Percutaneous intravenous catheter forceps biopsy in right atrial mass: two case reports and literature review

Abstract

Background: Primary malignant tumors of the heart are rare. Although preoperative histological diagnosis is difficult, it has paramount value in therapeutic strategy development and prognostic estimation. Herein, we reported 2 cases of intracardiac tumors.

Cases presentation: Both patients presented to the hospital with heart-related symptoms. Echocardiography showed massive masses in the atrium and positron emission tomography-computed tomography (PET/CT) revealed hypermetabolism and invasiveness. One patient cannot take surgery due to extensive metastasis and poor condition. The other patient was primarily diagnosed with lymphoma, and surgery was not recommended. They successfully underwent intravenous atrial biopsy, and histological samples confirmed intimal sarcoma and diffuse large B cell lymphoma. Based on immunohistochemical and molecular assessments, targeted chemotherapy was administered, resulting in clinical and imaging remission at discharge.

Conclusions: Percutaneous intravenous catheter biopsy as a safe invasive test provides an accurate pathological diagnosis after imaging evaluation, and offers a therapeutic direction. Nonmalignant masses and some chemo-radiosensitive malignant tumors in the atrium could have good prognosis after targeted therapy.

Keywords: Cardiac lymphoma; Cardiac sarcoma; Case report; Intimal sarcoma; Intravenous biopsy.

Fig. 1

CMR shows the right atrium soft tissue mass closed to the tricuspid orifice (a). PET/CT scan suggests intensive tracer uptake of the right atrial mass, pericardium, lung and mediastinal lymph nodes (b, c)

Fig. 2

CT imaging displayed right atrium mass (a) and suspected metastases in liver (b). Scan enhancement CT scan show abnormal signals in the right atrium, pericardium (c), and liver (d) in 2 months. After 5 cycles of comprehensive immune anti-tumor therapy, significant reduction is detected in the right atrial intimal sarcoma (e) and liver mass (f) dimension

Fig. 3

The pathology of the first biopsy via femoral vein shows a large amount of cellulose and blood cells, diagnosed as thrombus (a hematoxylin and eosin, 40 × 10). The pathology of the secondary biopsy through the right internal jugular vein reveals a spindle cell tumor, some areas are rich in spindle cells, with moderate atypia and focal necrosis, and the histology is consistent with intimal sarcoma (b hematoxylin and eosin, 40 × 10). Immunohistochemistry-positive neoplastic cells for PRAME (c 40 × 10)

Fig. 4

CMR confirmed left atrial mass invaded right atrium (a, b) and PET-CT scan revealed high FDG uptake in atrum and mediastinal lymph nodes (c)

Fig. 5

The histopathological section shows diffuse growth of large lymphocytes with a small amount of apoptotic necrosis (a hematoxylin and eosin, 40 × 10). Immunohistochemistry-positive neoplastic lymphoid cells for CD20 (b 40 × 10), CD5 (c × 400) and Bcl2 (d 40 × 10)