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Successful surgical resection of a metastatic clear cell sarcoma in the heart: a case report
Ayano Osawa1, Hiroto Utsunomiya2, Shuichiro Takanashi3
1Department of Cardiovascular Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Insights
This case report details a rare instance of clear cell sarcoma (CCS) metastasizing to the heart in a patient previously treated for limb CCS. Surgical resection was successfully performed, marking a first for cardiac CCS treatment.
Area of Science:
- Cardiovascular Pathology
- Oncology
- Surgical Oncology
Background:
- Clear cell sarcoma (CCS) is an exceptionally rare soft tissue sarcoma with a poor prognosis.
- Cardiac involvement by CCS is exceedingly rare, with limited documented cases.
- This report addresses a unique presentation of metastatic CCS in the heart.
Observation:
- A 33-year-old male with a history of left arm CCS presented with cardiac findings on PET-CT.
- Positron emission tomography computed tomography (PET-CT) revealed fluorodeoxyglucose accumulation in the left ventricle myocardium.
- Surgical exploration identified distinct lesions within the left ventricle, consistent with neoplastic masses.
Findings:
- Intraoperative pathology confirmed the cardiac masses as sarcoma.
- Histopathological analysis post-excision definitively diagnosed clear cell sarcoma.
- This represents the first reported case of cardiac CCS treated surgically.
Implications:
- Highlights the potential for extraskeletal metastasis of clear cell sarcoma to the heart.
- Demonstrates the feasibility and success of surgical resection for cardiac CCS.
- Emphasizes the importance of advanced imaging and multidisciplinary approaches in diagnosing and managing rare cardiac tumors.
Background:
Clear cell sarcoma (CCS) is a very rare disease and one with a very poor prognosis. Furthermore, its occurrence in the heart is very rare and past reports are scarce.
Case Summary:
A 33-year-old man who had undergone left arm amputation due to CCS came to the hospital because a positron emission tomography computed tomography (PET-CT) four years post-amputation showed an accumulation in the heart. The PET-CT with glucose suppression treatment showed fluorodeoxyglucose accumulation in the myocardium between the middle of the anterolateral wall and the papillary muscle of the posterior lateral wall of the left ventricle (LV). Based on the course of the disease up to now, it was considered that the accumulation was most likely metastasis of CCS. Observation of the heart after a median sternotomy revealed a white tone, well-defined lesion in the middle of the anterolateral wall of LV. The tumour on the posterolateral side of LV was not exposed on the surface, but it was palpated and was still recognizable as a firm neoplastic lesion. Because the mass was identified as a sarcoma on intraoperative rapid pathology, we decide to perform a total resection. Both lesions were excised, and pathology revealed a diagnosis of CCS.
Discussion:
Clear cell sarcoma is a very rare disease that accounts for <1% of all soft tissue sarcomas, and its occurrence in the heart is even rarer. It requires a combination of many imaging modalities. To our knowledge, this is the first case of CCS in the heart treated with surgical resection.
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