Primary cardiac osteosarcoma in a 42-year-old woman
- Honghe Luo1,
- Yiyan Lei1,
- Chunhua Su1,
- Lie Cai2,
- Tao Wang3,
- Jianyong Zou1 and
- Zhenguang Chen†1Email author
© Luo et al; licensee BioMed Central Ltd. 2010
Received: 21 July 2010
Accepted: 27 November 2010
Published: 27 November 2010
We describe here a 42-year-old woman who was admitted to hospital with a pedunculated mass in her left atrium. She was diagnosed with a primary cardiac osteosarcoma with special immunohistochemical characteristics. Echocardiography and computed tomography can be used to differentiate cardiac osteosarcomas from routine intracardiac tumors. The patient was treated by surgical removal of the mass. Two years later, she has shown no evidence of disease recurrence. We discuss primary osteosarcomas in the cardiac cavity and their management.
Although osteosarcoma is a common tumor of the skeletal system, primary cardiac osteosarcoma is an extremely rare malignant disease with nonspecific symptoms, making early diagnosis a challenge. We describe here a 42-year-old woman with a primary cardiac osteosarcoma, which was surgically removed by cardiopulmonary bypass. Two years later, she has shown no evidence of tumor recurrence.
Most primary cardiac tumors are myxomas, and only a very small proportion of these cardiac tumors (< 0.28%) are malignant . Only a few isolated cases of primary cardiac osteosarcoma have been reported, making the etiology of these tumors unclear [1–5]. To our knowledge, therefore, primary cardiac osteosarcomas are rare and difficult to diagnose.
The symptoms of primary cardiac osteosarcoma have been described as protean, with obstruction and heart failure being the primary manifestations [1, 3]. On echocardiography, cardiac osteosarcomas often show asymmetrical internal echoes, and computed tomography has shown the calcification of cardiac osteosarcomas. Certain features (e.g., a broad base of attachment or origin at a site other than the atrial septum) help differentiate these tumors from left atrial myxomas . However, the tumor in our patient presented as a soft symmetrical parenchymal tumor, the presence of calcification did not seem useful in differentiating atrial osteosarcoma from myxoma.
Cardiopulmonary bypass is essential for removing the primary cardiac osteosarcoma. We chose a right angle type superior vena cava tube to avoid crushing the tumor in our patient. The mass was removed, along with at least 5 mm of the surrounding endocardium. Because of the risks of tumor fragmentation and embolization, vigorous manipulation should be avoided during surgical treatment.
In brief, we have shown that, although rare, primary cardiac osteosarcoma should be included in the differential diagnosis of patients with neoplasms in the cardiac cavity.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
This study was supported by grants Key Scientific and Technological Projects of Guangdong Province (No. 2008B030301311, and 2008B030301341).
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