Case series: cardiac sarcoma

Abstract

Background: Cardiac masses encompass a wide differential including primary and secondary malignancies and can present with a variety of symptoms, many of which are non-specific. Early identification and classification are important, particularly for cardiac malignancies such as sarcomas as these are aggressive tumours with exceptionally poor prognoses when metastases are present at diagnosis.

Case summary: We report two cases of patients who presented with dyspnoea and were diagnosed with cardiac sarcomas; the former a primary sarcoma (undifferentiated pleomorphic subtype) and the latter a secondary sarcoma (round cell myxoid liposarcoma) that serve as comparisons for presentation and management of different types of this disease. Computed Tomography (CT) and echocardiography imaging findings are demonstrated showing the typical location and morphology of each subtype.

Discussion: Cardiac sarcomas are the most common primary cardiac malignancy, of which undifferentiated pleomorphic sarcoma is a common subtype. Undifferentiated pleomorphic sarcomas are aggressive, have a tendency to arise in the left atrium, and can appear similar to benign cardiac masses. Round cell myxoid liposarcomas by contrast are rare causes of secondary cardiac malignancies, metastasizing to the heart from soft tissues. Both diagnoses carry poor prognoses and although rare, are important to recognize as timely intervention with surgery, radiotherapy, and consideration of chemotherapy is key to maximizing survival.

Keywords: Cardiac malignancy; Cardiac mass; Cardiac tumour; Case report; Case series; Liposarcoma; Round cell myxoid liposarcoma; Sarcoma; Undifferentiated pleomorphic sarcoma.

Figure 1

CT and echocardiographic images. (A) Initial CT pulmonary angiogram axial view demonstrating left atrial mass (arrow) and right pleural effusion. (B) Repeat CT pulmonary angiogram axial view 1 month later demonstrating recurrence of left atrial mass (arrow). (C) Intraoperative transoesophageal echocardiogram four-chamber view demonstrating left atrial mass. (D) Transthoracic echocardiogram apical four-chamber view demonstrating left atrial mass.

Figure 2

Admission ECG.

Figure 3

CT and echocardiographic images. (A) CT pulmonary angiogram axial view demonstrating large right ventricular mass (arrow) with septal displacement. (B) Transthoracic echocardiogram subcostal view corresponding to CT image demonstrating right ventricular mass (arrow) compressing left ventricle. (C) Transthoracic echocardiogram parasternal long axis view with imaging enhancer showing right ventricular mass. (D) Transthoracic echocardiogram apical four-chamber view with imaging enhancer demonstrating right ventricular mass (arrow).