SHARE @ Advocate Health - Midwest - Scientific Day: Unique Case of Metastatic Atrial Sarcoma to Brain and Bone
 

Affiliations

Advocate Lutheran General Hospital

Abstract

Introduction/Background:

This case highlights an exceedingly rare presentation of malignant atrial sarcoma with metastases to the brain and potentially bone. There are almost no documented similar case presentations given the rarity of atrial sarcomas to metastasize. When they do metastasize, the lungs and liver are the most common sites, rather than the brain or humerus. Of note, it is far more common for metastatic tumors to spread to the heart rather than be of cardiac origin.

Description:

A 51-year-old female with PMH of atrial sarcoma status post resection and chemotherapy (doxorubicin) and past neurocysticercosis presented from an outside hospital for a right-sided cerebellar brain mass. Her sarcoma was originally diagnosed after presenting 1 month prior for chest pain and dyspnea. An atrial intimal sarcoma was diagnosed and resected with pacemaker implantation for postoperative complete heart block. The patient was discharged on rivaroxaban for heparin-induced thrombocytopenia (HIT) during that admission. On admission, she reported worsening headaches, nausea, vomiting, and left sided blurry vision. CT head revealed a 4 cm right cerebellar mass with vasogenic edema and mass effect flattening the left ventricle. She was started on levetiracetam and dexamethasone. Neurosurgery performed surgical resection via a right suboccipital craniotomy, and biopsy confirmed metastatic intimal sarcoma. She was discharged with oncology follow-up. Subsequently, outpatient imaging identified a heterogeneously enhancing mass from the distal humerus to the antecubital fossa, with differential diagnoses including soft tissue sarcoma and angiomatoid fibrous histiocytoma. Metastasis is under investigation.

Discussion:

Atrial sarcomas are exceedingly rare. Primary cardiac sarcomas make up ~20% of all primary cardiac tumors. This case is unique due to the rarity of the atrial sarcoma as its own entity, but even more so with metastases to the brain and humerus. These tumors typically spread to the liver, lungs, and adrenal glands. This case provides bolstering data on atrial sarcomas’ preference for metastasis. These tumors are highly aggressive and may recur. This case demonstrates that atrial sarcomas cannot be ruled out based solely on location of the metastases. Overall, close monitoring is recommended in these patients including 3–6-month CT chest, abdomen, pelvis, MRI, and echocardiography, and for at least 5 years if the sarcoma has been resected, since recurrence is highest during this time.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

Full Text of Presentation

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Document Type

Poster


 

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May 21st, 11:41 AM May 21st, 1:15 PM

Unique Case of Metastatic Atrial Sarcoma to Brain and Bone

Introduction/Background:

This case highlights an exceedingly rare presentation of malignant atrial sarcoma with metastases to the brain and potentially bone. There are almost no documented similar case presentations given the rarity of atrial sarcomas to metastasize. When they do metastasize, the lungs and liver are the most common sites, rather than the brain or humerus. Of note, it is far more common for metastatic tumors to spread to the heart rather than be of cardiac origin.

Description:

A 51-year-old female with PMH of atrial sarcoma status post resection and chemotherapy (doxorubicin) and past neurocysticercosis presented from an outside hospital for a right-sided cerebellar brain mass. Her sarcoma was originally diagnosed after presenting 1 month prior for chest pain and dyspnea. An atrial intimal sarcoma was diagnosed and resected with pacemaker implantation for postoperative complete heart block. The patient was discharged on rivaroxaban for heparin-induced thrombocytopenia (HIT) during that admission. On admission, she reported worsening headaches, nausea, vomiting, and left sided blurry vision. CT head revealed a 4 cm right cerebellar mass with vasogenic edema and mass effect flattening the left ventricle. She was started on levetiracetam and dexamethasone. Neurosurgery performed surgical resection via a right suboccipital craniotomy, and biopsy confirmed metastatic intimal sarcoma. She was discharged with oncology follow-up. Subsequently, outpatient imaging identified a heterogeneously enhancing mass from the distal humerus to the antecubital fossa, with differential diagnoses including soft tissue sarcoma and angiomatoid fibrous histiocytoma. Metastasis is under investigation.

Discussion:

Atrial sarcomas are exceedingly rare. Primary cardiac sarcomas make up ~20% of all primary cardiac tumors. This case is unique due to the rarity of the atrial sarcoma as its own entity, but even more so with metastases to the brain and humerus. These tumors typically spread to the liver, lungs, and adrenal glands. This case provides bolstering data on atrial sarcomas’ preference for metastasis. These tumors are highly aggressive and may recur. This case demonstrates that atrial sarcomas cannot be ruled out based solely on location of the metastases. Overall, close monitoring is recommended in these patients including 3–6-month CT chest, abdomen, pelvis, MRI, and echocardiography, and for at least 5 years if the sarcoma has been resected, since recurrence is highest during this time.

 

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