Cardiac sarcoma: A rare case of primary cardiac sarcoma

Abstract

Introduction and importance: Primary cardiac sarcoma is a rare malignancy with a poor prognosis because of diagnostic delay, therapeutic difficulties, and high metastatic potential. The therapeutic approach includes surgery, chemotherapy, and radiation therapy, alone or in combination. However, there is a lack of evidence to guide the treatment.

Case presentation: We present a case of primary cardiac sarcoma. Our patient was presented in the department of emergency medicine (ED) in our institute with shortness of breath on exertion associated with orthopnea. Based on the history and cardiovascular examination, he underwent an echocardiogram, which revealed a sizeable echogenic density in the right ventricular outflow tract. He underwent surgical resection of the cardiac mass via median sternotomy and total cardiopulmonary bypass approach. The patient was eventually diagnosed with primary cardiac sarcoma, confirmed by tissue biopsy after surgical intervention.

Clinical discussion: Through this report, we highlight the rarity of primary cardiac sarcomas, the importance of multidisciplinary tumor board (MDT) discussion and provide evidence of surgical excision being the treatment of choice, followed by systemic chemotherapy in selected cases.

Conclusion: Cardiac sarcoma is a rare but highly malignant tumor with a poor prognosis. However, early diagnosis and surgical resection of a primary cardiac sarcoma can significantly increase the patient's survival and quality of life. Therefore, physicians should keep a high suspicion of a patient with clinical features suggestive of cardiac sarcoma, and echocardiography should be the diagnostic modality of choice in such patients.

Keywords: Cardiac sarcoma; Chemotherapy; Malignancy; Surgery.

Fig. 1

Low power view of the tumor with pleomorphic cells showing abnormal mitotic figures (arrow). Hematoxylin and Eosin (H&E) stain 10 × 10.

Fig. 2

Positron emission tomography (PET) scan performed after surgery shows a hypermetabolic focus seen over the right ventricular wall with SUV-max of 6.4 (residual tumor). Non-homogeneous uptake is seen over the mediastinum, consistent with surgical intervention.