Ethics statement
Approval for publication was obtained from the patient and from our Institutional Review Board.
Legend Figure 1
Transesophageal echocardiogram. (A) Bicaval view demonstrating the left atrial mass attached to the atrial septum. (B) Mid esophageal 120° view showing the dynamic obstruction of the mitral valve by the mass. RA, right atrium; LA, left atrium; LV, left ventricle.
Legend Figure 2
Four chamber post-contrast cardiac magnetic resonance imaging revealing the left atrial mass (asterisk). LA, left atrium; LV, left ventricle.
Legend figure 3
Thoracoscopic view of the reddish and slightly gelatinous mass attached to the left side of the interatrial septum. LA, left atrium; RA, right atrium; IA septum, interatrial septum; Asterisk, mass.
Legend figure 4
Scattered stellate and spindle cells without abnormal mitotic figures in abundant loose myxoid matrix suggesting the diagnosis of cardiac myxoma (Stain: H&E, ×10).
Legend figure 5
Post- contrast cardiac MRI showing the recurrence of the left atrial mass attached to the interatrial septum in 4 chambers view (A) and short axis view (B). Asterisk, mass.
Legend figure 6
Resected yellowish, slightly lobulated left atrial mass with a part of the atrial septum
Legend figure 7
(A) Histopathology pictures of cardiac intimal sarcoma showing spindle cells in fascicles with nuclear pleomorphism and mitotic figures (Stain: H&E, ×10). (B) Immunohistochemistry profile shows positivity for MDM2.
References
1. Thuraisingam A, Fletcher N, Mckay G. Primary Cardiac Intimal Sarcoma. Heart, Lung and Circulation. 2019;28:S104.
2. Valecha G, Pau D, Nalluri N, Liu Y, Mohammad F, Atallah JP. Primary Intimal Sarcoma of the Left Atrium: An Incidental Finding on Routine Echocardiography. Rare Tumors [Internet]. 2016 Nov 17 [cited 2020 Jul 5];8(4). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5136772/
3. Ogechukwu C-N, Christopher N, Christoph S, Etinosasere O, Jose B. The Insidious Cardiac Tumor: A Primary Left Atrium Intimal Cardiac Sarcoma in a Young Patient [Internet]. Vol. 2019, Case Reports in Cardiology. Hindawi; 2019 [cited 2020 Jul 9]. p. e7245676. Available from: https://www.hindawi.com/journals/cric/2019/7245676/
4. Hudzik B, Miszalski-Jamka K, Glowacki J, Lekston A, Gierlotka M, Zembala M, et al. Malignant tumors of the heart. Cancer Epidemiol. 2015 Oct;39(5):665–72.
5. Marques Mendes E, Ferreira A, Felgueiras P, Silva A, Ribeiro C, Guerra D, et al. Primary intimal sarcoma of the left atrium presenting with constitutional symptoms. Oxf Med Case Reports [Internet]. 2017 Jul 5 [cited 2020 Jul 8];2017(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497514/
6. Nguyen A, Awad WI. Cardiac Sarcoma Arising From Malignant Transformation of a Preexisting Atrial Myxoma. Ann Thorac Surg. 2016 Apr;101(4):1571–3.
7. Wang Bin, Li He, Xie Yuji, Cai Jie, Zhang Li, Li Yuman, et al. Undifferentiated Cardiac Sarcomas Originating From Malignant Transformation of Atrial Myxoma. Circulation: Cardiovascular Imaging. 2020 May 1;13(5):e010277.
8. Leduc C, Maleszewski JJ. Misconceptions About Malignant Metamorphosis in Myxoma. The Annals of Thoracic Surgery. 2016 Nov 1;102(5):1766.
9. Burke AP, Cowan D, Virmani R. Primary sarcomas of the heart. Cancer. 1992 Jan 15;69(2):387–95.
10. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. The Lancet. 1997 Dec;350(9092):1647–54.
11. Li H, Yang S, Chen H, Yang Z, Hong T, Hou Y, et al. Survival after heart transplantation for non-metastatic primary cardiac sarcoma. Journal of Cardiothoracic Surgery. 2016 Oct 3;11(1):145.