Recurrent cardiac chloroma presenting as acute chest pain

A 41-year-old man presented to the hospital with sudden onset of chest tightness. His past medical history was notable for diagnosis of chronic myeloid leukemia (CML), made at 33 years. He was treated with imatinib, dasatinib and allogeneic peripheral blood stem cell transplant (PBSCT) with HLA mismatched, unrelated donor and he was still in complete hematologic response. On admission, his vital signs and cardiac enzymes were normal. Right ventricular hypertrophy was newly developed compared with his previous electrocardiography. He got an urgent coronary angiography due to ongoing chest pain, and the result showed no significant stenosis but anomalous tumor feeding vessels from left circumflex artery. A huge branch of left circumflex artery was supplying the tumor, which seems to be consistent with development of chest discomfort, relative myocardial ischemia.1 Transthoracic echocardiography showed a 3.6 × 3.7 cm sized, irregular shaped mass in the right atrium (Figure 1A). The cardiac magnetic resonance image also revealed an intracardiac lobulating mass, which was considered as lymphoma at first, followed by chloroma and primary cardiac sarcoma.