Primary Cardiac Angiosarcoma: A Case Report of an Uncommon Tumor and a Brief Review of the Literature

Primary cardiac angiosarcoma (CAS) is a rare, malignant, aggressive, vascular tumor that commonly causes nonspecific cardiac symptoms and thus is a challenging diagnosis. A 56-year-old man with a history of hypertension and hyperlipidemia reported a three-month history of increased exertional dyspnea, periodic non-pleuritic chest pain, and fatigue. At two outpatient visits, routine laboratory studies and electrocardiograms were unremarkable. Nonsteroidal anti-inflammatories were ineffective in relieving symptoms. His symptoms progressed to heart palpitations and loss of exercise capacity. Trans-thoracic echocardiography (TTE) demonstrated a 3.5 cm heterogeneous mass at the right atrial free wall. A multilobulated, heterogeneous-enhancing mass with hemorrhage and necrosis was seen on cardiac magnetic resonance imaging (MRI), which is indicative of a primary cardiac malignancy.The surgically excised tumor was positive by using immunohistochemical (IHC) studies for CD31, ERG, factor VIII, and FLI-1, consistent with high-grade cardiac angiosarcoma. Adjuvant chemotherapy was also administered. At nine months, bilateral metastatic lung nodules were identified. Palliative care was introduced, and the patient was put on secondary taxane-based chemotherapy. His condition deteriorated rapidly, and the patient passed away 15 months after diagnosis. The case emphasizes the importance of considering primary cardiac tumors as part of the possible causes of a patient's presentation of persistent, nonspecific cardiac symptoms.