CASE REPORT Recurrent primary cardiac osteosarcoma: a case report and literature review Andrea Dell’Amore • Nizar Asadi • Guido Caroli • Giampiero Dolci • Alessandro Bini • Franco Stella Received: 21 January 2013 / Accepted: 12 March 2013 Ó The Japanese Association for Thoracic Surgery 2013 Abstract Primary malignant cardiac tumors are very rare. Among malignant tumors, sarcomas occupy first place. In particular, primary cardiac osteosarcoma is extremely rare. To the best of our knowledge, only 42 cases have been reported worldwide. Cardiac malignant tumors usually require complex operations due to the difficulty in completely removing the tumor with acceptable free sur- gical margins and because of the proximity to vital struc- tures. The current multimodality treatment strategies for cardiac sarcoma are still suboptimal, and surgery in par- ticular frequently has unsatisfactory results. We report a case of recurrent primary cardiac osteosarcoma in a young male who underwent trans-sternal right pneumonectomy and a wide resection of the left and right atrium followed by reconstruction with heterologous pericardium under extracorporeal circulation. The patient died 6 months after the operation due to local and systemic disease recurrence. Keywords Cardiac tumors Á Sarcoma Á Osteosarcoma Á Primary cardiac sarcoma Introduction Primary malignant cardiac tumors are exceedingly rare and about 75 % of these are sarcomas [1]. Angiosarcoma is the commonest sarcoma of the heart, but tumors arising from all cell lines, including bony, neurogenic, and soft tissue sarcomas, have been reported mainly as case series or case reports [1, 2]. In particular, osteosarcoma accounts for less than 10 % of all primary cardiac malignant tumors [3–5]. We report a case of recurrent primary cardiac osteosarcoma in a young male who underwent trans-sternal right pneu- monectomy and a wide resection of the left and right atrium followed by reconstruction with heterologous peri- cardium under extracorporeal circulation. Case report A 40-year-old man presented at our department for symptomatic recurrence of cardiac osteosarcoma. At the age of 38, the patient was operated to remove a cardiac mass in the left atrium initially suspected to be an atrial myxoma. Unfortunately, the postoperative pathology examination showed that the mass was an osteosarcoma. The patient therefore received 15 chemotherapy cycles with Methotrexate, Cisplatin, Adriamycin, and Ifosfamide. Twenty months after surgery, the patient complained of dyspnea, syncope and supraventricular arrhythmias, and trans-esophageal echocardiography and then showed local tumor recurrence. The patient was referred to us from the oncology department to evaluate the possibility of a second operation to remove the mass. The preoperative evaluation was carried out to exclude systemic recurrence and to evaluate the possibility for a re-operation with radical intent. The CT scan showed a left atrial heterogeneous mass that occupied nearly all the left atrial space, protruding through the mitral valve orifice into the left ventricle. The tumor extended into the left superior and inferior pulmonary veins (Fig. 1a, b). At fluorine-18- fluorodeoxyglucose positron emission tomography (PET) scan, the mass was shown to have a maximum standardized uptake value (SUV max ) of 6.6; no other lesions were A. Dell’Amore (&) Á N. Asadi Á G. Caroli Á G. Dolci Á A. Bini Á F. Stella Thoracic Surgery Unit, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna, Italy e-mail: dellamore76@libero.it 123 Gen Thorac Cardiovasc Surg DOI 10.1007/s11748-013-0236-2