Cardiac angiosarcoma: A case report and review of current treatment

Abstract

Rationale: Primary cardiac angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. As there are currently no guidelines or effective therapeutic strategies, management of this condition depends on previous experiences of the clinician treating and the consideration of reported cases.

Patient concerns: A 65-year-old male presented to our department with a 4-day history of chest tightness, dyspnea, lower extremity weakness and occasional dizziness, and a transthoracic echo (TTE) revealed a right atrium occupying mass.

Diagnoses: TTE showed right atrium occupation, and the post-operative histopathology showed the tumor to be a primary cardiac angiosarcoma.

Interventions: Right atrium tumor resection and right atrium reconstruction with a bovine pericardium were performed.

Outcomes: The patient recovered from surgery and discharged but died 10 months after surgery because of complete resection was impossible and adjuvant therapy was not performed.

Lessons: Resection of primary cardiac angiosarcomas should be integrated with a combination of chemotherapy, radiotherapy, and targeted therapy based on tumor cell gene mutation and altered expression.

Figure 1

(A) Preoperative transthoracic echocardiography (TTE) revealed an iso-echoic mass (8.0 × 4.8 cm) with a broad base (3.6 cm, from tricuspid inferior leaflet annulus to the mural) in right atrium. The mobile mass entered into the tricuspid orifice in diastole, and back in to the right atrium in systole. (B) Preoperative computed tomography angiography (CTA) demonstrated right superior pulmonary artery embolism (yellow arrow) and pleural effusion (blue arrow). (C) The neoplasm penetrated the right atrium. (D) The right atrium was opened and tumor mass (yellow arrow) attached to the atrial wall were seen. (E) Resected tumor mass. (F) Right atrium was reconstructed by bovine pericardium. (G) Microscopic examination showed apparent hemorrhage and necrosis within, unequally distributed spindle and ovoid cells with obvious atypia and mitotic figures which had invaded and spread locally. A characteristic anastomosing vascular channel line with atypical cells was also observed. (H) Postoperative TEE revealed the remaining hypoechoic mass (3.5 cm × 2.8 cm) was separated from the right atrium chamber by hyperechoic bovine pericardium.