Indian Journal of Nuclear Medicine

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


Sarthak Tripathy, Madhavi Tripathi, Girish Kumar Parida, Chandrasekhar Bal, Shamim Ahmed Shamim 
 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

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

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.



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;34:241-243


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 Oct 18 ];34:241-243
Available from: http://www.ijnm.in/text.asp?2019/34/3/241/260748


Full Text



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}{Figure 2}

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Conflicts of interest

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