Diagnostic challenges and therapeutic approaches in cardiac intimal sarcoma: a rare clinical case study

Ma ChaoTang JunyiXiao YinTian WenbinWang Tao^*

• Department of Thoracic and Cardiovascular Surgery, Zhuzhou Central Hospital, Zhuzhou, China

Background: Primary cardiac tumors are exceedingly rare, with the majority being benign, while malignant tumors are even less common. Cardiac intimal sarcoma represents a rare and aggressive variant of primary cardiac tumors, characterized by its stromal origin and frequent association with genetic abnormalities. They typically present with non-specific symptoms, making early diagnosis difficult. Case demonstration: A 61-year-old female patient with a medical history notable for multiple neoplasms and surgical interventions is discussed. In 2006, she was diagnosed with uterine fibroids and underwent surgical excision. A decade later, in 2016, she was diagnosed with breast cancer, for which she received surgical treatment followed by radiotherapy. In 2023, the patient developed bilateral lower extremity arterial embolism, and a thrombectomy revealed a mixed thrombus. In 2024, she experienced a recurrence of arterial embolism in the left lower extremity. Following a thrombectomy, the embolus was identified as a myxoma, and subsequent echocardiographic evaluation revealed a mass within the left ventricle. Surgical intervention was performed to excise the left ventricular mass, and the final postoperative pathological examination confirmed the diagnosis of cardiac intimal sarcoma. Conclusion: Cardiac intimal sarcoma of the left ventricle is an uncommon condition, and the absence of specific symptoms complicates early diagnosis, frequently resulting in misdiagnosis. While chemotherapy and gene-targeted therapies may improve patient outcomes, early and complete surgical resection is crucial for achieving long-term survival in individuals with cardiac intimal sarcoma.