Multiple skeletal muscle metastases revealing a cardiac intimal sarcoma

Abstract

We report the case of a 59-year-old female with progressive bilateral painful swelling of the thighs. MRI revealed multiple intramuscular necrotic masses with similar morphologic patterns. Whole-body CT and 18-FDG PET-CT scans demonstrated additional hypermetabolic muscular masses and a lobulated lesion within the left atrial cavity. As biopsy of a muscular mass was compatible with a poorly differentiated sarcoma with MDM2 oncogene amplification, two diagnoses were discussed: a dedifferentiated liposarcoma with muscle and heart metastases or a primary cardiac sarcoma, mainly a cardiac intimal sarcoma, with muscular metastases, which was finally confirmed by array-comparative genomic hybridization (aCGH) in a sarcoma reference center. This case emphasizes the potential for intimal sarcoma to disseminate in skeletal muscle prior to any other organ and the need for a genomic approach in addition to classical radiopathologic analyses to distinguish primary from secondary locations facing simultaneous tumors of the heart and skeletal muscles with MDM2 amplification.

<p>Identification Of Actionable Genetic Targets In Primary Cardiac Sarcomas</p>

“…In addition, we detected a small segment 12q gain (4 copies) containing CDK4 gene and a nearby 9 copies-amplification containing MDM2 gene. Our results further support previous findings in an oral inflammatory myofibroblastic tumor23 and in two primary cardiac tumors24,25 and provide a rationale for applying precision medicine approaches to these types of tumors with TP53 therapy (PRIMA-1 or MDM2 inhibitors) and CDK4 inhibitors such as palbociclib. The neoplastic nature of inflammatory myofibroblastic tumors and the possible relation with inflammatory events are still debated: some exceptional spontaneous or steroid-induced regression has been described,26 but surgical resection remains the treatment of choice.…”

18F-FDG-PET/CT imaging in cardiac tumors: illustrative clinical cases and review of the literature

“…Scattered case reports in literature describe how integrated PET/CT with FDG imaging can incidentally show cardiac neoplasia, particularly metastatic involvement, 11 – 17 or may be used in case of suspected aggressive cardiac malignancy to strengthen the diagnosis and detect possible occult distant disease. 18 – 26 …”

“…Findings suggestive of a malignant cardiac tumor at MRI include: right atrial location; involvement of more than one cardiac chamber, size > 5 cm, hemorrhagic pericardial effusion, broad base of attachment, extension into the mediastinum or great vessels and a 'moderate,' 'strong,' or heterogeneous delayed enhancement pattern. 10 18 F-fluorodeoxyglucose positron emission tomography/computed tomography Scattered case reports in literature describe how integrated PET/CT with FDG imaging can incidentally show cardiac neoplasia, particularly metastatic involvement, [11][12][13][14][15][16][17] or may be used in case of suspected aggressive cardiac malignancy to strengthen the diagnosis and detect possible occult distant disease. [18][19][20][21][22][23][24][25][26] However, unlike many other solid tumors, FDG PET does not have an established role in the routine evaluation of cardiac tumors, which is probably due both to their low frequency and to the physiologically high uptake of FDG in the myocardium, although with interindividual and intraindividual variability.…”

Skeletal muscle metastases of hepatocellular carcinoma: A case report and literature review

“…Liver transplantation offers the advantage of radical treatment for HCC, as it can remove the tumor and restore normal liver function. The occurrence SMM, a malignant tumor that often occurs in patients with advanced cancer and appears to be a sign of systemic hematogenous metastases, is rare after liver transplant[ 3 , 4 ]. Almusarhed et al [ 5 ] reported a case of solitary biceps muscle metastasis from breast cancer, 6 mo after postoperative chemotherapy combined with endocrine therapy.…”