Dramatic Presentation of Cardiac Pleomorphic Liposarcoma

HomeCirculation: Cardiovascular ImagingVol. 14, No. 8Dramatic Presentation of Cardiac Pleomorphic Liposarcoma Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toSupplementary MaterialsFree ReportPDF/EPUBDramatic Nicholas Y. Tan, MD, MS, Maria Najam, MBBS, Melissa A. Lyle, Joseph J. Maleszewski, Jeremy D. Collins, MD and Kyle W. Klarich, TanNicholas Tan https://orcid.org/0000-0002-0365-9471 Department Medicine (N.Y.T., M.N., K.W.K.), Mayo Clinic, Rochester, MN. Search for more papers by this author , NajamMaria Najam https://orcid.org/0000-0003-4339-3396 LyleMelissa Lyle Medicine, Jacksonville, FL (M.A.L.). MaleszewskiJoseph Maleszewski https://orcid.org/0000-0003-3239-6460 Laboratory Pathology (J.J.M.), CollinsJeremy Collins https://orcid.org/0000-0003-0707-1736 Radiology (J.D.C.), KlarichKyle Klarich Correspondence to: Clinic College 200 1st St Southwest, MN 55905. Email E-mail Address: [email protected] Originally published13 Aug 2021https://doi.org/10.1161/CIRCIMAGING.121.012620Circulation: Imaging. 2021;14:e012620Other version(s) articleYou are viewing the most recent version article. Previous versions: August 13, 2021: Ahead Print A 45-year-old man Moroccan descent with no significant cardiovascular history presented dyspnea, chest pain, night sweats, weight loss, fatigue ≈1 year. Transthoracic echocardiogram showed a 42 32 millimeter mass within right atrium; appeared attached septal leaflet tricuspid valve extending fill coronary sinus (Figure 1, left). Additionally, interventricular septum was markedly thickened enhanced significantly microbubble administration right). Movies I through IV in Data Supplement provide additional visualization these findings. magnetic resonance imaging (cMRI) performed, revealing 5.7 cm extension into inferior lateral walls left ventricle, wall pericardium avid enhancement on first-pass perfusion delayed consistent solid, likely malignant mass. cMRI redemonstrated abutting annulus small circumferential pericardial effusion (Figures 2 4; V VI Supplement). The lesion associated demonstrated different signal characteristics than (no low imaging), overall suggestive thrombus.Download figureDownload PowerPointFigure 1. still images. Left: Right ventricular inflow view demonstrating atrium. Right: Apical 4-chamber myocardial contrast administration. There is minimal atrial mass; however, thick agent.Download 2. performed at 1.5T. Balanced steady-state free precession images horizonal long axis orientation masses diastole (left) systole (right).Download 3. First-pass cardiac 1.5T following 0.05 mmol/kg Gadobutrol (Gadavist, Bayer) masses. demonstrates reduced compared adjacent myocardium soft tissue does not enhance favoring benign cause.Download 4. Segmented, breath-held late gadolinium 1.5 phase sensitive inversion recovery gradient echocardiography pulse sequence. time optimized null magnitude imaging. Magnitude (top left) (lower corresponding (right). characteristic peripheral dark loss centrally thrombus. retention both reconstructions mass.Follow-up fluorodeoxyglucose positron emission tomography large foci intense activity, centered atrium distal septum, primary malignancy. Fluorodeoxyglucose uptake throughout also supportive malignancy involvement rather thrombus 5). evidence distant metastatic disease. percutaneous transpericardial biopsy subsequently pathology revealed high-grade sarcoma pleomorphic features liposarcoma 6).Download 5. (FDG) tomography/computed Two FDG activity correspond towards apex heart Maximum standardized values were 13.8 11.4, respectively.Download 6. liposarcoma. biopsied (A) proliferation highly atypical cells myxoid stroma (hematoxylin & eosin stain, original magnification, ×200) (B) scattered lipoblasts ×400).Multidisciplinary discussions conducted between Cardiology, Surgery, Oncology teams. Surgical resection thought be feasible option given its extensive involvement. Hence, decision made proceed chemoradiation therapy. He received cycles doxorubicin ifosfamide along 6250 cGy (in 25 fractions) radiation treatment. placed anticoagulation due suspicion superimposed Follow-up 6 months postchemoradiation decrease size alongside decreased sizes patient continued experience anxiety from his malignancy, but longer had pain or exertional dyspnea. 12 after diagnosis reduction lesions 7 9; VII VIII Supplement); unfortunately, he developed back found have T10 region requiring spinal surgery. On 18-month follow-up cMRI, new 20 mm enhancing nodule noted, suspicious metastasis 10; Movie IX Supplement).Download 7. One-year balanced cine horizontal orientation. diastole. systole. Both pretreatment study.Download 8. Following 0.5 mmol gadobutrol early (right) again relative hypoenhancement myocardium.Download 9. image. Single-shot image focusing predominantly chronic Segmented persistent abnormal known mass.Download 10. Eighteen-month basal inferolateral wall. isointensity (upper left), mild hyperintensity blood half fourier single-shot turbo spin proton density weighting right), postcontrast T1 weighted fat suppression using point Dixon method conventional segmented recalled Diffuse thickening noted as well lower images.Less 10% tumors reported malignant.1 Liposarcoma, one morphological types sarcoma, categorized pleomorphic, well-differentiated/undifferentiated, myxoid, respectively. Given rarity neoplasms, high index needed initially. before often difficult overlapping clinical symptoms other diseases, such failure valvular stenosis. Also, it crucial make clear distinction neoplasms thrombus, embolic complications caused Echocardiography used initially identify characterize intracardiac However, modalities valuable information help distinguish Certain (eg, thrombus) appearances cMRI.2 When nonspecific identified, suspected following: >1 chamber; presence effusion; multiple lesions; fully attachment. In case, pointed cause. Ultimately, definitively establish diagnosis.In regards specifically, there histological that correlate biological functionality. Well-differentiated less potential. contrast, round cell show potential local destruction tissue.3 Our patient’s which carries poor prognosis.From management standpoint, sarcomas induce tissues makes selection treatment modality challenging. tumor may curative if absent, recurrence postsurgical mortality rate.4 precluded wide extent invasion. Chemotherapy therapy, described report, well, although type duration course currently well-defined.In summary, we highlight key findings striking presentation Despite disease, able receive afforded him prolonged period survival exceeded our initial expectations. hope highlighted current report will aid providers recognition surveillance rare deadly disease.Nonstandard Abbreviations AcronymscMRIcardiac imagingSources FundingDr receives stipend Heart Rhythm Society (Wilton Webster Research Fellowship Award Clinical Catheter Ablation). Dr research funding National Institutes Health (R01-CA233878-01, R01-HL151079-01).Disclosures reports stock ownership controlling interest privately held health care consulting company (CETA, LLC; Chicago, IL). authors conflicts.FootnotesThe available https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.121.012620.For Sources Funding Disclosures, see page 835.Correspondence klarich.[email protected]eduReferences1. JJ, Anavekar NS, Moynihan TJ, KW. Pathology, imaging, tumours.Nat Rev Cardiol. 2017; 14:536–549. doi: 10.1038/nrcardio.2017.47CrossrefMedlineGoogle Scholar2. Motwani M, Kidambi A, Herzog BA, Uddin Greenwood JP, Plein S. MR masses: review methods applications.Radiology. 2013; 268:26–43. 10.1148/radiol.13121239CrossrefMedlineGoogle Scholar3. Ghadimi MP, Liu P, Peng T, Bolshakov S, Young ED, Torres KE, Colombo C, Hoffman Broccoli D, Hornick JL, et al.. liposarcoma: observations molecular variables.Cancer. 2011; 117:5359–5369. 10.1002/cncr.26195CrossrefMedlineGoogle Scholar4. Ramlawi B, Leja MJ, Abu Saleh WK, Al Jabbari O, Benjamin R, Ravi V, Shapira OM, Blackmon SH, Bruckner Reardon MJ. sarcomas: single-institution experience.Ann Thorac Surg. 2016; 101:698–702. 10.1016/j.athoracsur.2015.07.087CrossrefMedlineGoogle Scholar Back top Next FiguresReferencesRelatedDetails 2021Vol Issue 8Article InformationMetrics © 2021 American Association, Inc.https://doi.org/10.1161/CIRCIMAGING.121.012620PMID: 34387092 publishedAugust Keywordsheart neoplasmsliposarcomacardiac techniquesPDF download Advertisement SubjectsCardio-OncologyEchocardiographyMagnetic Resonance Imaging (MRI)