Primary cardiac tumor: a case report of right atrial angiosarcoma and review of the literature

Advancements in Diagnosis and Treatment of Cardiac Sarcomas: A Comprehensive Review

OPINION STATEMENT

Cardiac sarcomas are rare, aggressive malignancies originating from various cardiac cell types, presenting significant challenges in both diagnosis and treatment. This comprehensive review explores recent advancements in diagnosis and treatment of cardiac angiosarcoma, fibrosarcoma, leiomyosarcoma, and rhabdomyosarcoma. And we briefly discuss the exceedingly rare occurrence of cardiac osteosarcoma and present our perspectives on its treatment. Development of these tumors is influenced by genetic mutations, environmental factors, and chromosomal abnormalities, necessitating a multidisciplinary approach for accurate diagnosis and management. Advanced imaging techniques, biomarkers, and immunohistochemical analysis assist in confirming the diagnosis and guiding treatment decisions. Surgical resection, adjuvant therapies, and personalized treatment strategies based on genetic profiling offer promising avenues for improving patient outcomes. Emerging therapeutic approaches, such as targeted therapies and immunotherapies, have shown promising progress in recent years. Despite these advancements, the prognosis for patient with cardiac sarcomas remains poor, highlighting the urgent need for continued research to refine treatment methods and enhance long-term survival outcomes. Ongoing efforts and clinical trials are essential for advancing the management of these rare and aggressive tumors, ultimately improving quality of life for affected patients.

A surgical case of right atrial wall perforation caused by an invasive angiosarcoma

Cardiac angiosarcoma is a rare, diagnostically elusive disease with a poor prognosis. Herein, we describe the case of a 61-year-old man who presented with cardiac tamponade caused by perforation of the right atrial wall resulting from an invasive angiosarcoma. The tumour, which had spread throughout the entire right atrial free wall, was resected under cardiopulmonary bypass. Subsequent reconstruction of the right atrial wall involved the use of both autologous and bovine pericardial patches. Cardiac wall rupture due to invasive cardiac angiosarcoma is an extremely rare complication, with only a few cases reported. Therefore, we also review the relevant literature herein.

[MEP-35] Primary Cardiac Tumor: A Case Report of Right Atrial Angiosarcoma

Cardiac tumors mainly present as metastases from tumors in other extracardiac organs. Primary cardiac tumors are relatively rare tumors, with a prevalence rate of 0.002 to 0.33%. Myxomas, which commonly occur in the left atrium, are the most frequent benign primary cardiac tumors. Angiosarcomas are the most common primary malignant cardiac tumors. A 63-year-old female patient who had exertional dyspnea presented to the clinic. After the detection of an invasive mass on the wall of the right atrium from the test results, the case was initiated following sternotomy, with aortic and peripheral venous cannulation. The right atrium was opened, and the tumor was dissected broadly from the normal tissue of the atrium wall. The right atrial defect was reconstructed with a pericardial patch. After extensive tumor resection and repair with a pericardial patch, the patient was transferred to the intensive care unit with inotropic support. The pathology result of the excised material was reported as angiosarcoma. The patient was discharged on the seventh postoperative day and continued with chemoradiotherapy. Cardiac tumors are rare, and angiosarcomas, which are more commonly observed on the right side of the heart, account for 25 to 30% of primary cardiac malignancies. Surgical resection of primary cardiac angiosarcoma is the primary treatment approach. Full resection of the tumor offers long-term survival for the patients. Reconstruction of cardiac structures may also be necessary after wide resections.

Recurrent Pericardial Effusion Secondary to Cardiac Angiosarcoma

Cardiac angiosarcoma is a malignant cardiac tumour. We present the case of a young patient in his mid-30s with recurrent pericardial effusion. He had flu-like symptoms a month earlier and had shortness of breath, lethargy, and tightness in his throat for the past ten days. Echocardiography demonstrated global pericardial effusion > 4 cm with tamponade features, and the patient was blue-lighted to our hospital. He underwent emergency pericardiocentesis, and > 1 litre of pericardial fluid was drained. Computed tomography of the chest, abdomen, and pelvis revealed small-volume ascites and moderate right-sided pleural effusion, with associated lobar collapse. The patient presented to the hospital with global pericardial effusion requiring emergency pericardiocentesis three weeks later and underwent cardiac magnetic resonance imaging demonstrating global pericardial effusion and a 48 × 26 mm pericardial space mass adjacent to the right atrium. He underwent surgical resection of the tumour, followed by chemotherapy, and tolerated the treatment well. The patient is currently under follow-up.

Case report: Primary pericardial angiosarcoma, a rare cause of cardiac tamponade

Primary pericardial angiosarcoma is a rare malignancy of the pericardium with variable clinical features and imaging characteristics. Herein, we report a case of histopathologically confirmed pericardial angiosarcoma in a 66-year-old man. The patient developed cardiac tamponade in a short time period. The transthoracic echocardiography showed the presence of multiple irregular echodensities, heterogeneous in echogenicity, encasing the apex of both ventricles in the pericardial space, initially misinterpreted as pericardial effusion. The patient died of cardiogenic shock despite undergoing a surgical pericardiectomy. Pericardial angiosarcoma can manifest as a mass obliterating the pericardial sac, rather than the typical pericardial effusion observed on echocardiography. Multimodality imaging studies aid in diagnosing primary pericardial angiosarcoma, but the final diagnosis relies on tissue histopathology.