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Eur Heart J Case Rep
Eur Heart J Case Rep
ehjcr
European Heart Journal. Case Reports
2514-2119
Oxford University Press UK

10.1093/ehjcr/ytae477
ytae477
Cardiovascular Flashlight
AcademicSubjects/MED00200
Eurheartj/31
Eurheartj/35
Eurheartj/32
Eurheartj/38
Eurheartj/39
Eurheartj/40
Intimal cardiac sarcoma
https://orcid.org/0000-0002-6846-8254
Diop Sylvain Department of Anesthesiology, Centre Chirurgical Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, 92350 Le Plessis-Robinson, France

Thomas De Montpreville Vincent Department of Pathology, Centre Chirurgical Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Le Plessis-Robinson, France

Guihaire Julien Department of Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Le Plessis-Robinson, France

Tini Melato Giacomo Handling Editor
Corresponding author. Tel: +33140948637, Email: menes.diop@gmail.com
Conflict of interest: None declared.

9 2024
03 9 2024
03 9 2024
8 9 ytae47716 7 2024
08 8 2024
21 8 2024
17 9 2024
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
2024
https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmc

A 72-year-old woman without previous medical history was admitted to intensive care unit for acute onset of a New York Heart Association Class III dyspnoea with orthopnoea, heart palpitations, and crepitant rales consistent with the diagnosis of acute pulmonary oedema. Electrocardiogram showed atrial fibrillation at 130 b.p.m., and echocardiography revealed a large heterogeneous spherical mass into the left atrium protruding into the ventricle at each diastole and leading to the mechanical obstruction of the left ventricle filling (Panel A; see Supplementary material online, Video S1). Chest computed tomography scan imaging showed a 7 cm intra-atrial mass invading the left upper pulmonary vein, the pericardium, and the left pleura (Panel B). A diagnosis of an invasive malignant tumour was suspected. There was no evidence of distant metastases. A salvage open-heart surgery was decided to remove the intra-cardiac obstructive mass. Surgical examination under cardiopulmonary bypass revealed a solid tumour coming from the left upper pulmonary vein with an extravascular extension on the left atrial roof and on the left atrioventricular groove. The resection of the intra-cardiac mass was performed (Panel C). The proximal part of the tumour coming from the left upper pulmonary vein could not be removed due to major adhesions and extravascular invasion. Histologic analysis displayed typical spindle and pleomorphic cell sarcoma (Panel D; hematoxyline-eosine-safran coloration, 20-fold magnification). Immunohistochemical analysis showed an overexpression of murine double minute 2, which is a characteristic of intimal cardiac sarcoma (Panel E; brown nuclei, 20-fold magnification), an extremely rare type of aggressive sarcoma associated with very poor outcomes. Post-operative course was uneventful, and the patient was referred to an oncology specialist for initiation of adjuvant chemotherapy few weeks later.

Supplementary Material

ytae477_Supplementary_Data

Supplementary material

Supplementary material is available at European Heart Journal – Case Reports online.

Consent: Written informed consent was obtained from the patient before submitting the manuscript.

Funding: None declared.

Data availability

Not applicable.
