Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology

Primary cardiac angiosarcoma: A clinical report of 1 case and review of the literature

RATIONALE

Primary cardiac angiosarcoma is very rare with a poor prognosis, and there is no recognized guideline for its diagnosis and treatment. Currently, there is no standardized adjuvant chemotherapy regimen following radical surgery for cardiac angiosarcoma. To date, the literature lacks reports on the use of albumin-bound paclitaxel as an adjuvant chemotherapy agent in this context. This case report aims to document and evaluate the imaging characteristics of the disease and the efficacy of albumin-bound paclitaxel as adjuvant chemotherapy, thereby providing valuable insights for clinical diagnosis and treatment.

PATIENT CONCERNS

We report a 70-year-old patient with right atrial angiosarcoma, who presented with atrial fibrillation as the initial symptom.

DIAGNOSES

Transesophageal echocardiography, chest computed tomography, and cardiac magnetic resonance imaging showed a right atrial mass.

INTERVENTIONS

After radical resection, the patient was given 4 cycles of albumin-bound paclitaxel adjuvant chemotherapy.

OUTCOMES

Multiple metastases occurred in a short period of time, and the patient died 13 months after surgery. Surgical resection is the most important treatment for cardiac angiosarcoma, and the optimal adjuvant therapy needs to be further studied.

LESSONS

The limitation of this case report is its reliance on a single case, resulting in a limited sample size. To comprehensively characterize cardiac angiosarcoma and evaluate the efficacy of albumin-bound paclitaxel chemotherapy, future studies should collect additional cases and conduct long-term follow-up.

Case report: Primary cardiac synovial sarcoma with suspected connective tissue disease diagnosed by EBUS-TBMB

Primary cardiac synovial sarcoma (PCSS) most commonly originates in the right atrium of the heart and is exceptionally rare. Although biomarkers of autoimmune diseases, such as antinuclear antibodies (ANAs), have been reported as potential indicators of certain tumors, the association between PCSS and ANAs remains unclear. Herein, we describe a case of pleural effusion that was initially considered to be due to connective tissue disease (CTD) but was finally diagnosed as PCSS through endobronchial ultrasound-guided transbronchial mediastinum biopsy (EBUS-TBMB). Clinicians need to update their knowledge regarding the potential association between PCSS and ANAs. This case report also emphasizes the importance of EBUS-TBMB, under the guidance of positron emission tomography/computed tomography (PET/CT), in the diagnosis of this rare tumor in an unusual location.

Complete resection of a giant intrapericardial cardiac synovial sarcoma

Synovial sarcoma of the heart is a rare tumor. Herein we would like to report a case of giant intrapericardial cardiac synovial sarcoma that originated from the right ventricle and grew outward near the diaphragm. After making adequate preoperative preparation, we performed the surgery as quickly as possible and resected the tumor completely. Based on the identification of the translocation on chromosome 18 rearrangement, the tumor can be diagnosed as a primary cardiac synovial sarcoma. Through this study, we aim to afford more information about cardiac synovial sarcomas as well as a reference for similar cases.

Minimally-Invasive Approach in the Setting of a Malignant Primary Cardiac Tumor

A 71-year-old man with dilated cardiomyopathy without clinical complaints revealed a suspicious finding in checkup. After a multimodality cardiac imaging, the suspicion of a malignant primary cardiac tumor in the left ventricle was substantiated and the patient underwent minimally-invasive cardiac surgery for tumor resection. Postoperative chemotherapy with multiple cycles of liposomal doxorubicin was established and supported by proton beam radiotherapy. Two-year follow-up revealed no disease recurrence.

Genomic Landscape Comparison of Cardiac versus Extra-Cardiac Angiosarcomas

Angiosarcomas (ASs) are rare malignant vascular entities that can affect several regions in our body, including the heart. Cardiac ASs comprise 25-40% of cardiac sarcomas and can cause death within months of diagnosis. Thus, our aim was to identify potential differences and/or similarities between cardiac and extra-cardiac ASs to enhance targeted therapies and, consequently, patients' prognosis. Whole-transcriptome analysis of three cardiac and eleven extra-cardiac non-cutaneous samples was performed to investigate differential gene expression and mutational events between the two groups. The gene signature of cardiac and extra-cardiac non-cutaneous ASs was also compared to that of cutaneous angiosarcomas (n = 9). H/N/K-RAS and TP53 alterations were more recurrent in extra-cardiac ASs, while POTE-gene family overexpression was peculiar to cardiac ASs. Additionally, in vitro functional analyses showed that POTEH upregulation conferred a growth advantage to recipient cells, partly supporting the cardiac AS aggressive phenotype and patients' scarce survival rate. These features should be considered when investigating alternative treatments.

Heart Transplantation as a Treatment Option for Recurrent Myxofibrosarcoma: A Clinical Case

Myxofibrosarcoma is one of the most rare tumors of the heart. Surgical resection is the principal method of treatment; however, in some cases, radical removal of the tumor is not possible. Here, we present a case of heart transplant in a patient who experienced recurrent myxofibrosarcoma of the left atrium and examine the morphological features of this tumor. A 40-year-old female patient presented for treatment for heart failure of a high functional class. An examination revealed a tumor in the left atrial cavity, which was subsequently surgically removed. Morphological examination revealed an inflammatory myofibroblastic tumor. After 2 years, the patient's tumor recurred. The tumor was removed, and a morphological study again diagnosed myxofibrosarcoma of the heart. A year later, recurrence was again diagnosed. Instrumental examination determined that the tumor had incurred into the mitral valve and possibly spread to the myocardium. Tumor resection was not possible, and the need to perform a heart transplant was determined. The given case contributes to the practical conclusion that heart transplant contributes to an increase in the life expectancy for patients with inoperable cases of cardiac sarcoma.

A case of cardiac tamponade caused by T4N2M1 lung squamous cell carcinoma invading the aorta

In patients with known lung squamous cell carcinoma, it is necessary to be alert to the presence of cancer cell infiltration in the large blood vessels and the heart. In this report, we report a case of a 49-year-old man who was previously diagnosed with squamous cell carcinoma of the lung, underwent autoimmune cell therapy, and was diagnosed posthumously with lung cancer invading the aorta and heart, resulting in severe cardiac tamponade. This case illustrates the value and key points of autopsy in evaluating sudden deaths.

Dataset for the reporting of neoplasms of the heart, pericardium, and great vessels: recommendations from the International Collaboration on Cancer Reporting (ICCR)

The International Collaboration on Cancer Reporting (ICCR) was founded by major pathology organizations from around the world to produce internationally standardized and evidence-based datasets for pathologists' reporting of cancer. Its goal is to improve cancer patient outcomes worldwide and to advance international benchmarking in cancer management. The ICCR cancer dataset development schedule is aligned with revisions of the WHO Classification of Tumours ("Blue Book") series, and in 2015 ICCR developed an initial series of thoracic datasets including a dataset for neoplasms of the heart, pericardium, and great vessels. This edition has now been updated to align with the 2021 WHO Blue Book series. An expert panel was convened to review and revise the dataset. While the majority of ICCR datasets are focused on malignant tumors, the scope of this dataset includes a number of benign tumors and tumor-like entities because of the rarity of cardiac malignancies and the serious implications of even histologically benign lesions. Due to the rarity of cardiac tumors, evidence in support of reporting elements is limited.

Primary undifferentiated high-grade pleomorphic cardiac sarcoma in the left atrium with atypical presentation

A woman in her 60s had 4 months of malaise, fatigue, dyspnoea, night sweats and grade 3 clubbing. She had a pansystolic murmur and signs of congestive heart failure. Multimodal imaging with a transthoracic echocardiogram, transoesophageal echocardiogram and CT was carried out to diagnose and reconstruct the mass for surgical planning. A 2×2.8 cm circular dense mass was found in the left atrium with vegetations on the mitral valve. Positron emission tomography and cardiac MRI confirmed the mass's hypermetabolic activity and malignant features. Mitral valve replacement and surgical resection were performed. She was diagnosed with grade 3 undifferentiated cardiac sarcoma and referred to the sarcoma multidisciplinary team for further management given sarcoma's rarity and complexity. The poor prognosis of sarcoma was evident as her symptoms recurred 2 months postoperatively.

Genomic Characterization of Rare Primary Cardiac Sarcoma Entities

Primary cardiac sarcomas are considered rare malignant entities associated with poor prognosis. In fact, knowledge regarding their gene signature and possible treatments is still limited. In our study, whole-transcriptome sequencing on formalin-fixed paraffin-embedded (FFPE) samples from one cardiac osteosarcoma and one cardiac leiomyosarcoma was performed, to investigate their mutational profiles and to highlight differences and/or similarities to other cardiac histotypes. Both cases have been deeply detailed from a pathological point of view. The osteosarcoma sample presented mutations involving ATRX, ERCC5, and COL1A1, while the leiomyosarcoma case showed EXT2, DNM2, and PSIP1 alterations. Altered genes, along with the most differentially expressed genes in the leiomyosarcoma or osteosarcoma sample versus the cardiac angiosarcomas and intimal sarcomas (e.g., YAF2, PAK5, and CRABP1), appeared to be associated with cell growth, proliferation, apoptosis, and the repair of DNA damage, which are key mechanisms involved in tumorigenesis. Moreover, a distinct gene expression profile was detected in the osteosarcoma sample when compared to other cardiac sarcomas. For instance, WIF1, a marker of osteoblastic differentiation, was upregulated in our bone tumor. These findings pave the way for further studies on these entities, in order to identify targeted therapies and, therefore, improve patients' prognoses.