Malignant mesothelioma of the pleura with a large tumor embolus in the left atrium: an autopsy case

Sarcomatous Pleural Mesothelioma Metastatic to Left Ventricular Endocardium

A 71-year-old man, a cigarette smoker with long-term asbestos exposure, developed multifocal malignant sarcomatous pleural mesothelioma that metastasized to the left ventricular endocardium without invading pericardium, myocardium, or the contiguous pulmonary vein. This is the first reported case of malignant pleural mesothelioma to metastasize in such a manner.

Cardiac intracavitary metastasis of a malignant solitary fibrous tumor: case report and review of the literature on sarcomas with left intracavitary extension

BACKGROUND

Solitary fibrous tumor (SFT) of the pleura with malignant progression occurs uncommonly. Cardiac intracavitary extension of tumors is rarely seen, with left side location being exceptional.

METHODS AND RESULTS

The authors report the first case of a malignant SFT metastatic to the heart occurring in a 74-year-old woman. The tumor first presented as a slow-growing pleural SFT that in 6 years reached a size of 16 cm. Two months after a complete surgical resection, the tumor was found to spread to the left atrium by intracavitary extension from the left upper pulmonary vein, simulating a cardiac myxoma. The primary tumor showed established features of malignancy including size greater than 10 cm; gross findings of necrosis; high cellularity, cytological atypia, and eight mitoses per 10 high-power fields. Immunohistochemical study revealed positivity of the tumor cells for CD34, bcl-2, and CD99. Aside from the present report, 52 previous cases of sarcoma with intracavitary extension to the left side of the heart have been described. Bone sarcoma is the type most frequently found. Peripheral arterial embolism can be a complication of advanced mesenchymal malignancy in 21% (11/53) of reported cases.

CONCLUSION

Accurate histopathologic recognition of this rare type of metastatic disease is important because of the adverse prognosis as compared to cardiac myxoma.