Primary osteosarcoma of the heart

Primary Cardiac Osteosarcoma

BACKGROUND

Primary cardiac osteosarcoma is extremely rare. There is no cohort study on such tumours to date. The aim of this study is to investigate the clinical characteristics and outcome patterns of such tumours.

METHODS

A thorough literature review was performed, and all relevant clinical items were collected. A total of 53 cases of primary cardiac osteosarcoma were enrolled in this study, including 25 males and 28 females.

RESULTS

The age at diagnosis ranged from 14 to 77 years with a mean age of 43.6 years. The clinical manifestations, imaging features, and laboratory tests of the primary cardiac osteosarcomas were similar to other types of primary cardiac tumours. Sex, tumour size and adjunctive chemo-radiotherapy were found to affect the overall survival pattern.

CONCLUSIONS

The present study may provide an effective consultation for the diagnosis and treatment of this tumour.

A primary cardiac osteosarcoma: Case report and review of the literature

Primary cardiac osteosarcoma is a rare and aggressive neoplasm that can be difficult to diagnose. We report a case of a previously healthy 49-year-old woman who presented with dyspnea, atrial flutter, and heart failure. A mass was visualized in her left atrium by echocardiography and cardiac computed tomography, and the diagnosis of cardiac myxoma was raised. The patient subsequently underwent surgical resection of the mass and atrial reconstruction. Surprisingly, histological and immunohistological analyses revealed the mass to be an osteosarcoma. The patient received chemotherapy and radiotherapy. Eight months later, she has shown evidence of local recurrence. We briefly discuss primary osteosarcomas in the cardiac cavity and their management. <Learning objective: Primary cardiac tumors are very rare and most likely benign. Malignant tumors constitute less than 25% of primary cardiac neoplasms. However, both primary sarcomas and benign tumors are often found in the left atrium. As a consequence of their location and similar clinical presentation, primary cardiac sarcomas can be easily confused with a benign myxoma, therefore abnormal imaging features (immobility of the mass, neovascularity, multicentricity, calcification and invasion into the heart structures) should raise suspicion for a cardiac sarcoma.>.

Primary osteosarcoma of the right heart ventricle and atrium; a case report

Most primary malignancies of the heart, among them also osteosarcoma are found in the left and very uncommonly in the right ventricle. We report a 75-year-old patient with a primary osteosarcoma sited in the right ventricle occluding the pulmonary outflow. The diagnosis was made when the patient was alive, using echocardiography and computerized scan tomography examinations. Like in previous reports on such malignancies, it was far too late for surgical or other therapeutic interventions, and the histological diagnosis was made post mortem.

Polypoid osteosarcoma of the left atrium: report of a new case with autopsy confirmation and review of the literature

We describe a new case of heart osteosarcoma manifesting as a large polypoid mass of the left atrium. Clinically, the lesion presented with dyspnea, syncopal attacks, and fever. Ultrasound scans of the heart were suggestive of a cardiac myxoma, although some imaging features could retrospectively indicate a malignant neoplasm. In particular, the lesion was relatively immobile, did not show the characteristic myxoma motion during the heart cycle, and extended into the left pulmonary veins. Exploratory thoracotomy showed a nonresectable polypoid mass of the left atrium widely infiltrating the myocardium and the epicardium, histological features of a polymorphic sarcoma. The patient died 5 months after presentation with diffuse metastases. At autopsy, a 5-cm polypoid tumor was seen protruding into the left atrium. Neoplastic infiltration of the atrial myocardium, pericardium, and pulmonary veins was evident. Extensive metastatic deposits were observed in numerous sites, including the skin, lung, liver, and brain. Microscopically, a spindle cell sarcoma forming malignant osteoid was seen, admixed with areas indistinguishable from myxoid and pleomorphic malignant fibrous histiocytoma. This case provides further evidence that although rare, osteosarcoma of the heart usually presents as a polypoid mass of the left atrium and is histologically characterized by conspicuous polymorphism. It is associated with a poor prognosis and rapid appearance of distant metastases. Although at echocardiography it may mimic a myxoma, subtle features such as tumor extension into pulmonary veins and main origin from nonseptal atrial walls suggest the presence of a nonmyxomatous tumor and a preoperatory diagnosis of aggressive malignant disease.

Primary chondroblastic osteogenic sarcoma of the left atrium. Case report

A case of chondroblastic osteogenic sarcoma of the left atrium is presented. The malignant nature of the tumour was not revealed until surgery. It was considered to be nonresectable. At autopsy the tumour was found to be confined to the atrial septum. The possibility of preoperatively establishing the diagnosis and determining the extent of the tumour is discussed.

Osteogenic sarcoma of the tongue: case report with light and electron microscopy studies and review of the literature

A case of osteosarcoma of the tongue is reported, with microscopic findings. The patient underwent chemotherapy, left hemiglossectomy, and neck dissection, followed by radiotherapy. Five years after initial therapy, he is still alive and well, with no evidence of recurrence.

Osteogenic sarcomas mimicking left atrial myxomas: clinical and two-dimensional echocardiographic features

Two patients presenting with acute pulmonary edema were found to have a left atrial cardiac osteogenic sarcoma (primary and secondary). The two-dimensional echocardiographic appearance in both cases mimicked that of atrial myxoma. However, two echocardiographic features (that is, tumor extension into pulmonary veins and origin from nonseptal atrial walls) suggested the presence of a nonmyxomatous cardiac tumor.

Primary osteosarcoma of left atrium: complete surgical excision

A patient with primary osteogenic sarcoma of the left atrium with clinical features of severe congestive heart failure is described. The operative procedure required excision of the posterior atrial wall in continuity with the left pulmonary veins. The resultant defect in the atrium was reconstructed with the left atrial appendage. The left pulmonary artery was ligated, and the lung was removed at a subsequent procedure. The patient survived operation but subsequently was found to have distant metastasis. He died seven months after the operation.

Malignant mesenchymoma of the heart

A case of a rare primary cardiac tumor in a 46-year-old woman is described. The tumor arose from the left atrium and was histologically composed of multiple mesenchymal elements of fibrosarcoma, rhabdomyosarcoma, chondrosarcoma, myosarcoma, and liposarcoma. Metastasis of this tumor occurred in the left femur, lung, and hilar lymph nodes after the second heart operation. Histogenesis of malignant mesenchymoma was considered with a survey of the literature.

Osteogenic sarcoma of the tongue

A 45-year-old woman had a mass in the left side of the tongue. Histologic examination of the tumor revealed it to be an extraskeletal osteogenic sarcoma. Pulmonary metastases were seen on admission. The patient had a rapid downhill course and died. Extraskeletal osteogenic sarcomas are well-recognized albeit rare neoplasms. In a search of the literature we were unable to find a single case arising in the tongue. The electron microscopic findings are also presented.

Angiosarcoma of the heart: ultrastructural study

Two angiosarcomas of the heart, both arising from the right atrium, were studied with the electron microscope. Ultrastructural characteristics of angiomatous development were demonstrated both at the better differentiated vascular areas and at the less differentiated, spindle-cell foci. Both tumors were dominated by immature endothelial cells. These cells were associated with primitive mesenchymal cells and transitional forms of pericytes. Intracytoplasmic lumen formation and junctional specialization with neovascular development are unique features of angiogenesis in these tumors. Ultrastructural studies may provide useful diagnostic features separating a true malignant vascular neoplasm of endothelial cell origin from other forms of mesenchymal neoplasia that may have a prominent stromal vascular component.

Right ventricular obstruction secondary to intracardiac metastatic osteosarcoma

A 30-year-old female with a history of surgically treated osteosarcoma 2 years prior to admission presented with progressive dyspnea and cyanosis. Physical examination was otherwise negative. Cardiac catheterization demonstrated a right ventricular mass lesion. At surgery, a metastatic osteosarcoma filling the entire right ventricle and extending from the pulmonary valve across the tricuspid valve and into the right atrial cavity was partially excised. Despite marked improvement postoperatively, she did 33 d after surgery. Postmortem findings were unusual in that the heart represented the sole site of metastasis. The diagnostic approach to cardiac symptoms from malignancy is discussed in relation to this patient.

Imaging procedures in the detection of cardiac tumors, with emphasis on echocardiography: a review

Although cardiac tumors are relatively rare, their diagnosis is important because successful treatment is usually feasible if the diagnosis is made preoperatively. An analysis of 219 reports of cardiac tumors described in the English literature from 1972 through 1977 demonstrated the predominance of benign tumors, in particular myxoma, which is in agreement with past reviews. The methods of diagnosis employed included plain chest films, echocardiography, cardiac catheterization, angiocardiography, and cardiac scintigraphy. Conventional x-ray examination of the chest was abnormal in 83% of cardiac tumors but non-specific and should lead to further evaluation, first by echocardiography. Echocardiography, the most efficient diagnostic procedure for screening possible cardiac tumors, was abnormal in 94% of the cases. Cardiac catheterization was abnormal in 80% of cardiac tumors while definitive detection was made by angiocardiography in 94% of the cases. Cardiac scintigraphy has had limited use in the diagnosis of cardiac tumors, but has been diagnostic in 100% of the cases in a small series of myxomas.

Primary cardiac tumors

Cardiac tumors are a rare, but potentially curably form of heart disease. A high index of clinical suspicion is necessary for diagnosis as these tumors have protean manifestations that mimic a variety of other cardiac and noncardiac diseases. Presently, M-mode and two-dimensional echocardiography are utilized as safe, reliable, and noninvasive imaging modalities. Seventy-five per cent of these tumors are benign, with myxoma accounting for 50% and rhabodomyoma comprising 20% of lesions. Various histologic types of sarcoma are the predominant malignant cardiac neoplasms. With strict attention to avoiding perioperative tumor embolization, surgical resection of these lesions can be accomplished with minimal morbidity and mortality. Sixteen consecutive primary tumors of the heart have been surgically treated at Duke University Medical Center since 1966 with no perioperative deaths and no late recurrences.

Mixed malignant mesenchymal tumor of the cerebellar vermis

In an example of mixed malignant mesenchymal tumor of the cerebellar vermis, striking osteoblastic differentiation was present along with extensive intradural spinal invasion. The CNS sarcomas and their variants are discussed as well as the extraskeletal osteosarcomas. Comparison is made to the teratoid tumors and other mixed and unusual posterior fossa tumor elements, and the capability of midline posterior fossa tissues for multipotential differentiation is considered.

Primary osteogenic sarcoma of the heart

The clinical course of a 17-year-old boy with primary osteogenic sarcoma of the left atrium with partial obstruction of the mitral valve and the right pulmonary veins is described. After operative removal of the tumor, echocardiography documented its rapid recurrence. Despite two subsequent open-heart operations and adjuvant chemotherapy and radiotherapy, the patient died twenty-one months after the initial symptoms. Previous reports of such tumors are reviewed, and technical difficulties of removal are discussed.

Rapid platelet consumption in a case of metastatic osteogenic sarcoma of the breast

An operation was carried out on an elderly female because of an osteogenic sarcoma of the breast. One year later she developed a state of rapid thrombocytolysis resistant to high dose prednisolone therapy and spleenectomy. At autopsy a large single metastasis was found in the right atrium and tumour emboli in the pulmonary artery. It is suggested that the shortening in platelet survival might have had an immunological background. Trapping of fibrinous material within tumour emboli and mechanical platelet destruction caused by the tumour appear to have been contributing factors.

Malignant mesenchymoma. Case report with electron microscopic study

A malignant tumor from the thigh of a 65-year-old man was examined by light and electron microscopy. The tumor was diagnosed by light microscopy as malignant mesenchymoma with prevalence of leiomyosarcomatous or liposarcomatous components, but electron microscopic study revealed that the basic cell was similar to chondroblastic or osteoblastic cells. However, a precise ultrastructural classification of the tumor cells was not possible, since the majority of the cells had mixed features. The histogenesis, differentiation, and relation to prognosis are discussed.

Primary osteogenic sarcoma of the mediastinum

Ikeda, T., Ishihara, T., Yoshimatsu, H., Kikuchi, K., Murakami, M., Kobayashi, K., Inoue, H., and Kasahara, M. (1974). Thorax, 582-588. Primary osteogenic sarcoma of the mediastinum. A 22-year-old man with primary osteogenic sarcoma of the superior mediastinum is reported. This case is the second instance of primary osteogenic sarcoma of the mediastinum and the first case of superior mediastinal origin to be reported. The patient had local recurrence one year after the first operation. After resection of the recurrent tumour with left upper lobectomy and partial pericardectomy followed by radiation, he has been well for more than five years without recurrence.

Extraosseous osteogenic sarcoma of soft tissue is very rare and has been reported in 103 patients. The five-year survival of patients with extraosseous osteogenic sarcoma is 22·4%. The distribution and prognosis of this tumour are similar to those of rhabdomyosarcoma in soft tissue. Primary amputation or wide excision is the treatment of choice.