Long term survival of patient with primary cardiac sarcoma. Cardiac magnetic resonance place for diagnosis and follow-up

Aim To present a rare case of cardiac sarcoma. Methods Clinical case of a 48-year-old female with dyspnea and palpitations over the last two months. Results Patient ECG showed left ventricular hypertrophy. Her laboratory findings: anemia and elevated LDH. Transthoracic echocardiography demonstrated large masses in the left ventricle (LV) partially obstructing LV outflow tract. Additional smaller tumor was seen left atrium. Cardiovascular magnetic resonance (CMR) was performed. Specific characteristics of masses showed a heterogeneous 71×45×21 mm tumor in the LV, isointense on non-contrast T1, hyperintense on T2, heterogeneous enhancement on LGE. The mass was partially infiltrating LV myocardium. The diagnosis of malignant cardiac sarcoma was suspected. Computed tomography (CT) of chest and abdomen was performed, there were no distant metastasis. Cytoreductive surgery was performed. Histology revealed undifferentiated pleomorphic sarcoma. Post-surgery CMR revealed remaining tumor masses in LV. Chemotherapy with Doxorubicin and Ifosfamide was initiated. Totally, 7 cycles performed. Echocardiography and CMR were performed to assess response to chemotherapy and revealed very good partial response. Repeated CT showed no metastasis. Follow up was done every 3 months with no evidence of progression. Patient is still alive with no evidence of disease progression after 13 months after diagnosis. Conclusion The diagnosis of primary cardiac tumors is frequently challenging. Echocardiography remains the first-choice imaging modality. CMR improves noninvasive characterization of cardiac masses. Extremely good response to chemotherapy granted patient prolonged survival compared with median survival only about 6 months