case_images: PMC10655095_01
case_images: Preoperative echocardiography, cardiac CT and MRI. Echocardiography (A) showed multiple mixed echogenic masses on the lateral wall of the right atrium; CT scan (B-D) showed a giant cardiac mass with the invasion of the RA and SVC; MRI (E) indicated that the mass attached to the wall of RA with unclear boundary. AO, ascending aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; SVC, superior vena cava.
case_images: fcvm-10-1279177-g001.jpg
case_images: PMC10655095_01_fcvm-10-1279177-g001.jpg
case_images: F1
case_images: Preoperative echocardiography indicated an enlarged heart shadow, delineating multiple masses of uncertain nature in the right atrium, including a minor pericardial effusion (Figure 1A). The cardiac CT highlighted a right atrium lesion with superior vena cava invasion (Figures 1B-D). The cardiac MRA was performed and depicted an occupying lesion in the right atrium, signifying a high likelihood of a malignant tumor (Figure 1E). A giant mass was observed extent encompassing from the right atrial appendage and the superior vena cava, to the right atrioventricular sulcus, the posterior atrial wall, and approximately 2 cm downward from the inferior vena cava opening (Figure 2A, Supplementary Video S1). An incision was made in the right atrium, facilitating the removal of the mass and the invaded right atrial wall (Figure 2B, Supplementary Video S1).
case_images: Intraoperative view showing a giant mass located in the RA, SVC and pera-AO (A), infiltrating the wall of RA and SVC (B); after totally removal, the mass was measured approximately 5 cm x 5 cm x 4 cm, exhibited parenchymal characteristics, a firm consistency, dark red coloration, and an uneven surface (C,D). AO, ascending aorta; RV, right ventricle; SVC, superior vena cava.
case_images: fcvm-10-1279177-g002.jpg
case_images: PMC10655095_01_fcvm-10-1279177-g002.jpg
case_images: F2
case_images: A giant mass was observed extent encompassing from the right atrial appendage and the superior vena cava, to the right atrioventricular sulcus, the posterior atrial wall, and approximately 2 cm downward from the inferior vena cava opening (Figure 2A, Supplementary Video S1). An incision was made in the right atrium, facilitating the removal of the mass and the invaded right atrial wall (Figure 2B, Supplementary Video S1). The mass, measuring approximately 5 cm x 5 cm x 4 cm, exhibited parenchymal characteristics, a firm consistency, dark red coloration, and an uneven surface (Figures 2C,D).
case_images: Histology and immunohistochemistry of the masses. Malignant tumor derived from mesenchymal tissue, with obvious cell atypia, many mitoses, large areas of hemorrhage and necrosis, rich blood vessels, invasion of surrounding muscle tissue with HE staining (A,B); immunohistochemical support for angiosarcoma with positive of CD34 (C), ERG (D), et al. 100x for panel A, C and D; 40x for panel B.
case_images: fcvm-10-1279177-g003.jpg
case_images: PMC10655095_01_fcvm-10-1279177-g003.jpg
case_images: F3
case_images: The pathology postoperatively from both the right atrium and para-aorta were detected similar and revealed that the grayish-red solid mass featured a 2.5 cm x 2 cm x 1.5 cm size portion showcasing pronounced cellular heterogeneity, conspicuous nuclear divisions, extensive hemorrhagic necrosis, and abundant blood vessels (Figures 3A,B). P16 (focal+), and CD10 (-) were documented (Figures 3C,D). Post-surgery, the patient's stay in the intensive care unit spanned 18.5 h and discharge on the 12th day with the recommendation of transferred to the oncology department and subsequently underwent conventional and experimental chemoradiotherapy for angiosarcoma [stereotactic radiotherapy and weekly paclitaxel (80-100 mg/m2) for 6 cycles].
case_images: Postoperative echocardiography showed that the right atrial mass was totally resected (A), no hemodynamic abnormality (B) and no recurrence signals.
case_images: fcvm-10-1279177-g004.jpg
case_images: PMC10655095_01_fcvm-10-1279177-g004.jpg
case_images: F4
case_images: The postoperative echocardiography revealed that the right atrial mass was totally resected, no hemodynamic abnormality and no recurrence signals (Figures 4A,B).