Diagnostic features and surgical treatment of malignant heart tumor - hemangioendothelioma: A case report

Objective: Primary heart tumors are neoplasms heterogeneous in histological structure, growing from the tissues and membranes of the heart.Their diagnosis is difficult due to the absence of pathognomonic signs, as well as the possibility of a long-term asymptomatic course.We report a case of successful management of malignant right atrial tumor manifested with arrhythmias.Case presentation: A 27-year-old patient was admitted to our clinic with the diagnosis of myxoma.He had history of round cell B tumor removal from shoulder and underwent radiotherapy.On admission, he had arrhythmia -atrial fibrillation.Transesophageal echocardiography revealed the floating mass in right atrium with pedicle attached to the wall of right atrium.The cardiac function was intact.We decided to perform surgery of tumor removal under cardiopulmonary bypass.On exploration of right atrium, the tumor on pedicle of dense-elastic consistency with a size of 4x5 cm was revealed.Its surface was tuberous, brown.External revision revealed the growth of the tumor pedicle on the outer surface of the right atrium in the form of "cauliflower".The tumor was removed from right atrium together with part of the wall of right atrium where the pedicle was attached.The atrial gap was closed using pericardial patch.There were no postoperative complications.Histomorphological analysis of tumor species demonstrated malignant hemangioendothelioma. Patient was discharged with recommendation to undergo chemotherapy and radiotherapy, and is being followed-up by cardiologist and oncologist.Conclusion: Primary malignant heart tumor like hemangioendothelioma is characterized by rapid onset, presence of cardiac arrhythmias, and presence of right atrium invasion.Transesophagial echocardiography is useful in detection, characterization of tumor and planning surgery.The open heart surgery removal of tumor with part of affected chamber wall and repaired by pericardial patch resulted in a good outcome in our patient.