Primary cardiac angiosarcoma arising from the interatrial septum: magnetic resonance imaging appearances

Multimodality treatment of primary cardiac angiosarcoma: A systematic literature review

BACKGROUND

Primary cardiac angiosarcoma (PCA) is the most prevalent histological type of cardiac sarcoma but its rarity poses a challenge for standardizing treatment protocols. Moreover, published studies are limited by small patient numbers and lack of randomization, making it challenging to establish evidence-based treatment strategies. This systematic review aims to consolidate the heterogeneous published data and identify factors related to the treatment outcome of PCA patients.

METHODS

The PubMed and Scopus bibliographic databases were systematically searched for original articles reporting clinical, treatment and outcome data for PCA patients. Kaplan-Meier analysis was used to calculate the time to progression and survival. The Log-Rank test was used to compare progression-free and overall survival data. The Cox proportional hazards regression model was used for univariate and multivariate analysis of survival data.

RESULTS

A total of 127 studies containing data for 162 patients were analyzed. The median age of the patient cohort was 45 years, with males being 1.5 times more frequently affected than females. Tumors were primarily located on the right side of the heart, with a median size of 6 cm. Median progression-free and overall survival of 5 months and 12 months, respectively, were calculated. Age, sex, and resection margins did not have a significant impact on PCA survival, as determined by both univariate and multivariate analyses. The presence of metastases at diagnosis was associated with lower overall survival in univariate analysis, although this effect was not significant in multivariate analysis. Multimodality treatment that incorporated surgery and adjuvant chemo-radiotherapy was associated with a statistically significant survival benefit. Median overall survival increased from 6 months with surgery alone to 13 months and 27 months with adjuvant chemotherapy and chemo-radiotherapy, respectively.

CONCLUSION

Multimodality treatment including surgery and chemo-radiotherapy was found to offer the greatest survival benefit for PCA patients.

Cardiac MRI for the evaluation of cardiac neoplasms

Primary cardiac neoplasms are extremely rare and are far outnumbered by metastases. These are difficult to diagnose and differentiate clinically due to lack of specific clinical manifestations. Technological advances have revolutionised cardiac imaging, with the cardiac magnetic resonance imaging (CMRI) showing promising results in the non-invasive evaluation of cardiac masses. Further, CMRI may envisage the malignant potential of a lesion based on its location, morphology, and signal characteristics, in addition to determining its impact on cardiac function. With the ever-increasing application of CMRI in the evaluation of neoplasms, comprehensive knowledge of their imaging characteristics becomes crucial.

Primary cardiac epithelioid angiosarcoma with frond-like features: a rare and ominous radiological mimicker of benign cardiac tumors

Most primary cardiac tumors are benign neoplasms, which generally can be differentiated from malignant neoplasms via certain radiological features. We present briefly a case of a 26-year-old man undergoing resection of a right atrial mass that based on preceding radiologic findings represent a myxoma. After pathologic examination, the lesion was determined to be an epithelioid angiosarcoma with unique frond-like architecture and multiple pedicular attachments to the atrial wall.

18F-FDG PET/CT imaging in primary cardiac angiosarcoma: diagnosis and follow-up

A 40-year-old woman presented with recurrent chest tightness and shortness of breath for 10 days. The echocardiogram and MRI revealed a mass in the right atrium. FDG PET/CT was performed for further evaluation. The images demonstrated abnormally increased activity in the right atrial mass. The result of pathological examination after the surgical removal of the mass was consistent with angiosarcoma. Despite of receiving aggressive therapy including radiation, the patient had recurrent and metastatic malignancy 8 months later.

Primary malignancies of the heart and pericardium

Primary malignancies of the heart and pericardium are rare. All the available data come from autopsy studies, case reports, and, in recent years, from large, specialized, single-center studies. Nevertheless, if primary malignancy is present, it may have a devastating implication for patients. Malignancies may affect heart function, also causing left-sided or right-sided heart failure. In addition, they can be responsible for embolic events or arrhythmias. Today, with the widespread use of noninvasive imaging modalities, heart tumors become evident, even as an incidental finding. A multimodality imaging approach is usually required to establish the final diagnosis. Despite the increased awareness and improved diagnostic techniques, clinical manifestations of primary malignancy of the heart and pericardium are so variable that their occurrence may still come as a surprise during surgery or autopsy. No randomized clinical trials have been carried out to determine the optimal therapy for these primary malignancies. Surgery is performed for small tumors. Chemotherapy and radiation therapy can be of help. Partial resection of large neoplasms is performed to relieve mechanical effects, such as cardiac compression or hemodynamic obstruction. Most patients present with marginally resectable or technically nonresectable disease at the time of diagnosis. It seems that orthotopic cardiac transplantation with subsequent immunosuppressive therapy may represent an option for very carefully selected patients. Early diagnosis and radical exeresis are of great importance for long-term survival of a primary cardiac malignancy. This can rarely be accomplished, and overall results are very disappointing.

Primary cardiac angiosarcoma confirmed by multimodality imaging guided liver biopsy

Primary cardiac angiosarcoma is an extremely rare malignant tumor with various clinical presentations but usually in late stage. We report a case presented with bloody pericardial effusion, in which the final diagnosis was confirmed by multiple imaging modalities such as echocardiography, computed tomography, magnetic resonance imaging and fluorine-18-fluorodeoxyglucose positron emission tomography, as well as ultrasound-guided liver biopsy.