Primary undifferentiated pulmonary valve sarcoma complicated by thromboembolism in a patient with cavitary tuberculosis. A case report

Primary pulmonary valve tumor is a rare pathology in cardiology practice. Long asymptomatic period and the manifestation of nonspecific complaints, such as a persistent cough, intoxication, shortness of breath, and chest pain, characteristic of a wide range of diseases, significantly complicate timely diagnosis. This article presents a case of primary undifferentiated pulmonary valve sarcoma complicated by pulmonary embolism in a patient with cavitary tuberculosis. This case is unique in demonstrating diagnostic pitfalls associated with the combination of this pathology with active tuberculosis. The stages of differential diagnosis with infective endocarditis and myxoma are described, and the role of morphological verification is emphasized. The patient underwent successful pulmonary artery thrombectomy, followed by replacement with a 21 mm bioprosthetic valve. Subsequent pathological examination confirmed the diagnosis of undifferentiated pleomorphic sarcoma (FNCLCC G3) with valve/artery wall invasion. The patient was discharged with clinical improvement. However, despite the success of the surgical intervention, his long-term prognosis remains uncertain due to the advanced disease stage at diagnosis. This case highlights the importance of apprehensive attitude to cancer when detecting cardiac space-occupying processes, taking into account a combination of clinical, anamnestic, and imaging data.

1. Butany J, Nair V, Naseemuddin A, et al. Cardiac tumours: diagnosis and management. Lancet Oncol. 2005;6(4):219-28. doi:10.1016/S1470-2045(05)70093-0.

2. Rahouma M, Arisha MJ, Elmously A, et al. Cardiac tumors pre­valence and mortality: A systematic review and meta-analysis. Int J Surg. 2020;76:178-89. doi:10.1016/j.ijsu.2020.02.039.

3. Lee S, Lau L, Lim K, et al. The Presence of Cough and Tu­ber­culosis: Active Case Finding Outcomes in the Philippines. Tuberc Res Treat. 2019;2019:1-9. doi:10.1155/2019/4578329.

4. Antwi‐Amoabeng D, Meghji Z, Thakkar S, et al. Survival Dif­fe­rences in Men and Women With Primary Malignant Cardiac Tumor: An Analysis Using the Surveillance, Epidemiology and End Results (SEER) Database From 1973 to 2015. JAHA. 2020;9(10):e014846. doi:10.1161/JAHA.119.014846.

5. Sarachan DA, Skrebtsov AV, Zakharyan EA, et al. Primary car­diac angiosarcoma: modern methods of diagnosis and treatment. Russian Journal of Cardiology. 2020;25(4):3824. (In Russ.) doi:10.15829/1560-4071-2020-3824.

6. Tyebally S, Chen D, Bhattacharyya S, et al. Cardiac Tumors: JACC CardioOncology State-of-the-­Art Review. JACC CardioOncology. 2020;2(2):293-311. doi:10.1016/j.jaccao.2020.05.009.

7. Yu JF, Cui H, Ji GM, et al. Clinical and imaging manifestations of primary cardiac angiosarcoma. BMC Med Imaging. 2019; 19(1):16. doi:10.1186/s12880-019-0318-4.

8. Basso C, Rizzo S, Valente M, et al. Cardiac masses and tu­mours. Heart. 2016;102(15):1230-45. doi:10.1136/heartjnl-2014-306364.

9. Pourkia R, Faghanzadeh Ganji G, Vakili Sadeghi M, et al. A case of cardiac angiosarcoma and pulmonary tuberculosis; diagnostic challenges and review of literature. Caspian J Intern Med. 2021; 12(Suppl 2):S500-S504. doi:10.22088/cjim.12.0.500

10. Shrivastava S. Primary Cardiac Synovial Sarcoma Misdiagnosed as Tuberculoma. In: The Misdiagnosis Casebook in Clinical Me­dicine. A Case-­Based Guide. Tohid H, Baratta LG, Maibach H (Eds). Springer Int Publ. 2023:85-90. doi:10.1007/978-3-031-28296-6. ISBN: 978-3-031-28295-9.

11. Kurian KC, Weisshaar D, Parekh H, et al. Primary cardiac angio­sarcoma: case report and review of the literature. Cardiovasc Pathol. 2006;15(2):110-2. doi:10.1016/j.carpath.2005.10.003.

12. Shanmugam G. Primary cardiac sarcoma. Eur J CardioThoracic Surg. 2006;29(6):925-32. doi:10.1016/j.ejcts.2006.03.034.