Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jul 10;16(7):e64273.
doi: 10.7759/cureus.64273. eCollection 2024 Jul.

Rapid Development of Primary Right Atrial Angiosarcoma

Sophie Talbot  1 , Vishal Bandaru  1 , Tung Nguyen  1 , Dauod Arif  2 , Pooja Sethi  1
Affiliations
Case Reports

Rapid Development of Primary Right Atrial Angiosarcoma

Sophie Talbot et al. Cureus. .

Abstract

Cardiac angiosarcomas are rare and generally followed by a high level of metastasis with poor median survival outcomes. Echocardiograms, CT scans, and MRIs are the standard methods for finding sites of cardiac tumors; however, immunohistochemical confirmation is necessary for a definitive diagnosis of angiosarcoma. A 58-year-old male presented to the emergency room with one week of dyspnea on moderate exertion accompanied by chest pain and alleviated with rest. A workup done to evaluate mass found a single 5 x 3.5 x 4.8 cm mass heavily vascularized by the right coronary artery and left circumflex involving the free wall of the right atrium with no extension to the tricuspid valve. Surgical resection was performed, and immunohistochemistry was consistent with a primary cardiac angiosarcoma. An exudative fluid analysis on pericardial and pleural fluid analysis may warrant screening for malignancy more frequently in concurrence with a patient's history and presentation. Although the time from onset of symptoms to diagnosis of cardiac angiosarcoma is not well established, further investigation of such correlation may offer insight into survival post-treatment.

Keywords: cardiac angiosarcoma; cardiac tamponade; exudative fluid analysis; pericardial effusion; primary cardiac tumor; transesophageal echocardiogram.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Left heart catheterization depicting a right atrial mass (arrow) with vascularization through small branches coming from both the left circumflex artery and the right coronary artery, respectively.
Figure 2
Figure 2. TEE with right atrial mass (arrows) with hyperechoic core and hypoechoic filamentous fronds attached to the mass suggestive of significant vascularization.
Mass is closer to the SVC and thought to be either one large entity measuring up to 4.2 x 2.4 cm or two distinct adjacent 2 x 2 cm masses. TEE: transesophageal echocardiogram, SVC: superior vena cava.
Figure 3
Figure 3. MRI of the chest with a single 5 x 3.5 x 4.8 cm mass (arrows) involving the free wall of the right atrium.
No involvement of the tricuspid valve was found. MRI: magnetic resonance imaging.
Figure 4
Figure 4. H&E stain at 10x and 40x, respectively, depicting irregularly shaped anastomosing vascular channels lined by atypical endothelial cells which are polygonal-epithelioid in shape and mitotically active.
H&E: hematoxylin and eosin.
Figure 5
Figure 5. Immunohistochemical stain of biopsied mass is ERG positive, a marker for vascular tumors.
ERG: ETS-related gene, a vascular marker (ETS: erythrocyte transformation-specific transcription factor).
See this image and copyright information in PMC

References

    1. Angiosarcoma: a review of diagnosis and current treatment. Cao J, Wang J, He C, Fang M. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895451/ Am J Cancer Res. 2019;9:2303–2313. - PMC - PubMed
    1. Outcomes after surgical resection of cardiac sarcoma in the multimodality treatment era. Bakaeen FG, Jaroszewski DE, Rice DC, et al. J Thorac Cardiovasc Surg. 2009;137:1454–1460. - PubMed
    1. Cutaneous soft tissue sarcoma incidence patterns in the U.S.: an analysis of 12,114 cases. Rouhani P, Fletcher CD, Devesa SS, Toro JR. Cancer. 2008;113:616–627. - PubMed
    1. Characteristics and survival of malignant cardiac tumors: a 40-year analysis of >500 patients. Oliveira GH, Al-Kindi SG, Hoimes C, Park SJ. Circulation. 2015;132:2395–2402. - PubMed
    1. Angiosarcoma. Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ. Lancet Oncol. 2010;11:983–991. - PubMed

Publication types

LinkOut - more resources