A Review of Intracardiac Mass Cases Encountered Over a Two-Year Period

TL;DR

This paper reviews five cases of intracardiac masses over two years, highlighting the challenges in diagnosis and treatment, especially for malignant tumors.

Contribution

The study provides a detailed case series of intracardiac masses with varied pathological diagnoses and treatment outcomes.

Findings

Early diagnosis and surgical resection improve outcomes for intracardiac masses.

Malignant tumors like angiosarcoma and undifferentiated pleomorphic sarcoma have poor prognoses despite combined therapies.

Complete tumor excision remains the only curative option for cardiac tumors.

Abstract

Intracardiac mass is a rare condition that poses significant diagnostic and therapeutic challenges. Regardless of the pathological diagnosis, these cases are often difficult to manage, as patients typically present with urgent clinical symptoms at their initial visit. Most symptoms result from blood flow disturbances caused by a large intracardiac tumor. Furthermore, patients face a high risk of thromboembolism.

Herein, we present five cases of intracardiac masses, including three malignant tumors, encountered over approximately two years. Each case had a different pathological diagnosis: angiosarcoma (n = 2), undifferentiated pleomorphic sarcoma (n = 1), benign myxoma (n = 1), and a simple ball thrombus (n = 1). Early and accurate diagnosis and treatment, ideally complete surgical resection, is the primary approach to managing intracardiac mass. However, extensive tumor resection can be difficult to achieve while preserving adequate cardiac function, especially in advanced-stage cases. In our series, surgical resection was not indicated for two patients (one with a ball thrombus and the other with angiosarcoma) due to impaired consciousness from multiple cerebral thromboembolism or advanced-stage sarcoma. The remaining three patients, diagnosed with myxoma, angiosarcoma, and undifferentiated pleomorphic sarcoma, underwent tumor excision. However, in the two malignant cases, early recurrence occurred, and postoperative management proved to be extremely challenging.

The three patients with primary cardiac sarcoma received radiation therapy combined with chemotherapy or multiple chemotherapy regimens as either primary or secondary treatment. Of the two patients diagnosed with angiosarcoma, one died two months after admission without undergoing surgery, while the other died 11 months following tumor resection, highlighting the limited effectiveness of available treatments. The remaining patient, diagnosed with undifferentiated pleomorphic sarcoma, also received combination therapy with radiation and chemotherapy. In this case, the primary in the left atrium and a solitary metastasis to the left adrenal gland were relatively controlled with proton beam therapy.

In cases of intracardiac mass, early diagnosis and prompt surgical excision are crucial. If the tumor is malignant, combined treatment with radiation and chemotherapy should be promptly considered as a second-line approach based on the tumor's characteristics and the extent of surgical resection. However, there are currently no curative treatments for either malignant or benign primary cardiac tumors other than complete tumor excision. Therefore, early-stage diagnosis is directly linked to improved prognosis.

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