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Machuca-Aguado J, Rendón-García R, Miraglia A, Téllez-Cantero JC, Gutiérrez-Domingo Á. Rare primary cardiac myxofibrosarcoma in adolescence: Diagnostic challenges and surgical insights. Cardiovasc Pathol 2024; 70:107623. [PMID: 38373641 DOI: 10.1016/j.carpath.2024.107623] [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: 11/25/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
This article presents a unique case of primary myxofibrosarcoma, an exceptionally rare cardiac neoplasm, in a 16-year-old girl. With fewer than 40 documented cases, this tumor's occurrence in adolescence is particularly uncommon. The patient presented with right-sided paresthesia and subsequent right hemiparesis and dysarthria, along with bilateral pleural effusion. Imaging tests revealed a cerebral ischemic lesion and the presence of a left atrial mass. Initially suspected as a myxoma, the tumor exhibited significant infiltration. Despite prompt excision and cardiac intervention, the patient experienced rapid decompensation and succumbed to heart failure 2 days later. Histopathological analysis revealed an intermediate grade myxofibrosarcoma. This case underscores the diagnostic complexity, emphasizing the need for early identification given the grim prognosis associated with cardiac myxofibrosarcomas, requiring detailed imaging, surgical, and histopathological insights.
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Affiliation(s)
- Jesús Machuca-Aguado
- Pathology Department, Virgen Macarena University Hospital, Seville, Spain.; University of Seville, Seville, Spain..
| | - Rosa Rendón-García
- Pathology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Alessia Miraglia
- Cardiovascular Surgery Department, Virgen Macarena University Hospital, Seville, Spain
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2
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Soltani S, Garousi M, Mirzaee E, Koolaji S, Nazari H, Emami S, Zare Mehrjardi A, Arefpour AM. A rare presentation of primary cardiac myxofibrosarcoma: Case report and literature review. Cancer Rep (Hoboken) 2024; 7:e2033. [PMID: 38600050 PMCID: PMC11006601 DOI: 10.1002/cnr2.2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Primary cardiac myxofibrosarcoma is a rare and aggressive malignancy, with the majority of approaching strategies relying on case reports. This article provides insights into its diagnosis and treatment. CASE PRESENTATION This paper presents the case of a 40-year-old man with sudden onset hemoptysis, leading to the diagnosis of primary cardiac myxofibrosarcoma. Treatment involved open-heart surgery to excise the left atrium tumor, followed by 6 cycles of adjuvant chemotherapy. Unfortunately, brain metastasis developed, leading to the patient's death 1 year after initial diagnosis. CONCLUSION Primary cardiac myxofibrosarcoma remains a clinical challenge with an unfavorable prognosis. Early diagnosis through advanced imaging is crucial, and research is needed to explore innovative treatments. This case underscores the complexities of managing this rare cardiac malignancy and highlights the necessity for ongoing investigations to enhance patient outcomes.
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Affiliation(s)
- Sepideh Soltani
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Maryam Garousi
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Elahe Mirzaee
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Sogol Koolaji
- Non‐communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Hengameh Nazari
- Department of RadiologyIsfahan University of Medical SciencesIsfahanIran
| | - Sepideh Emami
- Department of Cardiology, Firoozgar Hospital, School of MedicineIran University of Medical SciencesTehranIran
| | - Ali Zare Mehrjardi
- Department of Pathology, Firoozgar HospitalIran University of Medical SciencesTehranIran
| | - Amir Mohammad Arefpour
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
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Gozzellino L, Nannini M, Urbini M, Pizzi C, Leone O, Corti B, Baldovini C, Angeli F, Foà A, Pacini D, Folesani G, Costa A, Palumbo T, Nigro MC, Pasquinelli G, Astolfi A, Pantaleo MA. Genomic Landscape Comparison of Cardiac versus Extra-Cardiac Angiosarcomas. Biomedicines 2023; 11:3290. [PMID: 38137511 PMCID: PMC10741871 DOI: 10.3390/biomedicines11123290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Angiosarcomas (ASs) are rare malignant vascular entities that can affect several regions in our body, including the heart. Cardiac ASs comprise 25-40% of cardiac sarcomas and can cause death within months of diagnosis. Thus, our aim was to identify potential differences and/or similarities between cardiac and extra-cardiac ASs to enhance targeted therapies and, consequently, patients' prognosis. Whole-transcriptome analysis of three cardiac and eleven extra-cardiac non-cutaneous samples was performed to investigate differential gene expression and mutational events between the two groups. The gene signature of cardiac and extra-cardiac non-cutaneous ASs was also compared to that of cutaneous angiosarcomas (n = 9). H/N/K-RAS and TP53 alterations were more recurrent in extra-cardiac ASs, while POTE-gene family overexpression was peculiar to cardiac ASs. Additionally, in vitro functional analyses showed that POTEH upregulation conferred a growth advantage to recipient cells, partly supporting the cardiac AS aggressive phenotype and patients' scarce survival rate. These features should be considered when investigating alternative treatments.
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Affiliation(s)
- Livia Gozzellino
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (L.G.); (M.N.); (F.A.); (M.C.N.); (M.A.P.)
| | - Margherita Nannini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (L.G.); (M.N.); (F.A.); (M.C.N.); (M.A.P.)
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Milena Urbini
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Carmine Pizzi
- Unit of Cardiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.P.); (A.F.)
| | - Ornella Leone
- Division of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (O.L.); (B.C.); (C.B.)
| | - Barbara Corti
- Division of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (O.L.); (B.C.); (C.B.)
| | - Chiara Baldovini
- Division of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (O.L.); (B.C.); (C.B.)
| | - Francesco Angeli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (L.G.); (M.N.); (F.A.); (M.C.N.); (M.A.P.)
| | - Alberto Foà
- Unit of Cardiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.P.); (A.F.)
| | - Davide Pacini
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (D.P.); (G.F.)
| | - Gianluca Folesani
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (D.P.); (G.F.)
| | - Alice Costa
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Teresa Palumbo
- Interdepartmental Center Alma Mater Institute on Healthy Planet, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy;
| | - Maria Concetta Nigro
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (L.G.); (M.N.); (F.A.); (M.C.N.); (M.A.P.)
| | - Gianandrea Pasquinelli
- Division of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Annalisa Astolfi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (L.G.); (M.N.); (F.A.); (M.C.N.); (M.A.P.)
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Maria Abbondanza Pantaleo
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (L.G.); (M.N.); (F.A.); (M.C.N.); (M.A.P.)
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Makarov IA, Papko KA, Makarova TA, Bendov DV, Mitrofanova LB. Heart Transplantation as a Treatment Option for Recurrent Myxofibrosarcoma: A Clinical Case. EXP CLIN TRANSPLANT 2023; 21:784-789. [PMID: 37885296 DOI: 10.6002/ect.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Myxofibrosarcoma is one of the most rare tumors of the heart. Surgical resection is the principal method of treatment; however, in some cases, radical removal of the tumor is not possible. Here, we present a case of heart transplant in a patient who experienced recurrent myxofibrosarcoma of the left atrium and examine the morphological features of this tumor. A 40-year-old female patient presented for treatment for heart failure of a high functional class. An examination revealed a tumor in the left atrial cavity, which was subsequently surgically removed. Morphological examination revealed an inflammatory myofibroblastic tumor. After 2 years, the patient's tumor recurred. The tumor was removed, and a morphological study again diagnosed myxofibrosarcoma of the heart. A year later, recurrence was again diagnosed. Instrumental examination determined that the tumor had incurred into the mitral valve and possibly spread to the myocardium. Tumor resection was not possible, and the need to perform a heart transplant was determined. The given case contributes to the practical conclusion that heart transplant contributes to an increase in the life expectancy for patients with inoperable cases of cardiac sarcoma.
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Genomic Characterization of Rare Primary Cardiac Sarcoma Entities. Diagnostics (Basel) 2023; 13:diagnostics13020214. [PMID: 36673024 PMCID: PMC9858520 DOI: 10.3390/diagnostics13020214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Primary cardiac sarcomas are considered rare malignant entities associated with poor prognosis. In fact, knowledge regarding their gene signature and possible treatments is still limited. In our study, whole-transcriptome sequencing on formalin-fixed paraffin-embedded (FFPE) samples from one cardiac osteosarcoma and one cardiac leiomyosarcoma was performed, to investigate their mutational profiles and to highlight differences and/or similarities to other cardiac histotypes. Both cases have been deeply detailed from a pathological point of view. The osteosarcoma sample presented mutations involving ATRX, ERCC5, and COL1A1, while the leiomyosarcoma case showed EXT2, DNM2, and PSIP1 alterations. Altered genes, along with the most differentially expressed genes in the leiomyosarcoma or osteosarcoma sample versus the cardiac angiosarcomas and intimal sarcomas (e.g., YAF2, PAK5, and CRABP1), appeared to be associated with cell growth, proliferation, apoptosis, and the repair of DNA damage, which are key mechanisms involved in tumorigenesis. Moreover, a distinct gene expression profile was detected in the osteosarcoma sample when compared to other cardiac sarcomas. For instance, WIF1, a marker of osteoblastic differentiation, was upregulated in our bone tumor. These findings pave the way for further studies on these entities, in order to identify targeted therapies and, therefore, improve patients' prognoses.
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Myxofibrosarcoma or myxoma: malignant transformation or misdiagnosis. Indian J Thorac Cardiovasc Surg 2022; 38:290-293. [PMID: 35529008 PMCID: PMC9023637 DOI: 10.1007/s12055-021-01298-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
Inadequate excision, seeding, multicentricity and malignancy are often ascribed for recurrence of atrial myxomas. Differentiation between benign myxomas and malignant myxofibrosarcomas can be challenging, and a high index of clinical suspicion and vimentin staining on immunohistochemistry is needed to confirm the diagnosis. Early recurrence is common in these patients and completeness of excision is the key. Prognosis despite successful excision is poor. We report a benign atrial myxoma in a young female patient which upon recurrence turned out to be a myxofibrosarcoma.
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7
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Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
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8
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Urbini M, Astolfi A, Indio V, Nannini M, Pizzi C, Paolisso P, Tarantino G, Pantaleo MA, Saponara M. Genetic aberrations and molecular biology of cardiac sarcoma. Ther Adv Med Oncol 2020; 12:1758835920918492. [PMID: 32489430 PMCID: PMC7238448 DOI: 10.1177/1758835920918492] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 03/19/2020] [Indexed: 12/19/2022] Open
Abstract
Cardiac tumors are rare and complex entities. Early assessment and differentiation between non-neoplastic and neoplastic masses, be they benign or malignant, is essential for guiding diagnosis, determining prognosis, and planning therapy. Cardiac sarcomas represent the most frequent primary malignant histotype. They could have manifold presentations so that the diagnosis is often belated. Moreover, considering their rarity and the limitation due to the cardiac location itself, the optimal multimodal management of patients affected by primary cardiac sarcomas still remains highly difficult and outcome dismal. Therefore, there is an urgent need to improve these results mainly focusing on more adequate tools for prompt diagnosis and exploring new and more effective therapies. Knowledge about the molecular landscape and pathogenesis of cardiac sarcoma is even more limited due to the rarity of this disease. In this sense, the molecular characterization of heart tumors could unfold potentially novel, druggable targets. In this review, we focused on genetic aberrations and molecular biology of cardiac sarcomas, collecting the scarce information available and resuming all the molecular findings discovered in each tumor subtype, with the aim to get further insights on mechanisms involved in tumor growth and to possibly highlight specific molecular profiles that can be used as diagnostic tests and unveil new clinically actionable targets in this tricky and challenging disease.
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Affiliation(s)
- Milena Urbini
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Annalisa Astolfi
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Valentina Indio
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Margherita Nannini
- Department of Specialized, Experimental and
Diagnostic Medicine, Medical Oncology Unit, Sant’Orsola-Malpighi Hospital,
University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Department of Specialized, Experimental and
Diagnostic Medicine, Cardiology and Transplantation, Sant’Orsola-Malpighi
Hospital, University of Bologna, Bologna, Italy
| | - Pasquale Paolisso
- Department of Specialized, Experimental and
Diagnostic Medicine, Cardiology and Transplantation, Sant’Orsola-Malpighi
Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Tarantino
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Maria Abbondanza Pantaleo
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
- Department of Specialized, Experimental and
Diagnostic Medicine, Medical Oncology Unit, Sant’Orsola-Malpighi Hospital,
University of Bologna, Bologna, Italy
| | - Maristella Saponara
- Department of Specialized, Experimental and
Diagnostic Medicine, Medical Oncology Unit, Sant’Orsola-Malpighi Hospital,
University of Bologna, Via Massarenti, 9, Bologna, Bologna 40138,
Italy
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