Ewing Sarcoma in the Right Ventricle

Abstract

Ewing sarcoma is the second most prevalent malignant primary bone tumor but constitutes only a small proportion of cardiac metastases. We present a case of asymptomatic Ewing sarcoma metastatic to the right ventricle. A 36-year-old man presented for evaluation and resection of a pedunculated right ventricular cardiac tumor. Three years before, he had been diagnosed with translocation-negative Ewing sarcoma, for which he had undergone chemotherapy and amputation of the left leg below the knee. We resected the right ventricular tumor. Analysis of the resected mass supported the diagnosis of metastatic Ewing sarcoma. Postoperative transthoracic echocardiograms showed normal biventricular size and function. One year later, the patient had no recurrence of the sarcoma. In addition to discussing this case, we review the relevant medical literature.

Keywords: Heart neoplasms/secondary/surgery; heart ventricles/surgery; neoplasm invasiveness; oncogene proteins, fusion; sarcoma, Ewing/genetics/pathology/surgery; treatment outcome.

Fig. 1

Magnetic resonance image (T2 fat-saturated axial planar view) shows an enhancing mass in the right ventricle.

Fig. 2

Fused positron emission tomographic–computed tomographic image with fluorodeoxyglucose (axial plane) shows a metabolically active tumor in the right ventricle.

Fig. 3

Photomicrographs show tumor cells with A) necrosis (H & E, orig. ×20) and B) a high mitotic rate (H & E, orig. ×40).