Primary cardiac angiosarcoma initially diagnosed on pericardial fluid cytology with histology and autopsy correlation
Yan Li1,2, Yoo Min Ahn1,2, Shuang Niu1,2
1Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA.
Insights
Primary cardiac angiosarcoma, a rare heart cancer, was diagnosed using pericardial fluid cytology. This case highlights the potential for early detection of this deadly malignancy through fluid analysis, despite diagnostic challenges.
Area of Science:
- Oncology
- Cardiology
- Cytopathology
Background:
- Primary cardiac angiosarcoma is a rare, aggressive heart malignancy.
- Diagnosis is challenging due to nonspecific symptoms and imaging findings.
- Often presents with recurrent pericardial effusions, but diagnosis from fluid is infrequent.
Purpose of the Study:
- To report a case of primary cardiac angiosarcoma diagnosed via pericardial fluid.
- To discuss the cytomorphology and immunophenotype of angiosarcoma in pericardial fluid.
- To highlight challenges and provide recommendations for early diagnosis using pericardial fluid cytology.
Main Methods:
- Case report of primary cardiac angiosarcoma.
- Analysis of pericardial fluid cytology.
- Review of cytomorphology and immunophenotype.
- Discussion of diagnostic challenges and recommendations.
Main Results:
- Primary cardiac angiosarcoma was successfully diagnosed on initial pericardial fluid analysis.
- The study details the cytomorphologic and immunophenotypic features of the malignancy in fluid.
- Challenges in early diagnosis due to low cell counts and potential misdiagnosis were identified.
Conclusions:
- Pericardial fluid cytology can be a valuable tool for the early diagnosis of primary cardiac angiosarcoma.
- Increased awareness and specific workup protocols are crucial for timely diagnosis.
- Early diagnosis improves the potential for timely intervention in this rare and aggressive cancer.
Abstract:
Primary cardiac angiosarcoma is an exceedingly rare high-grade malignancy of the heart originating from endothelial cells, with a predilection for the right atrium in male. Clinical diagnosis is extremely challenging because of the nonspecific symptoms and radiological findings. Although almost always presenting with massive recurrent pericardial effusions, cardiac angiosarcoma diagnosed based on pericardial fluid has rarely been reported, either due to the paucity of malignant cells or misdiagnosis due to low familiarity/suspicion and lack of proper workup. Unfortunately, patients with this disease often receive definitive diagnosis post-mortem. We report a case of primary cardiac angiosarcoma initially diagnosed on pericardial fluid. The cytomorphology and immunophenotype of angiosarcoma in fluid, as well as the challenges and practical recommendations in using pericardial fluid cytology for early diagnosis of this deadly disease are discussed.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...