Research Article

Propose a Case of Cardiac Osteosarcoma Primary-Results and Review of Literature

Nguyen Huu Uoc, Phung Duy Hong Son*, Hoang Trong Hai, Nguyen Sy Lanh, Nong Bich Hong

Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi Medical University, Hanoi, Vietnam

*Corresponding author: Phung Duy Hong Son, Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi Medical University, Hanoi, Vietnam

Received Date: 13 June 2023

Accepted Date: 17 June 2023

Published Date: 20 June 2023

Citation: Uoc NH, Son PDH, Hai HT, Lanh NS, Hong NB (2023) Propose a Case of Cardiac Osteosarcoma Primary-Results and Review of Literature. Ann Case Report. 8: 1350. https://doi.org/10.29011/2574-7754.101350

Abstract

Overview: Primary cardiac osteosarcoma, a bone connective tissue cancer, is a rare form of heart cancer. In the literature, there are few reports of primary osteosarcoma. Herein, we report a rare clinical case of primary cardiac osteosarcoma. A 71-yearold male patient was admitted to the hospital with symptoms of dyspnea, echocardiography revealed a tumor in the left atrium verified as an osteosarcoma following biopsy. After surgery, the patient self-treated with traditional medicine but relapsed and passed after 20 months.

Research Methods: Based on a clinical case at Viet Duc University Hospital, we reviewed the literature to describe the pathology and discuss treatment methods.

Conclusion: Primary cardiac sarcoma is rare, treated with surgical resection and adjuvant chemotherapy, has high recurrence rate, and continue to maintain a poor survival prognosis.

Keywords: Cardiac tumor primary, Osteosarcoma.

Introduction

Primary cardiac tumors are rare and, according to Butany in the treatment of cardiac sarcoma. If the tumor is localized to et al., the incidence is 0.001 - 0.030 % 1. About 75% of primary the heart, treatment with heart transplantation has been shown cardiac tumors are benign, including myxoma, lipoma, papillary to provide long survival in some patients with little evidence of fibroelastoma and rhabdomyoma. Myxomas are predominant. recurrence observed despite immunosuppression. However, the Malignant heart tumors are usually derived from metastases prognosis of primary cardiac sarcoma is generally poor. Median elsewhere in the body. Among primary malignancies, sarcomas survival in patients with cardiac sarcoma has been reported to be are the predominant cancer. Currently, only a few hundred cases of approximately 11 months on average. In patients with primary cardiac sarcomas have been reported in the literature. Angiosarcoma cardiac sarcoma, complete resection of the tumor is recognized and myxofibrosarcoma are the most common types of cardiac as the most effective and mainstay treatment to prolong survival. tumors with osteosarcomas being rare. Primary myocardial In this study, we report a case wherein after surgical treatment of sarcoma may occur at any age but is more common during middle the primary cardiac osteosarcoma, the patient relapsed and died 20 age. The clinical presentation of patients with cardiac sarcoma months after surgery. In this study, we review the literature from depends on the size and location of the tumor. Patients often have which to make recommendations on management and treatment of dyspnea alongside other symptoms due to embolism, pericardial cardiac osteosarcomas.

Research Methods

Clinical case description at Viet Duc University Hospital in August 2021 with follow-up after 20 months in April 2023 and retrospective literature review on pathological descriptions and treatment of cardiac osteosarcomas.

Clinical Case

We describe a case of a 71-year-old male patient with no previous history of cardiovascular disease or chronic disease. The patient’s primary occupation is that of a rural farmer. A week before admission, the patient appeared to have dyspnea and chest tightness. He was referred to Viet Duc University Hospital wherein a large tumor was discovered in the left atrium. Clinical examination revealed NYHA class II dyspnea, regular heart rate, and no abnormal murmurs. Echocardiography: detected in the left atrium a mass of 3.16 x 4.16 cm in size attached to the atrial septum causing moderate stenosis of the mitral valve (Figure 1). Cardiac multi-slice computed tomography showed a mass occupying most of the left atrium and part of the left ventricle measuring 80x39 mm with lack of enhancement after injection (Figure 2). Electrocardiogram: sinus rhythm 100 beats per minute, regular, normal axis.


Figure 1: Echocardiography.


Figure 2: Computer Tomography tumor in the left atrial.

After diagnosing left atrial tumor with mitral valve obstruction, we decided to pursue surgical removal of the tumor. The operation consisted of a midsternal chest cavity exposure and extracorporeal bypass circulation with 2 IV cannulas. We chose the incisions through the right atrium and the atrial septum to access the tumor. The tumor filled the left atrium and the atrial wall showed scattered infiltrates in biopsy. The tumor was completely resected via cauterization of the tumor’s stem. Moreover, we found the mitral valve to be hypertrophied with anterior prolapse in the A2 region (according to Carpentier), resulting in mitral regurgitation and a deformed annulus via a nodule on the anterior leaflet. We remove the nodule and placed a mitral valve ring. Biopsy confirmed the osteosarcoma (Figure 3). Extracorporeal circulation was 150 minutes. Aortic clamp time was 100 minutes. The patient was extubated after 5 hours.


Figure 3: Pathology of the Osteosarcoma, A. Macroscopic imaging of tumor organization shows heterogeneous colorization and density with pinkish-white regions with unclear borders for myocardial organization. B. HE x 100. Two interstitial components consisting of spindle cells, and neoplastic cells alternates within the hyaline and chondrocyte matrix. C. HE x 400. Tumor infiltration into the bone matrix with calcium deposition. Neoplastic cells are polymorphic and mitotic. D. HE x 400. Large necrotic neoplastic area alongside tumor infiltrate of the bone matrix.


Figure 4: Post-operative echocardiography (no mass in atrial, mild mitral regurgitation).

To identify additional sites of metastases, we performed PETCT, which did not show further observable malignancies. After the patient was stable, clinical examination and echocardiography showed no abnormal results (Figure 4). The patient was then sent further evaluated for adjuvant treatment. However, the patient did not receive any adjuvant chemotherapy, the patient’s family used unproven oriental medicine wherein he returned to our hospital for follow-up in March 2023. He reported with symptoms of dyspnea, lethargy, and diminished appetite. Echocardiography revealed a recurrence of a mass in the left atrium (Figure 5).