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(Circulation. 2006;113:e399-e400.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Ovarian Malignancy Presenting as Multiple Intracardiac Masses

Colin Edwards, MB, BCh, FCP(SA); William Bradlow, MB, ChB, FRACP; Graeme Taylor, MB, ChB, FRCPA; Jonathan P. Christiansen, MB, ChB, MD, FRACP

From the Cardiovascular Division (C.E., J.P.C.), North Shore Hospital, Waitemata Health, and the Cardiovascular Division (W.B.) and Histology Department (G.T.), LabPlus, Auckland City Hospital, Auckland, New Zealand.

Correspondence to Jonathan P. Christiansen, Cardiovascular Division, North Shore Hospital, Shakespeare Road, Takapuna, Auckland, New Zealand. E-mail Jonathan.Christiansen{at}WaitemataDHB.govt.nz

A 38-year-old woman with no significant previous illness presented with progressive breathlessness and abdominal distension of 6 months’ duration. Examination noted tachycardia, a blood pressure level of 100/60 mm Hg, an elevated jugular venous pressure to the angle of the mandible, a middiastolic heart sound, dullness at both lung bases, and hepatomegaly. Chest x-ray confirmed cardiomegaly and bilateral pleural effusions. Echocardiography demonstrated 6 intracardiac masses, 3 in the left atrium, 2 in the right atrium, and 1 in the apex of the right ventricle. There was obstruction to both the right and left ventricular inflows. Abdominal ultrasound revealed a small 3x2.5-cm left ovarian mass and pelvic ascites consistent with an ovarian malignancy. Whole-body computed tomography scanning noted 2 localized pleural masses but no further secondary deposits. The clinical assessment was of a primary ovarian malignancy with secondary spread to the heart and pleura. The cardiac tumors were large, well-circumscribed, and severely obstructing ventricular inflow; therefore, it was decided that they should be resected before initiation of a cisplatin-based chemotherapy regimen. Contrast-enhanced cardiac magnetic resonance imaging was performed (Figure 1) before surgery. The gross pathology and representative histology specimens are shown in Figure 2. Histological examination disclosed a sarcomatoid tumor, which demonstrated strong positivity with a cytokeratin immunostain. The appearances were consistent with a metastatic, malignant, mixed mullerian tumor. After an initial response to chemotherapy, the patient’s pelvic and cardiac diseases progressed rapidly, and she died within 3 months of the initial diagnosis.

View larger version (138K): [in this window] [in a new window]   Figure 1. Contrast-enhanced cardiac magnetic resonance imaging. A, Four-chamber cine image showing 6 intracardiac masses. Note 2 masses obstructing both the left and right ventricular inflows. B, Right ventricular long-axis cine image showing 3 masses, with a large tumor attached to the posterior right atrial wall moving into the right ventricle during diastole (arrow). C, First-pass perfusion, demonstrating no significant early contrast enhancement, and D, delayed-enhancement inversion-recovery image, illustrating a low level of delayed enhancement due to gadolinium retention within the intracardiac masses (arrows).

View larger version (152K): [in this window] [in a new window]   Figure 2. Surgical pathology specimens, illustrating the gross appearance of the masses removed from the right (A) and left (B) ventricular inflow tracts. The histological findings are displayed in C, demonstrating hematoxylin-eosin staining of tumor cells infiltrating between the myofibers and subsequent positive immunostaining for cytokeratin (D).

	Acknowledgments

 
Disclosures

None.

	Footnotes

 
The online-only Data Supplement can be found at http://circ.ahajournals.org/cgi/content/full/113/10/e399/DC1.

This Article Full Text (PDF) Data Supplement 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 Edwards, C. Articles by Christiansen, J. P. Search for Related Content PubMed PubMed Citation Articles by Edwards, C. Articles by Christiansen, J. P. Related Collections CT and MRI