¹⁸ F-fluoro-deoxyglucose positron emission tomography-computed tomography in initial assessment and diagnosis of right atrial angiosarcoma with widespread visceral metastases: A rare case report and review of the literature

Abstract

Cardiac angiosarcoma is the most common primary cardiac sarcoma in adults. Primary cardiac tumors are rare and have nonspecific clinical presentation, thus making its diagnosis challenging. Clinically, patients present with advanced disease demonstrating metastatic disease at initial presentation itself. It commonly metastasizes to lung, liver, brain, and bone; however metastases to lymph nodes, adrenal glands, spleen and skin has also been seen. We describe a case of right atrial angiosarcoma with extensive visceral metastases involving brain, lungs, liver, pancreas, kidney, and lymph nodes, demonstrated on contrast-enhanced 18F-fluoro-deoxyglucose positron emission tomography-computed tomography (FDG PET-CT). To the best of our knowledge metastases to pancreas and kidney have not been reported so far in the literature. With our report, we emphasize on the initial use of FDG PET-CT in workup of cardiac angiosarcoma for accurate staging and prognostication of this disease.

Molecular imaging of metastatic atrial angiosarcoma with positron emission tomography (PET) tracer 3′-deoxy-3′[(18)F]-fluorothymidine, [(18)F]-FLT imaging and early response evaluation

“…18 F-FDG PET-CT has been evaluated for characterisation, staging and restaging of cardiac angiosarcomas. There are two reviews of literature 1 2. A case series of 24 patients with cardiac tumours presented six angiosarcomas using FDG PET 12.…”

“…Arising from the vascular / lymphatic endothelial cells angiosarcomas are extremely rare neoplasms 1 2. They are highly aggressive neoplasms with a propensity to metastasise 1 3.…”

“…Therefore, it is vital to ascertain the precise extent of the primary lesion, to detect local recurrence and distant metastases for appropriate therapy management 4. A review of published literature have shown mainly the use of positron emission tomography (PET) with tracer 2-deoxy-2-[ 18 F]-fluoro-D-glucose ( 18 F-FDG PET-CT) in cardiac angiosarcoma 1–3 6–8. Around 20 cases have been reported in literature.…”

Pancreatic metastasis of angiosarcoma (Stewart–Treves syndrome) diagnosed using endoscopic ultrasound-guided fine needle aspiration

“…Pancreatic involvement of angiosarcoma is extremely rare, [4,5] and only 4 cases have been reported in the English literature. [4,5,7,8] In addition, only 2 reports have been published concerning the performance of EUS-FNA in patients with angiosarcoma. [7,9] The spleen was punctured in the first case, [7] while the retroperitoneum was punctured in the second.…”

Beating the Odds – 4-year Survival with Primary Cardiac Angiosarcoma

“…The most sensitive diagnostic imaging technique is transoesophageal echocardiography with sensitivity of 97% while transthoracic echocardiography may not detect right atrial masses [6,7] . Further investigations may include coronary angiography, cardiac MRI and staging CT and positron emission tomography (PET) scans [5,8,9] . Although many patients present with a pericardial effusion, cytology is often non-diagnostic [7] , and up to 50% of endomyocardial biopsies may be normal despite the presence of malignancy [10] .…”