Cardiac Angiosarcoma Diagnosed by Transvenous Endomyocardial Biopsy With the Aid of Transesophageal Echocardiography and Intra-Procedural Consultation

Abstract

SummaryWe report a case who had confirmed tumor cells in the biopsy specimens by transvenous endomyocardial biopsy with intra-procedural consultation and fast smear cytology. A 57-year-old female was admitted to our hospital because of shortness of breath and left back pain. Transthoracic echocardiography (TTE) and contrast-enhanced computed tomography (CT) scans demonstrated a large mass in the right atrium and multiple liver tumors thought to be due to spread of the disease. Coronary angiography showed the right coronary artery was involved in the mass. In order to confirm the histological diagnosis, we attempted transvenous endomyocardial tumor biopsy under fluoroscopic guidance. However, we failed to obtain adequate tissue material. Due to several risks associated with a surgical procedure such as an open surgical biopsy, transvenous endomyocardial tumor biopsy was again attempted with the aid of transesophageal echocardiography (TEE). Intra-procedural consultation and fast smear cytology enabled us to finish the procedure. Hematoxylineosin stained sections demonstrated spindle-shaped cells. Immunohistochemical stains of these cells were positive for anti-factor VIII antigen, CD31, and CD34. These findings indicated a definite diagnosis of angiosarcoma. Since there was no surgical indication for this tumor, the patient underwent chemotherapy with docetaxel and radiotherapy. Three months later, CT scans showed a reduction in the size of the cardiac tumor. (Int Heart J 2010; 51: 367-369) Key words: Primary cardiac angiosarcoma, Transvenous endomyocardial biopsy, Transesophageal echocardiography, Intra-procedural consultation, Smear cytology P rimary cardiac tumors are extremely rare and difficult to diagnose. A final diagnosis depends on histopathological confirmation. At the time of discovery, up to 75% have systemic metastases 1) and the effect of surgical resection is only temporary, 2) and hence the prognosis is relatively poor. A pathological diagnosis with cardiac biopsy is established antemorten in only 50% of patients.3) The specimen material is usually obtained by open biopsy or surgical resection. There have been reports of transvenous biopsy for cardiac tumors under transesophageal echocardiography (TEE) guidance, 4-7) although sometimes specimen material is not successfully obtained. 8) Case ReportA 57-year-old woman was admitted to our hospital because of shortness of breath and left back pain. She had been healthy previously without recent chest pain or pyrexia, and she denied any exposure to vinyl chloride. On physical examination, her heart rate was 94/minute, blood pressure was 90/54 mmHg, and SpO 2 was 98% with a 10 L/minute O 2 . Jugular vein dilatation and hepatomegaly were detected. Neither heart murmur nor lung rales were detected. The electrocardiogram showed sinus tachycardia (94 beats/minute), low voltage in limb leads, and a QS pattern in V 1 and V 2 leads. Chest X-rays revealed cardiomegaly and bilateral pleural effusion. Transthoracic echocardiography (TTE) showed reasonable left ve...

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