Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after
Dirk Vogelgesang1, Johannes B Dahm, Holm Grossmann
1Department of Pathology, University of Greifswald, Greifswald, Germany.
Insights
Primary cardiac angiosarcomas are rare tumors. Early diagnosis via stroke-like symptoms led to successful treatment of this rare cardiac angiosarcoma, highlighting its potential as a cause of embolic disease.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Primary malignant cardiac tumors, specifically cardiac angiosarcomas, are exceptionally rare.
- Diagnosis is often delayed due to nonspecific symptoms, typically occurring at advanced, incurable stages.
Observation:
- A 59-year-old female presented with cerebral ischemia symptoms, initially suggesting stroke.
- Transesophageal echocardiography identified a left atrial mass, initially misdiagnosed as a thrombus.
Findings:
- Surgical enucleation revealed a solitary cardiac angiosarcoma.
- The patient received adjuvant chemotherapy and remained disease-free at 14-month follow-up.
Implications:
- Cerebral embolic disease can be an early, presenting symptom of cardiac angiosarcoma.
- Prompt diagnosis, even when incidental, allows for potentially curative treatment of this rare malignancy.
Abstract:
Primary malignant cardiac tumors (cardiac angiosarcomas) are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT) scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease.
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