A difficult diagnosis?

Reflection & Reaction A difficult diagnosis? The case report “Left atrial sarcoma to debulk the left atrial mass, which angiosarcoma. It was at this point that presenting as cerebral infarction”, by had caused near complete obstruction he was referred to our centre. Lisa Pickering and colleagues in The to the mitral flow. During the Clinically, he had mitral stenosis. Lancet Oncology (2001; 2: 705–6) operation it was apparent that the Following evaluation, his haemogram highlighted a difficult and liver and renal-function diagnosis. We have recently tests were normal. A chest seen a very similar situation X-ray showed a bossulated that may provide additional left atrial appendage. A CT insight into this debate. scan of the brain was The diagnosis of primary normal and a CT scan of the angiosarcoma of the heart chest revealed a left atrial was doubted by the authors mass and opacity in the of this report. A alternate lower posterobasal segment diagnosis of a metastatic of the left lung. sarcomatoid renal-cell The final diagnosis was carcinoma was proposed. left atrial angiosarcoma. However, this seems rather With the partially resected unlikely. Molecular analysis primary tumour mass of 3p14–28, probably using accompanied by pulmonary FISH or CGH, on archival metastases, and an tissue would have either ischaemic attack in the left confirmed or refuted this carotid artery, we started the diagnosis. patient on a daily The patient we have combination of ifosfamide recently seen did not have a (10 mg), adriamycin (80 renal mass and consequently mg), cisplatin (170 mg) and there was no ambiguity with aspirin (75 mg). He has now the diagnosis. This 36-year completed four cycles and is old male had suffered from a tolerating the treatment weakness of the right upper well. A chest X-ray after and lower limbs for several three cycles showed a hours before consultation decrease in the size of the with his doctor. He had not left atrial appendage and he suffered from any conhas had no further cerebral vulsions or bladder and Figure 1. An echocardiogram showing mitral stenosis and left atrium related events. We plan to bowel incontinence. A thrombosis in a patient with an angiosarcoma. assess him with a further CT diagnosis of mitral stenosis, scan after he has completed probably of rheumatic origin, was mass was highly vascular and strongly two more cycles of chemotherapy. made. An echocardiogram showed adherent to the left atrial appendage K Govind Babu, D Lokanath, P Kumar, severe mitral stenosis with a large ball- and the mitral annulus. A total S Harita, N Nimit, R Girish, and PP valve thrombus in the left atrium with excision was therefore not possible, Bapsy. pulmonary arterial hypertension and a partial resection was done. The Department of Medical Oncology, Kidwai Institute of Oncology, Dr MH histopathology of the removed mass Memorial (figure 1). Marigowda Road, Bangalore 560 029, He underwent emergency surgery showed a poorly differentiated Karnataka, India.

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