Intimal (spindle cell) sarcoma of the left atrium presenting with abnormal neurological examination.
A 43-year-old man with an unremarkable medical history presented to our hospital with 2 weeks of headaches, ataxia and confusion. CT of the head revealed a large haemorrhagic cystic lesion. A subsequent chest CT revealed a large left atrial mass. The mass was subsequently biopsied with positive immunohistochemistry staining for MDM2, FLI1 and vimentin. Real-time PCR revealed MDM2 amplification, confirming the diagnosis of intimal sarcoma. The patient underwent surgical resection and reconstruction of the atrium with subsequent discharge to short-term rehabilitation, but his symptoms continued to progress. A repeat CT of the head revealed a new cerebellar mass. He underwent a second resection, but continued to experience worsening symptoms. He was diagnosed with stage IV intimal sarcoma and referred to hospice. The patient died 5 months after initial presentation. Autopsy was performed and revealed the cause of death as pneumonia. There was no involvement of the pulmonic or aortic vessels.
Department of Internal Medicine, NYU Lutheran Medical Center, Brooklyn, New York, USA.
Sunil Evan
SE
Saith
NYU Lutheran Medical Center, Brooklyn, New York, USA.
Anthony
A
Duzenli
NYU Lutheran Medical Center, Brooklyn, New York, USA.
Doris
D
Zavaro
NYU Lutheran Medical Center, Brooklyn, New York, USA.
George
G
Apergis
D000328:Adult; D001344:Autopsy; D002524:Cerebellar Ataxia / Q000209:etiology; D017809:Fatal Outcome; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology*; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications; D060888:Real-Time Polymerase Chain Reaction; D012509:Sarcoma / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed