case_images: PMC9897718_01
case_images: Cardiac magnetic resonance images of cardiac sarcoma. Top panels show steady-state free precession gradient echo images, and bottom panels show spin echo images of a large mass in the right atrium extending to the tricuspid valve apparatus and right ventricular inflow (yellow arrows; A1 and B1 four-chamber view, A2 and B2 short axis view, A3 and B3 coronal view). Red arrows show lung masses.
case_images: cureus-0015-00000033367-i01.jpg
case_images: PMC9897718_01_cureus-0015-00000033367-i01.jpg
case_images: FIG1
case_images: A cardiac magnetic resonance imaging (MRI) was performed for better visualization, which revealed a large 7.8 cm x 3.6 cm irregularly shaped mass in the inferior right atrium adjacent to the inferior vena cava and extending to the interatrial septum (Figure 1).
case_images: Hematoxylin and eosin (H&E) stains of the pathology sample. Panel A: H&E stain shows malignant spindle cell neoplasm with vague storiform pattern, original magnification x10.. Panel B: H&E stain shows malignant spindle cells with marked pleomorphism, atypical mitotic figure, and focal necrosis, original magnification x40.. Histopathologically, the right atrial mass of the heart showed poorly differentiated malignant neoplasm composed of predominantly spindle cells with marked pleomorphism in a vague storiform pattern. In addition, frequent atypical mitotic figures and focal necrosis were present. Immunohistochemistry demonstrated that the malignant cells are negative for CK Oscar, SOX10, Melan-A, HMB45, S100, CD31, ERG, Desmin, smooth muscle myosin heavy chain, and myogenin. The malignant cells are positive for Vimentin and SMA (focal), considered non-specific. Overall, the findings are consistent with spindle cell sarcoma, high grade, not further classifiable.
case_images: cureus-0015-00000033367-i02.jpg
case_images: PMC9897718_01_cureus-0015-00000033367-i02.jpg
case_images: FIG2
case_images: He underwent open heart surgery in October 2020, and pathology showed high-grade spindle cell sarcoma (Figure 2).
case_images: PMC9897718_02
case_images: Cardiac magnetic resonance imaging. Panel A: Steady-state free precession (SSFP) gradient echo image shows a bulging mass in the mid-lateral wall of the left ventricle.. Panels B-D: T1 and T2 MyoMaps show increased native T1 and T2 relaxation times with late gadolinium (Gad) enhancement, suggesting increased extracellular space and edema in the mass.. LV - left ventricle, RV - right ventricle, LA - left atrium, RA - right atrium
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case_images: PMC9897718_02_cureus-0015-00000033367-i03.jpg
case_images: FIG3
case_images: MRI of the brain showed a 3 mm area of enhancement in the right centrum semiovale concerning metastatic lesion, but it self-resolved on subsequent imaging (Figure 3).
case_images: Hematoxylin and eosin (H&E) staining of the pathology sample. Panel A: H&E stain shows diffuse sheets of malignant cells with scant cytoplasm, finely granular nuclear chromatin, inconspicuous nucleoli, focal crush artifact, and frequent mitoses, original magnification x10 (A1) and original magnification x40 (A2).. Panel B: Malignant cells are strongly positive for Synaptophysin immunostaining, original magnification x10 (B1), and CK Oscar, original magnification x10 (B2).
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case_images: PMC9897718_02_cureus-0015-00000033367-i04.jpg
case_images: FIG4
case_images: The tumor was positive for CK-OSCAR, chromogranin, and synaptophysin (Figure 4).