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.
The online version of this article (doi:10.1186/1749-8090-5-120) contains supplementary material, which is available to authorized users.
and Zhenguang Chen contributed equally to this work.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
HL and ZC conceived the study and drafted the manuscript. YL, CS and LC managed the histopathological analysis of tumor sample and participated in the manuscript preparation. TW participated in the figure preparation. All authors read and approved the final manuscript.
Introduction
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.
Case report
A 42-year-old woman was admitted to our hospital complaining of chest pain, shortness of breath and weight loss. Physical examination revealed an extra systolic murmur at the cardiac apex, with NYHA stage III. An electrocardiogram revealed sinus bradycardia, and echocardiography showed a pedunculated mass in her left atrium with weak aortic and mitral valve insufficiency, similar to myxoma (Figure 1). Computed tomography revealed a mass, 65 × 20 × 20 mm in size and attached to the posterior wall of the left atrium, without calcification or pericardial effusion. The patient was diagnosed with a primary cardiac tumor and was referred for surgical removal of the mass. During surgery, a tumor measuring 50 × 20 × 20 mm was found, with a stalk attached to the posterior wall of the left atrium and near the orifice of the left pulmonary vein. The mass was removed and a partial endocardiectomy was performed. Pathological examination of the tumor showed that the malignant cells were irregularly osteoid without polygonal to stellate shapes. The tumor cells were strongly stained with antibodies to the osteoclast marker CD68 and vimentin, but were weakly stained with antibodies to CK, EMA, S-100, and CD34 (Figure 1). Based on these histological and immunohistochemical findings, the final diagnosis was primary cardiac osteosarcoma [1, 2]. At present, 2 years after surgical removal of the tumor, the patient remains healthy with no evidence of tumor recurrence.
×
Anzeige
Discussion
Most primary cardiac tumors are myxomas, and only a very small proportion of these cardiac tumors (< 0.28%) are malignant [3]. 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 [6]. 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.
Anzeige
Consent
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.
Acknowledgements
This study was supported by grants Key Scientific and Technological Projects of Guangdong Province (No. 2008B030301311, and 2008B030301341).
Open Access
This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License (
https://creativecommons.org/licenses/by/2.0
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
HL and ZC conceived the study and drafted the manuscript. YL, CS and LC managed the histopathological analysis of tumor sample and participated in the manuscript preparation. TW participated in the figure preparation. All authors read and approved the final manuscript.
Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.
Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.
Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.
Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.
Update Chirurgie
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.
Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.
Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.