loading page

Friend or Foes -- two cardiac tumors with different natures
  • +2
  • Nan-Chun Wu,
  • Jhih-Yuan Shih,
  • Bor-Chih Cheng,
  • Zhih-Cherng Chen,
  • Wei-Ting Chang
Nan-Chun Wu
Chi Mei Medical Center
Author Profile
Jhih-Yuan Shih
Chi Mei Medical Center
Author Profile
Bor-Chih Cheng
Chi Mei Medical Center
Author Profile
Zhih-Cherng Chen
Chi Mei Medical Center
Author Profile
Wei-Ting Chang
Chi Mei Medical Center
Author Profile

Abstract

Primary cardiac leiomyosarcoma is not common but is lethal. Prompt surgery is mandatory for identifying the etiology while a comprehensive examination of pathology is crucial especially in the condition of two tumors with different etiologies. A 52-year-old man with medical history of systemic hypertension presented with chest discomfort and dyspnea. Echocardiography revealed the dilated right ventricle with a mass at right ventricular outlet tract (RVOT) (Figure 1A). It caused critical obstruction and resulted in severely pulmonary hypertension (estimated pulmonary systolic pressure up to 108mmHg). Cardiac magnetic resonance imaging confirmed a heterogeneous mass at RVOT with a high-intensity in T2 weighted image but failed to differentiate whether it is myxoma, metastasis or primary cardiac malignancy (Figure 1B). Given the exacerbating dyspnea, he received a prompt surgery which identified two tumors. One in the size of 9*4 cm originated from the RV dome extending to RVOT and pulmonary artery. The other smaller one (5*3 cm) mainly located within the RV (Figure 1C). The surgeon excised the smaller one for the frozen section while the immediate pathology reported that it was a benign lesion. Both tumors were removed. Surprisingly, post the operation the final pathology revealed that despite one tumor of benign degenerative tissues, the other of rare cardiac leiomyosarcoma at T1 stage. Immunohistochemical staining showed positive for smooth muscle actin and h-Caldesmon which is specific for leiomyosarcoma (Figure 1D). The patient subsequently received chemotherapies of Doxorubicin 75mg/m2 for 4 cycles.

Peer review status:ACCEPTED

19 Apr 2020Submitted to Journal of Cardiac Surgery
21 Apr 2020Submission Checks Completed
21 Apr 2020Assigned to Editor
22 Apr 2020Reviewer(s) Assigned
05 May 2020Review(s) Completed, Editorial Evaluation Pending
11 May 2020Editorial Decision: Revise Minor
12 May 20201st Revision Received
14 May 2020Submission Checks Completed
14 May 2020Assigned to Editor
20 May 2020Reviewer(s) Assigned
28 May 2020Review(s) Completed, Editorial Evaluation Pending
28 May 2020Editorial Decision: Accept