UTERINE RHABDOMYOSARCOMA METASTASIZING TO HEART: A RARE CAUSE OF ARRHYTHMIAS

Abstract

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Rhabdomyosarcoma( RMS) is a very rare and heterogeneous group of malignancies, found most commonly in childhood. Its appearance among adults is rare, accounting for 2 % to 5% of all the adult soft tissue sarcomas. Diagnosing a case of metastatic cardiac rhabdomyosarcoma is challenging for a physician because of its vague clinical features. Here, we present a case of a 49-year-old female who presented to the hospital with palpitations and was diagnosed with uterine rhabdomyosarcoma that had metastasized to the uterus. CASE PRESENTATION: A 49-year-old female presented to the hospital with palpitations and irregular heartbeat. She was vitally stable and EKG was negative for rhythm abnormalities. Trans-thoracic Echocardiogram (TTE) revealed a mass on the mitral leaflet of the left atrium and a presumptive diagnosis of atrial myxoma was made. MRI of the abdomen revealed a 3 cm mass in the myometrium with liver metastasis. Left atrial mass was excised and both atrial and Uterine biopsy showed rhabdomyosarcoma with cells having abundant mitoses. Immune profile and histology of cardiac and uterine mass revealed a neoplasm of atypical cells (Figure 1). Palpitations resolved after excision and the patient was scheduled for chemo/radiation therapy. DISCUSSION: Sarcomas have a wide variety of histopathological types that may be primary or metastatic. One type of sarcoma called RMS is a malignant tumor of mesenchymal origin which is very aggressive and has high metastatic potential. It is made up of striated muscle cells, which have failed to fully differentiate. It is most commonly seen in the pediatric population and is described as ‘small, blue, round cell tumors in the childhood’ due to its appearance in H&E staining. [1] The site of origin of RMS can be variable but is predominantly found in the head, neck, orbit, genitourinary tract, genitals, and extremities. [2] Presenting symptoms in adults can be quite variable and there are no known definite symptoms. The location of the tumor has a dominant effect on the presentation. It can present as palpitations, acute heart failure, regurgitation murmurs, heart block, and pericardial effusion with or without tamponade. In our case, cardiac RMS presented as a metastatic lesion from uterine RMS. It is a highly rare presentation and in our literature review, it is the second reported case of uterine RMS metastasizing to heart and the patient became asymptomatic from a cardiac standpoint after excision of the mass. CONCLUSIONS: Uterine rhabdomyosarcoma metastasizing to the heart is extremely rare and by the time it is diagnosed, management is primarily palliative. Data is based only on individual case reports so no definite management guidelines are available. Reference #1: Arndt C, Crist W. Common Musculoskeletal Tumors of Childhood and Adolescence. New England Journal of Medicine. 1999;341(5):342-352. Reference #2: Okcu F, Hicks J, Horowitz M. Rhabdomyosarcoma in childhood and adolescence: Epidemiology, pathology, and molecular pathogenesis. DISCLOSURES: No relevant relationships by Soban Farooq, source=Web Response no disclosure on file for Shuajul Haq; No relevant relationships by John Madara, source=Web Response No relevant relationships by Sohaib Roomi, source=Web Response no disclosure on file for Waqas ullah