Distinguishing Cardiac Sarcomas From Lymphomas: Comparative Insights From Clinical and Echocardiographic Characteristics

BACKGROUND: Cardiac sarcomas and lymphomas are rare malignant tumors with distinct treatment strategies and prognoses. Accurate preoperative differentiation remains clinically challenging. METHODS: This retrospective observational study included consecutive patients diagnosed with primary cardiac sarcoma or lymphoma between January 2010 and December 2024. All diagnoses were pathologically confirmed. Clinical profiles, echocardiographic features, imaging findings, and outcomes were systematically compared. Univariate and multivariate logistic regression analyses were performed to identify independent discriminatory factors, and receiver operating characteristic curves were used to evaluate diagnostic performance. RESULTS: Forty-four patients were enrolled (22 sarcomas, 22 lymphomas). Multivariate analysis identified younger age (OR: 1.08, 95% CI: 1.02-1.15; p = 0.009) and isoechoic lesions (OR: 0.09, 95% CI: 0.01-0.91; p = 0.041) as independent predictors of sarcoma, with the combined model yielding an AUC of 0.85 (95%CI: 0.71-0.94). Lymphomas more frequently exhibited mixed echogenicity (45.5% vs. 13.6%, p = 0.016) and multi-chamber involvement (50.0% vs. 22.7%, p = 0.006). No significant survival difference was observed between groups (log-rank p = 0.758). CONCLUSIONS: Age and echogenicity pattern are key independent discriminators: hypoechoic masses in younger patients favor sarcoma, whereas mixed‑echoic masses in older patients suggest lymphoma. Histopathological confirmation remains essential, and clinicians should be aware of potential misdiagnosis by advanced imaging.