Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 147 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
INTERESTING IMAGE
Year : 2019  |  Volume : 34  |  Issue : 3  |  Page : 241-243  

Primary cardiac angiosarcoma with extensive visceral metastases: Utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in response assessment to sorafenib


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. Shamim Ahmed Shamim
Room No. 4, Department of Nuclear Medicine, AIIMS, Rajkumari Amritkaur OPD, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_167_18

Rights and Permissions
   Abstract 


Primary cardiac angiosarcomas although rare neoplasms remain the most common primary malignant neoplasms affecting the heart. We discuss the sequential positron-emission tomography–computed tomography findings of a 50-year-old man who was diagnosed with the metastatic cardiac angiosarcoma at the outset and developed progressive disease despite sorafenib therapy.

Keywords: Cardiac angiosarcoma, metastases, positron-emission tomography–computed tomography, sorafenib


How to cite this article:
Tripathy S, Tripathi M, Parida GK, Bal C, Shamim SA. Primary cardiac angiosarcoma with extensive visceral metastases: Utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in response assessment to sorafenib. Indian J Nucl Med 2019;34:241-3

How to cite this URL:
Tripathy S, Tripathi M, Parida GK, Bal C, Shamim SA. Primary cardiac angiosarcoma with extensive visceral metastases: Utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in response assessment to sorafenib. Indian J Nucl Med [serial online] 2019 [cited 2019 Jul 16];34:241-3. Available from: http://www.ijnm.in/text.asp?2019/34/3/241/260748



A 50-year-old man diagnosed with primary cardiac angiosarcoma underwent 18F fluorodeoxyglucose positron-emission tomography–computed tomography (FDG PET–CT) for initial staging and metastatic work-up. The scan findings revealed an enlarged right atrium with increased FDG uptake in the right atrial appendage [Figure 1]a solid black arrow, c and d]. FDG avid metastases were seen in the bilateral lungs [Figure 2]a, adrenals [Figure 2]c, and spleen [Figures 1a dashed-red line and 2c]. He was started on sorafenib therapy and a followup of PET–CT scan was done after 3 months that revealed progressive metastatic disease in bilateral lungs [Figure 1]b and [Figure 2]b, liver [Figure 1]b solid purple arrow and [Figures 2]d], spleen [Figure 1]b solid red arrow and [Figures 2]d], abdominal lymph nodes, and bones [Figure 1]b solid blue arrows and [Figure 2]f]. Angiosarcoma accounts for <1% among sarcomas and primary angiosarcoma of the heart and the great vessels accounts for only 3% of all the angiosarcomas [1] with an autopsy prevalence of 0.001%–0.28%.[2] Most of these tumors primarily arise in the right atrium, involving the lateral wall of the right atrium and mostly sparing the septum which results in delay in the initial diagnosis.[3] Frequent sites of extra-cardiac metastases include lung, liver, brain, bone, lymph nodes, adrenal glands, spleen, and intestine.[4],[5],[6] Our case had metastatic disease involving the lungs, adrenals, spleen, liver, and bones with all of them progressing on follow-up PET–CT scan. Utility of 18-F-FDG PET–CT in initial staging as a part of extra-cardiac metastatic work-up and response assessment to chemo or radiotherapy; although, scarce has been reported in the literature by Hod et al., Tan et al., Jain et al., and Dhull et al., respectively.[7],[8],[9],[10] Due to aggressive and rapidly progressive behavior of the primary and metastatic disease, we advocate extensive use of 18-F-FDG PET-CT as a “one-stop shop” for immaculate assessment of the disease burden during the initial staging and restaging purposes.
Figure 1: (a) Pretherapy 18F fluorodeoxyglucose positron-emission tomography–computed tomography maximum intensity projection image showing focal increased fluorodeoxyglucose uptake in the thorax region (solid black arrow) suggestive of cardiac angiosarcoma. Dashed-red arrows show increased fluorodeoxyglucose uptake in the spleen suggestive of metastases. (b) Posttherapy 18F fluorodeoxyglucose positron-emission tomography–computed tomography maximum intensity projection image showing increased fluorodeoxyglucose uptake in the liver, spleen, thorax, and pelvis suggestive of metastases. (c) Trans-axial computed tomography image showing soft-tissue lesion in the right atrial appendage (d) Fused trans-axial positron-emission tomography–computed tomography image showing increased fluorodeoxyglucose uptake in the right atrial appendage suggestive of cardiac angiosarcoma

Click here to view
Figure 2: Fused axial pre-therapy positron-emission tomography–computed tomography image showing nodules in the right lung (a) which increased in size and fluorodeoxyglucose uptake in post-therapy scan. (b) Fused axial pre-therapy image (c) showing mildly fluorodeoxyglucose avid hypodense lesion in the spleen which increases in size and fluorodeoxyglucose avidity in post-therapy scan. (d) However, no significant change in Fluorodeoxyglucose avid liver lesion in segment V is seen. No significant fluorodeoxyglucose uptake is seen in the sternum (e) whereas post-therapy scan (f) shows increased fluorodeoxyglucose uptake in the sternum with no cortical changes suggestive of marrow metastases

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lantz DA, Dougherty TH, Lucca MJ. Primary angiosarcoma of the heart causing cardiac rupture. Am Heart J 1989;118:186-8.  Back to cited text no. 1
    
2.
Barreiro M, Renilla A, Jimenez JM, Martin M, Al Musa T, Garcia L, et al. Primary cardiac tumors: 32 years of experience from a Spanish tertiary surgical center. Cardiovasc Pathol 2013;22:424-7.  Back to cited text no. 2
    
3.
McMannus B. Primary tumors of heart. In: Bonow RO, Mann DL, Zipes DP, Libby P, editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia: Elsevier's Saunders; 2012. p. 163850.  Back to cited text no. 3
    
4.
Hou CH, Shen DH, Lin LF, Gao HW, Hsu YC, Cheng CY. Aggressive right atrial tumor with extensive FDG-avid metastases in a case of cardiac angiosarcoma. Ann Nucl Med Mol Imaging 2012;25:201-5.  Back to cited text no. 4
    
5.
Sabolek M, Bachus-Banaschak K, Bachus R, Arnold G, Storch A. Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: A case report and review. Acta Neurol Scand 2005;111:345-50.  Back to cited text no. 5
    
6.
Ramadhan A, Willen H, Thor A. Angiosarcoma of the mandible: Metastasis from a primary tumor of the right atrium of the heart. Case Rep Clin Med 2013;2:537.  Back to cited text no. 6
    
7.
Hod N, Shalev A, Levin D, Anconina R, Ezroh Kazap D, Lantsberg S, et al. FDG PET/CT of cardiac angiosarcoma with pulmonary metastases. Clin Nucl Med 2018;43:744-6.  Back to cited text no. 7
    
8.
Tan H, Jiang L, Gao Y, Zeng Z, Shi H. 18F-FDG PET/CT imaging in primary cardiac angiosarcoma: Diagnosis and follow-up. Clin Nucl Med 2013;38:1002-5.  Back to cited text no. 8
    
9.
Jain A, Simon S, Elangovan I. (18)F-fluoro-deoxyglucose positron emission tomography-computed tomography in initial assessment and diagnosis of right atrial angiosarcoma with widespread visceral metastases: A rare case report and review of the literature. Indian J Nucl Med 2015;30:51-4.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Dhull VS, Sharma P, Mukherjee A, Jana M, Bal C, Kumar R, et al. 18F-FDG PET-CT for evaluation of cardiac angiosarcoma: A case report and review of literature. Mol Imaging Radionucl Ther 2015;24:32-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed37    
    Printed0    
    Emailed0    
    PDF Downloaded14    
    Comments [Add]    

Recommend this journal