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A 43 year old man presented with severe congestive cardiac failure. The posteroanterior chest x ray shows extreme enlargement of the cardiac silhouette and a particularly prominent bulge in the left upper border. The magnetic resonance imaging in the coronal plane shows that the heart, the thoracic aorta, and the pulmonary arteries were all encased by an extremely thick mass of tissue. The patient underwent sternotomy and complete resection of the tumour, which was found to have encased the heart and the great vessels. The central venous pressure during operation was 22 mm Hg and 9 mm Hg before and after tumour resection, respectively, suggesting that there may have been some restriction in the haemodynamics. Haematoxylin and eosin stained sections showed that the tumour was composed of fascicles of moderately atypical cells with low mitotic activity. These cells were immunopositive for vimentin but negative for various epithelial, mesothelial, endothelial, muscle, and nerve sheath markers. The tumour was diagnosed as a fibrosarcoma.
The patient recovered very well after the operation; however, four months later he presented with abdominal masses. At laparotomy, large retrohepatic masses were noted and these were considered to be unresectable. Histological examination of the biopsy specimens taken from these masses showed similar findings to those taken from the cardiac tumour. The patient was given chemotherapy and other palliative forms of treatment.
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