOI: 10.1093/ehjcr/ytae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 05/22/2024]
Abstract
Background Secondary cardiac tumours are much more common compared with primary (100-1000 times). The majority of the primary cardiac tumours are benign; however, almost a quarter are malignant, and 95% of these are sarcomas. The rarest type of primary malignant cardiac sarcoma is intimal (spindle cell) sarcoma. Case summary A 37-year-old woman presented with episodes of breathlessness. Initially treated for a chest infection, however, the patient continued to deteriorate and presented to the emergency department. A large pericardial effusion was discovered and drained, with samples sent for analysis. A repeat interval echo confirmed the resolution of the pericardial effusion with preserved left ventricular (LV) systolic function. The computed tomography (CT) of the thorax showed suspicious lesions in the heart and lung while the repeat echo raised suspicion of an infiltrative disease. A cardiac magnetic resonance imaging scan was performed, which suggested evidence of an undifferentiated sarcoma involving the posterior wall of the LV and an overlying thrombus. Computed tomography of the abdomen and pelvis did not show any evidence of abdominal metastasis. A CT-guided lung biopsy was arranged. On histological analysis, the report was overall strongly supportive of a diagnosis of intimal sarcoma. She underwent chemotherapy until recently. Discussion Cardiac intimal sarcomas are the least reported type of primary malignant tumours of the heart. They are encountered more commonly in the large arterial blood vessels, including the pulmonary artery and aorta, and are extremely rare in the heart. A prompt diagnosis is essential as they are considered extremely aggressive.
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Affiliation(s)
- Mohsin Ullah
- Cardiology Department, Russells Hall Hospital , The Dudley Group NHS Trust, Pensnett Road, Dudley DY1 2HQ, UK
| | - Sawan Waidyanatha
- Cardiology Department, Russells Hall Hospital , The Dudley Group NHS Trust, Pensnett Road, Dudley DY1 2HQ, UK
| | - Konstantinos Stamos
- Cardiology Department, Papageorgiou General Hospital, Thessaloniki, Agiou Pavlou 76, 564 29 Pavlos Melas, Greece
| | - Nikolaos Tsanaxidis
- Cardiology Department, Russells Hall Hospital , The Dudley Group NHS Trust, Pensnett Road, Dudley DY1 2HQ, UK
- Cardiology Department, Papageorgiou General Hospital, Thessaloniki, Agiou Pavlou 76, 564 29 Pavlos Melas, Greece
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Chiarelli M, Zago M, Tagliabue F, Burati M, Riva C, Vanzati A, Dainese E, Gabrielli F, Guttadauro A, De Simone M, Cioffi U. Small Bowel Intussusception Due to Rare Cardiac Intimal Sarcoma Metastasis: A Case Report. Front Surg 2021; 8:743858. [PMID: 34671641 PMCID: PMC8521089 DOI: 10.3389/fsurg.2021.743858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Intimal sarcomas are rare malignant mesenchymal tumors arising from the heart and large blood vessels. Their intraluminal growth leads to vascular obstructive symptoms and peripheral neoplastic embolization. Direct infiltration of the lungs or metastases to the pulmonary system, occur in 40% of cases and extrathoracic spread is frequent, also in presentation. Intussusception is an unusual event in adults, accounting for <5% of bowel obstructions. In most cases it is caused by a malignancy and requires surgical resection. Case Presentation: We describe a rare case of a 50-year-old man suffering of bowel obstruction due to intussusception sustained by a small bowel metastasis of a primary cardiac intimal sarcoma. One year and a half before the onset of abdominal symptoms, a grade II intimal sarcoma was removed from his left atrium and consequently he followed a chemotherapy protocol. Four months later a CT scan revealed local recurrence. Eighteen months after heart surgery he referred to the ER with abdominal pain. CT scan showed an ileal intussusception and the patient was scheduled for surgery. A tract of 10 cm ileus was removed containing an intramural polypoid solid mass. Histological analyses revealed a grade II intimal sarcoma consistent with his first diagnosis. Conclusion: Primary heart tumors are late found and often partially resected, therefore metastatic pathways are to be expected. Adult small bowel intussusception is a rare event and caused by a malignancy in one third of cases. Therefore, our recommendation is to always resect the tract involved in order to perform a proper diagnosis.
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Affiliation(s)
- Marco Chiarelli
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Mauro Zago
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Fulvio Tagliabue
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Morena Burati
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Cristina Riva
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Alice Vanzati
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Emanuele Dainese
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Francesco Gabrielli
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano, Italy
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Chen YA, Li Y, Lee JC, Chen JW. Staged surgery for advanced cardiac intimal sarcoma involving the right atrium and the inferior vena cava. J Card Surg 2021; 36:3973-3975. [PMID: 34331777 DOI: 10.1111/jocs.15885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022]
Abstract
Intimal sarcomas simultaneously involving the right atrium and the inferior vena cava (IVC) are rare. We report an advanced cardiac intimal sarcoma in the right atrium of a 19-year-old man that was complicated by tumor-related IVC thrombosis. We initially performed partial tumor resection and vena cava thrombectomy to resolve the circulatory obstruction, because complete resection was difficult due to the invading malignancy and an unclear margin. The patient received adjuvant chemo- and radiotherapy along with anticoagulant therapy. After 3 months, the border of the residual sarcoma was clear, and the patient underwent a secondary complete sarcoma excision (including that of the right atrium) and a suprahepatic vena cava reconstruction. At the 2-year follow-up, there was no tumor recurrence. We conclude that aggressive treatment and a staged complete resection can lead to improved outcomes for advanced cardiac intimal sarcoma with poor prognosis.
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Affiliation(s)
- Yu-An Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yueh Li
- Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jen-Chieh Lee
- Department of Pathology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jeng-Wei Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
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Diamond JE, Mi MY, VanderLaan PA, Chu L, Gelfand EV. An Unusual Cause of Functional Mitral Stenosis: A Left Atrial Intimal Sarcoma. JACC Case Rep 2021; 3:829-833. [PMID: 34317634 PMCID: PMC8311188 DOI: 10.1016/j.jaccas.2021.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/26/2021] [Accepted: 02/28/2021] [Indexed: 12/05/2022]
Abstract
Primary cardiac tumors are rare, with an incidence of <0.1% in postmortem series; sarcomas comprise 75% of these. Cardiac sarcomas may be life-threatening at the time of presentation. We describe a left atrial intimal sarcoma presenting with constitutional symptoms, obstructive shock, and systemic emboli, and treated with proton beam therapy. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Jamie E Diamond
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Y Mi
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Louis Chu
- Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Eli V Gelfand
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Durieux R, Tchana-Sato V, Lavigne JP, Radermecker MA, Moonen M, Scagnol I, Gennigens C, Defraigne JO. Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma? J Card Surg 2020; 36:357-362. [PMID: 33225534 DOI: 10.1111/jocs.15200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/08/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
Cardiac intimal sarcoma is extremely rare and aggressive primary malignant cardiac tumors. Here, we reported the case of a young man initially operated for a tumor of the left atrium, causing a dynamic obstruction of the mitral valve and (mis-)diagnosed as a myxoma at the histopathological analysis. Patient presented a local recurrence at 3 months and was reoperated. Pathology revealed this time the presence of an intimal sarcoma. Patient received adjuvant chemotherapy. Despite a good local control, the 1-year follow-up positron emission tomography scan revealed the presence of a metastasis in the left adrenal gland that was surgically resected. This article aims to highlight the risk of misdiagnosis in case of cardiac tumors, the hypothetical concept of malignant transformation of a cardiac myxoma, the aggressive course of the extremely rare cardiac intimal sarcoma, and the therapeutic modalities available to treat this pathology.
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Affiliation(s)
- Rodolphe Durieux
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Vincent Tchana-Sato
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Paul Lavigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marc A Radermecker
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marie Moonen
- Department of Cardiology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Irène Scagnol
- Department of Pathology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Christine Gennigens
- Department of Medical Oncology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
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Bryer E, Hartner L. The Heart of the Matter: A Unique Convergence of Cardiac Neoplasm, Hereditary Nonpolyposis Colorectal Cancer, and Spindle Cell Sarcoma. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10313115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Primary cardiac tumours are exceedingly unusual and aggressive; they often develop in younger patients and present with advanced disease. The rarity and heterogeneity of primary cardiac tumours challenge the standardisation of therapeutic guidelines. Undifferentiated primary cardiac spindle cell sarcomas, a distinct subset of primary cardiac sarcomas, are especially unique with <20 cases reported worldwide, the majority of which are of left atrial origin. This article presents a review of the aetiology, pathophysiology, and therapy of undifferentiated primary cardiac spindle cell sarcomas. In conjunction, the authors present a unique case of a woman with hereditary nonpolyposis colorectal cancer (Lynch syndrome) who presented with a primary cardiac spindle cell sarcoma of left ventricular origin; this is the first case of this type and location of cardiac tumour reported in a patient with Lynch syndrome.
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Affiliation(s)
- Emily Bryer
- Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Lee Hartner
- Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Vinod P, Jabri A, Hegde V, Lahorra J, Cutler D. Functional Mitral Stenosis: Imposture of Primary Cardiac Intimal Sarcoma. Cardiol Res 2018; 9:307-313. [PMID: 30344829 PMCID: PMC6188046 DOI: 10.14740/cr748w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/08/2018] [Indexed: 01/27/2023] Open
Abstract
Cardiac intimal sarcomas are extremely rare, remarkably aggressive and least reported type of primary malignant tumors of the heart. Cardiac intimal sarcomas are encountered more commonly in the large arterial blood vessels including pulmonary artery and aorta, and are extremely rare in the heart. The mainstay of treatment is achievement of tumor-free margins with surgical resection, which is associated with improved survival. Here, we report a 66-year-old female with primary cardiac intimal sarcoma presented with functional mitral stenosis and heart failure. This case report emphasizes common presentation of a rare disease, and the significance of early diagnosis and timely intervention.
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Affiliation(s)
- Poornima Vinod
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA.,Inpatient Medicine, Aultman Hospital, Canton, OH, USA
| | - Ahmad Jabri
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Vinayak Hegde
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - Joseph Lahorra
- Department of Cardiothoracic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | - David Cutler
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
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