Introduction. Atrial masses represent a diagnostic challenge as the differential diagnosis includes a broad spectrum of formations. Thrombus is the most common form of non-neoplastic mass, whereas cardiac tumors are rare. We reported a case of a young woman with high-grade endometrial stromal sarcoma, complicated by cardiac metastatic dissemination.
Case report. A previously healthy woman of 36-years old, without medical history, underwent abdominal ultrasound due to frequent menorrhea. As suspicious uterine formation was observed, an abdomen magnetic resonance (MRI) was performed, showing a large formation located in correspondence of uterine corpus and fundus. Indeed, she underwent hysterectomy plus bilateral salpingectomy, and the subsequent histological examination revealed a high-grade endometrial stromal sarcoma (ESS). Consequently, the patient was hospitalized to undergo a total body computed tomography (CT) for tumor staging and to start chemotherapy (potential cardio-toxic). A trans-thoracic echocardiogram (TTE) showed normal function of LV, without valvulopathies. However, in correspondence of right atrium (RA) roof, a large, rounded mass, hypomobile and iso/hyper-echogenic, without extension into Superior Vena Cava, was detected. The total body CT confirmed the presence of a hypodense mass in the RA, and secondary lesions within left large pectoral muscle and right inferior lung lobe were founded. Thus, a Cardiac MRI was performed, showing a solid formation, with lobulated margins and oval morphology, at the level of the posterior wall of the RA, of about 2.5 x 1.8 cm and with longitudinal extension of about 3 cm, hypomobile and with a wide implant base. The lesion appeared heterogeneously hypo-isointense in T1-weighted images and hyperintense in T2-weighted images; in Delayed-Enhancement acquisitions, the formation resulted hyper-intense, more evidently in long-inversion recovery sequences. Indeed, considering clinical condition, right atrial location and morphological features, the diagnosis of secondary lesion of the ESS was entertained. First-line chemotherapy regimen was started. After 6 months follow-up the patients remained asymptomatic; at TTE, the cardiac mass resulted unchanged. Unfortunately, after 13 months, the patient died.
Conclusion. A multimodality imaging approach to the evaluation of atrial masses is crucial for obtaining a non-invasive evaluation to provide the appropriate therapeutic approach.
