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(Circulation. 2000;101:2220.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Primary Cardiac Osteosarcoma in Right Ventricular Outflow Tract

Masakazu Yamagishi, MD; Ko Bando, MD; Shinichi Furuichi, MD; Hatsue Ishibashi-Ueda, MD; Chikao Yutani, MD; Kunio Miyatake, MD

From Cardiology, Division of Medicine (M.Y., S.F., K.M.), Division of Cardiovascular Surgery (K.B.), and Division of Pathology (H.I.U., C.Y.), National Cardiovascular Center, Osaka, Japan.

Correspondence to Masakazu Yamagishi, MD, FACC, Cardiology, Division of Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565, Japan. E-mail myamagi{at}hsp.ncvc.go.jp

A 30-year-old woman was referred to our clinic because of shortness of breath and general fatigue. She had been well until 2 months earlier, when she noticed mild shortness of breath during and after exercise. Physical examination revealed a systolic heart murmur at the left parasternal area. Transthoracic echocardiography demonstrated an abnormal mass located just proximal to the pulmonary valve occupying the right ventricular outflow tract (Figure 1, top left). There was a small pericardial effusion, and a flattened ventricular septum suggested elevated right ventricular pressure. The regionally magnified image indicated relatively low echogenicity within the mass (Figure 1, top right). This mass was attached to the side of the right ventricular free wall and was free from the pulmonary valve. Transesophageal echocardiography demonstrated the mass in the right ventricular outflow tract with accelerated color flow across the mass, suggesting hemodynamically significant obstruction (Figure 1, bottom). Ultrasound and radiographic examinations did not demonstrate any other primary lesions in the abdominal or genital organs. One week later, radical resection of the mass and reconstruction of the right ventricular outflow tract were performed. The tumor originated from the right ventricular outflow tract. A small part of it had extended beyond the pulmonary valve into the main pulmonary artery. The mass seemed to be a myxoma (Figure 2, left), but microscopic examination of hematoxylin-eosin–stained specimens showed a uniform population of large atypical cells with prominent nucleoli. Interestingly, there was evidence of an osteogenic sarcomatous element (Figure 2, right). Immunohistochemical stains were negative for such antigens as myoglobin, -actin, S-100, factor VIII, CD31, and CD34. Thus, the tumor was considered to be an osteosarcoma, which constitutes only 0% to 3.4% of cardiac tumors.^{1 2}

View larger version (50K): [in this window] [in a new window]   Figure 1.

View larger version (63K): [in this window] [in a new window]   Figure 2.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

References

1. Putnam JB Jr, Sweeney MS, Colon R, Lanza LA, Frazier OH, Cooley DA. Primary cardiac sarcomas. Ann Thorac Surg. 1991;51:906–910.[Abstract]

2. Burke A, Virmani R. Primary cardiac sarcomas. In: Atlas of Tumor Pathology: Tumors of the Heart and Great Vessels. Washington, DC: Armed Forces Institute of Pathology; 1996:127–170.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yamagishi, M. Articles by Miyatake, K. Search for Related Content PubMed PubMed Citation Articles by Yamagishi, M. Articles by Miyatake, K. Related Collections Other etiology Other Treatment Echocardiography CV surgery: other