Malignant spindle cell cardiac tumour: one of the rarest of rare cardiac tumour

Excerpt

A previously healthy 32-year-old lady sought medical attention for 2 months and she had a history of class II dyspnoea and palpitation. On physical examination she had sinus tachycardia with a heart rate of 124 bpm, and blood pressure was 110/74 mm Hg. Systemic cardiovascular examination was unremarkable. Chest X-ray showed cardiomegaly. Her two-dimensional echocardiography in four chamber view showed 80 × 90 mm echogenic mass lesion in pericardial cavity with pericardial effusion (Fig. 1a; Supplementary Material Video 1). Short axis view showed 3 × 3 mm-sized echogenic mass lesion at confluence of pulmonary artery with extension on lateral aspect of left pulmonary artery without any Doppler evidence of pulmonary stenosis (Fig. 1b; Supplementary Material Video 2). Cardiac MRI showed abnormal signal intensity lesion on anterosuperior aspect of left ventricle and to the left of main pulmonary trunk, the lesion was iso to hypo intense on T1 weighted image and hyper-intense on T2 weighted image (Fig. 1c, d). Based on imaging characteristics, our differential diagnoses were haemangioma, rhabdomyosarcoma and malignant spindle cell tumour. Mass was resected surgically from its attachment site on the main pulmonary artery and sent for histo-pathological examination (Fig. 1e). High magnification section revealed high-grade spindle cell tumour, showing variable myxoid and collagenous stroma (Fig. 1f). Her postoperative course was uneventful and she was discharged on 7th post-op day with stable haemodynamics.

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