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Among the Masses: Multiple Left Atrial Undifferentiated Pleomorphic Sarcomas

Kevin Yager, Jerry Fan, Corry B. Sanford, Niloufar Pourfarrokh and Vinh Nguyen
Ochsner Journal September 2024, DOI: https://doi.org/10.31486/toj.23.0143

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    (A, B, C) Computed tomography shows 3 distinct left atrial masses adherent to the left atrium (measuring 4.18 cm, 5.02 cm, and 1.05 cm) with right-sided pleural effusion.

  • Figure 2.
    Figure 2.

    (A, B) Steady-state free precession magnetic resonance imaging sequence shows multiple left atrial masses, with the largest mass in relation to the fossa ovalis and the mitral valve. (C) Isointense signal to the myocardium on T1-weighted imaging. (D) Hyperintense signal to the myocardium on T2-weighted imaging. (A, B, C, D) Asterisks show the locations of the left atrial masses. (E) Heterogenous late gadolinium enhancement (arrows) and incidental infarct pattern at the lateral and apical segments (arrowheads). (F, G) Parametric mapping with increased T1 signal suggests inflammation, and increased T2 signal is consistent with edema. The circles represent the relaxation time measurement in the tumor on T1- and T2-weighted imaging which demonstrates the high fluid and interstitial content within the tumor. (H) Positron emission tomography scan shows multiple hypermetabolic foci (arrows). ECV, extracellular volume; ms, milliseconds.

  • Figure 3.
    Figure 3.

    (A) Hematoxylin and eosin [H&E] stain, magnification ×10, and (B) H&E stain, magnification ×20 show spindle to ovoid and markedly pleomorphic tumor cells admixed with marked inflammatory cells, including numerous plasma cells and a few scattered eosinophils. Numerous mitoses, including atypical mitoses, are present.

  • Figure 4.
    Figure 4.

    Left panel, baseline imaging: (A) Preoperative cardiac magnetic resonance imaging (MRI) in diastole. (B) Preoperative cardiac MRI in systole shows a D-shaped septum consistent with pulmonary hypertension from functional mitral stenosis. (C) Echocardiography shows pulmonary artery systolic pressure (PASP) of 48 mm Hg. (D) Echocardiography shows PASP elevated at 63 mm Hg, peak mitral inflow velocity of 321 cm/s, and mean gradient of 20 mm Hg. Right panel, postoperative imaging: (A) Postoperative cardiac MRI in diastole. (B) Postoperative cardiac MRI in systole shows resolution of the D-shaped septum. (C) Cardiac MRI of the left atrium after excision of the atrial masses. (D) Echocardiography shows postoperative normalization of the peak transmitral velocity and mean gradient.

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