case_images: PMC11790478_01
case_images: (A) Echocardiographic findings: A mass measuring approximately 69 mm x 41 mm was identified in the anterior wall of the left atrium. (B) Cardiac MRI scan findings: abnormal signals in the posterior wall of the left atrium. (C, D) Mediastinal CT scan findings: the posterior wall of the left atrium and the posterior esophagus were thickened. The gap between the esophagus and the left atrium disappeared, and tumor cell infiltration of the esophagus was considered.
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case_images: The mass had an irregular shape with uneven internal echogenicity and was partially protruding into the left ventricle near the mitral valve ( Figure 1A ). However, on January 25, 2024, cardiac MRI revealed abnormal signals in the posterior wall of the left atrium, raising concerns of tumor recurrence ( Figure 1B ). Mediastinal CT showed that after left atrial surgery, the posterior wall of the left atrium and the posterior esophagus were thickened ( Figures 1C, D ).
case_images: (A-G) Immunohistochemistry of the left atrium mass. (A) CK (focal +). (B) SMA (focal +). (C) Desmin (focal +). (D) CD34 (vascular +). (E) Ki67-MIB1 (50%). (F) Vimentin (+). (G) CD68 (+).
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case_images: The postoperative immunohistochemical analysis revealed the following results: CK (focal +), SMA (focal +), Desmin (focal +), S-100 (-), SOX 10 (-), CD34 (vascular +), Ki67-MIB1 (50%), Vimentin (+), MyoD1 (-), Myogenin (-), CD68 (+). ( Figures 2A-G ), confirmed that the tumor was consistent with cardiac sarcoma, undifferentiated sarcoma.
case_images: (A) Endoscopy reveals an esophagus ulcer covered with white exudate, narrowing of the lumen. (B) Endoscopy reveals an esophagus ulcer. (C, D) Esophagus stent implantation.
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case_images: Gastroscopy indicated that the distance between the esophagus and the incisor was approximately 28 cm, revealing an esophagus ulcer covered with white exudate, narrowing of the lumen, and obstruction preventing endoscopic passage ( Figure 3A ). On August 8, 2024, follow-up gastroscopy demonstrated an esophagus ulcer located about 30 cm from the incisor, consistent with an inability to pass the endoscope ( Figure 3B ). For treatment, a multidisciplinary team, including oncologists and gastroenterologists, recommended esophagus stent implantation, which was successfully performed on August 28, 2024 ( Figures 3C, D ).
case_images: (A, B) A 18F-FDG-PET-CT scan: Hypermetabolic lesion in the left atrium wall and esophagus.
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case_images: PET-CT revealed thickening of the left atrial wall and the esophagus wall, with increased FDG metabolism ( Figures 4A, B ).