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Bergonzoni E, De Gaspari M, D'Onofrio A, Cibin G, Rizzo S, Basso C, Gerosa G. A cardiac intimal sarcoma mimicking infective endocarditis. Cardiovasc Pathol 2024; 69:107598. [PMID: 38101526 DOI: 10.1016/j.carpath.2023.107598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/02/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
Primary malignant cardiac tumors are rare and usually misdiagnosed because they can mimic more common intracardiac lesions, therefore, in clinical practice it is important to always consider even uncommon diseases in order to avoid delayed diagnosis and to plan the most appropriate therapeutic strategy in a timely fashion. We report a case of a 73-year-old man with clinical signs and imaging findings (echocardiography) suggesting infective bacterial endocarditis of the mitral valve. However, intraoperative evaluation raised suspicion that the mitral lesions had a different nature. Surgical removal of the mass was performed, and the final correct diagnosis was made through pathologic examination, revealing a mitral valve sarcoma thus allowing for the beginning of specific oncological treatment.
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Affiliation(s)
- Emma Bergonzoni
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Monica De Gaspari
- Department of Cardiac, Cardiovascular Pathology, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Giorgia Cibin
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Department of Cardiac, Cardiovascular Pathology, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Cardiovascular Pathology, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Hu HM, Li YD, Wei CW, Liu Y, Lv XZ, Yang YH. Pulmonary artery sarcoma: an unexpected settler in the right ventricular outflow tract. J Cardiothorac Surg 2023; 18:178. [PMID: 37170135 PMCID: PMC10176877 DOI: 10.1186/s13019-023-02274-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
Pulmonary artery sarcoma (PAS) is a sporadic malignant tumor that mainly originates from the pulmonary arteries. However, PAS may also involve the right ventricular outflow tract (RVOT) and lead to obstruction, syncope, or sudden death. Early diagnosis and complete surgical resection are essential to prolong survival and improve the quality of life of patients with PAS. Herein, we report a case of a young female patient admitted for pulmonary malignancy and acute pulmonary embolism. The patient had a mass in the RVOT, which was detected by transthoracic echocardiography. Computed tomography and magnetic resonance imaging revealed the invasion depth and extent of the lesions. Surgical resection improved hemodynamics, while pathological and immunohistochemical tests confirmed the diagnosis of a pulmonary artery sarcoma. Local recurrence was detected in the adjacent tissues about two months after the surgery. Given the potential risk of reoperation, the patient was suggested to undergo conservative treatment.
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Affiliation(s)
- Hui-Min Hu
- Department of Ultrasound, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yi-Dan Li
- Department of Ultrasound, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Chang-Wei Wei
- Department of Anesthesia, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yan Liu
- Department of Cardiac Surgery, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiu-Zhang Lv
- Department of Ultrasound, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
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Mahdi A, Mahdi M, Ters P. A Journey From Cardiology to Oncology Reveals a Rare Case of Primary Intimal Sarcoma in a Patient With Dyspnea: A Case Report. Cureus 2023; 15:e38439. [PMID: 37273385 PMCID: PMC10234616 DOI: 10.7759/cureus.38439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Primary intimal sarcoma of the pulmonary artery is a rare and aggressive malignancy that arises from the intimal layer of the pulmonary artery. It typically presents with nonspecific symptoms such as dyspnea, chest pain, and hemoptysis, making early diagnosis challenging. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful in identifying the tumor's location and extent. A definitive diagnosis is established by biopsy, either via surgical resection or percutaneous needle biopsy. However, diagnosis can be difficult due to the rarity of the disease and the need for specialized expertise in interpreting pathology specimens. Treatment of primary intimal sarcoma of the pulmonary artery involves surgical resection, followed by adjuvant chemotherapy and radiation therapy. Despite aggressive treatment, the prognosis remains poor, with a median survival of approximately two years. However, early detection and aggressive multimodal therapy can improve outcomes. We hereby report a rare case of primary intimal sarcoma of the pulmonary artery and discuss its pathophysiology, presentation, diagnostic approach, and treatment options.
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Affiliation(s)
- Ahmad Mahdi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Mahmoud Mahdi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Patrick Ters
- Cardiology, University of Kansas School of Medicine, Wichita, USA
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Zhao M, Nie P, Guo Y, Chen H. Pulmonary artery intimal sarcoma: A rare cause of filling defects in pulmonary arteries. Am J Med Sci 2022; 364:655-660. [PMID: 35588894 DOI: 10.1016/j.amjms.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/07/2021] [Accepted: 05/11/2022] [Indexed: 01/25/2023]
Abstract
Pulmonary artery intimal sarcomas are very rare and arise from primitive pluripotent mesenchymal cells. They are often misdiagnosed as pulmonary thromboembolism, leading to futile anticoagulation treatment and delayed diagnosis. We present a case of a patient who showed nonspecific pulmonary symptoms and characteristic imaging manifestation. Progressive symptoms and additional imaging led to the suspicion of a pulmonary artery intimal sarcoma, which was finally confirmed by pathological biopsy. This case serves as a reminder to consider pulmonary artery intimal sarcomas in the differential diagnosis of patients with dyspnea and filling defects on computed tomography pulmonary angiography or contrast-enhanced computed tomography.
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Affiliation(s)
- Mimi Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003
| | - Yonghua Guo
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003.
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Shao N, Deng C. Pulmonary thromboembolic disease or pulmonary artery intimal sarcoma: Case report and literature review. Oncol Lett 2022; 24:350. [PMID: 36168308 PMCID: PMC9478618 DOI: 10.3892/ol.2022.13470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
The present case study reported on a patient initially diagnosed with pulmonary embolism at the First Affiliated Hospital of Fujian Medical University (Fuzhou, China) in May 2021. Furthermore, a relevant literature review was performed. The patient was a 57-year-old Chinese male who presented with dyspnea and wheezing following exercise. Physical examination revealed pulmonary valve second heart sound > aortic valve second heart sound but lack of swelling on both lower limbs, while the imaging results suggested pulmonary artery filling defects. Initially, the patient was diagnosed with pulmonary embolism and was administered anticoagulation treatment, which lasted for 3 months but proved to be ineffective. Subsequent re-examination via chest computed tomography further indicated multiple nodules in the left hilum and lung. Therefore, the patient was hospitalized for lung aspiration biopsy, which led to the final diagnosis of pulmonary artery intimal sarcoma based on the pathological review.
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Affiliation(s)
- Nan Shao
- Division of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Chaosheng Deng
- Division of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
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Bai X, Ruan L. A case report of primary pulmonary artery intimal sarcoma. Eur J Med Res 2021; 26:89. [PMID: 34372932 PMCID: PMC8351160 DOI: 10.1186/s40001-021-00568-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pulmonary artery intimal sarcoma (PAS) is a very rare disease, its prevalence is about 0.001–0.003%. PAS is often misdiagnosed as acute or chronic pulmonary thromboembolism due to its clinical presentation and radiological findings. Thus, early diagnosis is very crucial and may improve patient outcome. Case presentation Here, we report a case in a Chinese male where the symptom presentation was episodes of shortness of breath. Transthoracic echocardiography showed a solid mass in the pulmonary valve orifice, which was demonstrated to be a pulmonary artery intimal sarcoma diagnosed by histopathology. In this case, the initial differential diagnosis included pulmonary embolism. Because the initial symptom of primary pulmonary artery sarcoma is extremely similar to the pulmonary embolism, half of them may be misdiagnosed as pulmonary embolism. Imaging studies are very helpful. Ultrasound and CT are the best due to their resolution and ability to assess the relationship of the mass with the surrounding structures. The final diagnosis is mostly made after surgical excision and this is the most effective treatment. At the same time, radiotherapy and chemotherapy after surgery is also an adjuvant treatment. Conclusion We report a very rare case of pulmonary artery intimal sarcoma. Due to late diagnosis and delayed treatment in this case, the patient displayed a poor prognostic. Early diagnosis and right treatment can improve the prognosis of PAS and optimize overall health.
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Affiliation(s)
- Xiaofang Bai
- The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Litao Ruan
- The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, China.
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Massie E, White M, Robillard J, Demers P, Mondésert B, Doyon J, Chaix MA. Palpitations Revealing a Primary Pulmonary Artery Sarcoma. CJC Open 2021; 3:831-834. [PMID: 34169263 PMCID: PMC8209369 DOI: 10.1016/j.cjco.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Primary pulmonary artery sarcoma is an exceedingly rare and aggressive malignancy that carries poor prognosis. Clinical manifestations are nonspecific and include chest pain, dyspnea, syncope, palpitations, and asthenia, among others. Delay to diagnosis is common and compromises the prognosis. Here, we report an interesting case of primary pulmonary artery sarcoma presenting with frequent monomorphic premature ventricular contractions arising from the right/left ventricle outflow tract. Cardiac imaging is key in the evaluation of patients with frequent premature ventricular contractions to rule out rare pathologies such as tumour compression.
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Affiliation(s)
- Emmanuelle Massie
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
| | - Michel White
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
| | - Julie Robillard
- Department of Medicine, Division of Radiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Demers
- Department of Medicine, Division of Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Blandine Mondésert
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
| | - Josée Doyon
- Department of Medicine, Division of Pathology, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Québec, Canada
| | - Marie-A Chaix
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
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