PMC4899565_01
46-year-old female with spindle-cell sarcoma of the heart. Axial CT angiography image showed a large mass (asterisk) in the region of the left ventricle. Incidentally noted were also a small right pleural effusion and a right breast implant.
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It showed no evidence of acute pulmonary thrombo-embolic disease but showed masslike low density along the anterolateral left ventricular walls at the mid and apical levels (Fig. 1).
46-year-old female with spindle-cell sarcoma of the heart. Parasternal long-axis (A) and short-axis (B) views showed an echogenic mass in the left ventricular lumen (asterisk) and thickening of the left ventricular wall.
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Transthoracic echocardiography showed an ejection fraction of 25-30%, with global hypokinesis of the left ventricle (Fig. 2).
46-year-old female with spindle-cell sarcoma of the heart. Short-axis (A) and 4-chamber (B) bright-blood MRI images showed a mass in the left ventricle with predominantly hyperintense T2 signal. A fat-suppressed, postcontrast, T1-weighted, short-axis image (C) showed heterogeneous enhancement in the mass lesion.
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It showed a large heterogeneneous mass (Fig. 3) involving the anterior wall of the left ventricle from the base to apex and extending into the portions of the anterolateral and anteroseptal walls.
46-year-old female with spindle-cell sarcoma of the heart. Low-power 4x (A) and high-power 40x (B) images. On pathology, highly cellular spindle-cell proliferation in a fascicular growth pattern was noted, along with hemangiopericytoma-like vasculature ("staghorn" configuration) surrounded by spindle cells. The cells had a scant amount of acidophilic cytoplasm, and the nuclei were cigar-shaped or blunt-ended and curved with variable atypia. Mitotic figures were common (6-10 per high-power field), and atypical mitosis was also seen.
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A left-ventricular-mass core biopsy (Fig. 4) was performed.