Abstract
Primary cardiac tumors are uncommon and cardiac osteosarcoma is a rare disease. While complete surgical resection is considered to be the best treatment option for cardiac osteosarcomas, local and metastatic recurrences present challenges and indicate a poor prognosis. A combination of surgical resection with radio- and/or chemotherapy is a more effective course of treatment for osteosarcoma. In the present case, the patient underwent a complete resection of a primary cardiac osteosarcoma, and received chemotherapy and radiotherapy following local recurrence and metastasis to the bone post-operatively. Following these treatments, a rectal metastatic tumor was detected as causative of anemia. There is currently a lack of guidelines on the treatment of metastatic osteosarcomas in the intestine and there are few reports on rectal metastases. The present study described a laparoscopic resection of the osteosarcoma. The patient recovered without any complications and radiotherapy and chemotherapy were administered post-surgery to treat the bone metastases. The patient remained healthy at a follow-up examination, 61 months post surgery.
Highlights
Primary cardiac tumors are rare, as demonstrated by their low frequency (0.001‐0.03%) in an autopsy series [1,2], which indicated that 15‐25% of the primary cardiac tumors were malignant [3,4]
To the best of our knowledge, there have been no previous reports regarding the resection of a metastatic rectal tumor originating from an osteosarcoma of the heart and there are no published guidelines for the treatment of metastatic sarcomas in the intestine
Several reports have shown that effective palliation of local recurrences are possible and effective [8,9,10,11,18,19]
Summary
Primary cardiac tumors are rare, as demonstrated by their low frequency (0.001‐0.03%) in an autopsy series [1,2], which indicated that 15‐25% of the primary cardiac tumors were malignant [3,4]. To avoid bleeding from the tumor and future obstruction of the intestine, a laparoscopic rectectomy following indocyanine green marking [12] was performed to completely remove the rectal tumor (Fig. 3) Histological examination of this tumor specimen revealed dense groups of polygonal and spindle cells, with eosinophilic cytoplasms and pleomorphic nuclei with high density chromatin and irregular nucleoli. The osteoid matrix did not appear to have any calcification and there was no lymph node metastasis These pathological findings were detected in the cardiac osteosarcoma sample (Fig. 4). These findings were compatible with a histological diagnosis of a metastatic rectal osteosarcoma originating from the heart. The patient is still receiving chemotherapy and radiotherapy for the bone metastases
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