A Case of Ewing Sarcoma Presenting With Cardiac Metastasis

Metastatic extension of Ewing's sarcoma to the right heart chambers: a rare case report

BACKGROUND

Ewing's sarcoma (ES) is a common malignant bone tumor in adolescents and young adults. Its pelvic location is associated with a worse prognosis. Our case represents one of the rare instances in the literature involving an adult patient in whom the disease progressed fatally due to cardiac extension.

CASE PRESENTATION

We report the case of a 31-year-old female patient who initially presented with swelling in her right lower extremity, which was found to be caused by deep venous thrombosis (DVT) extending from the iliac vein to the inferior vena cava. A thoracic-abdominal CT scan, performed as part of the etiological workup, revealed a tumor in the right hip bone with a malignant appearance, exhibiting both endo and exopelvic extension, and extending to the inferior vena cava (IVC) and right heart chambers. An echo-guided biopsy of the tumor mass confirmed Ewing's sarcoma. The patient's condition rapidly deteriorated, leading to death due to the inoperability of the extensive tumor.

CONCLUSIONS

Ewing's sarcoma can affect adults, presenting with late-onset or rapidly metastatic forms. In its extensive form, ES requires multimodal imaging to assess operability and is associated with a poor prognosis. This case report represents one of the rare instances in the literature of Ewing's sarcoma metastasizing to the heart.

Primary and metastatic primitive neuroectodermal tumor of the heart: A systematic review

OBJECTIVE

Primary and metastatic primitive neuroectodermal tumors of the pericardium are uncommon. Two cases are presented and discussed.

METHODS

The cases of a 17- and 38-year-old male patients with neuroectodermal tumors of the pericardium are presented. In addition, a systematic review was performed according to the Preferred Reporting Items and checklist for Systematic reviews and Meta-Analyses (PRISMA). All selected articles' quality assessment was done using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports.

RESULTS

The systematic review yielded 29 patients with primary or metastatic PNET. Two patients underwent cardiac transplantation. It seems that unlike considering total resection in other organs, pericardiectomy in PNET patients with pericardial origin may lead to further invasion of the lesions, and it is not recommended. The average disease-free follow-up was 10 months. The combination of neoadjuvant and adjuvant chemotherapy along with surgery and radiotherapy offered the best disease-free outcomes.

CONCLUSION

Neuroectodermal heart tumors are rare, aggressive tumors requiring chemotherapy and radiotherapy in association with tumor resection surgery to have the best disease-free duration.

Cardiac tumours in children: a single-centre experience and literature review

Cardiac tumours are extremely rare in children. Although more than 90% are benign, children can develop obstructive or embolisation derived symptoms, arrhythmias, constitutional symptoms, cardiac tamponade, or even sudden death. Although the majority are asymptomatic, and some spontaneously regress, appropriate follow-up is needed on a case-by-case basis, as patients may develop late symptoms. Definitive diagnosis is only possible through histological analysis; however, it is possible to infer tumour type with a high grade of certainty based on imaging features, particularly cardiac magnetic resonance. Surgical resection is advocated for those causing symptoms, obstruction, cardiac dysfunction, and high risk of embolisation. The aim of this review is to present the state of the art related to cardiac tumours in the paediatric population, in the context of our own experience.