Sarcoma-to-Heart Case Highlights Need for Multidisciplinary Care

A large, heterogeneous mass extended into the left atrium of a 36-year-old man with a history of soft-tissue sarcoma (STS), partially blocking the right pulmonary veins and causing heart failure symptoms with imaging consistent with metastatic disease, according to a new case report in Clinical Case Reports.¹

The case, from researchers in Iran, illustrated how rarely but seriously STS can spread to the heart and why using echocardiography, cardiac MRI (CMR), and CT together can help catch cardiac involvement.

How Common Is Cardiac Metastasis?

Cardiac metastasis remains a rare complication of cancer, showing up in an estimated 2.3% to 18.3% of cancer patients on autopsy studies. The condition's presentation varies widely, from no symptoms at all to life-threatening heart failure, arrhythmias, or cardiac tamponade.

In 2025, a case report described a 74-year-old man whose synovial cell sarcoma metastasized to the left atrium and pulmonary veins, producing stroke-like neurologic symptoms rather than classic cardiac ones.^2,3

What the Imaging Revealed

In the current case, a man with a 4-year history of STS, which was previously treated with surgery, radiotherapy, and chemotherapy, presented with progressive shortness of breath and intermittent chest pain.¹ A chest x-ray showed an enlarged cardiac silhouette and a right-sided lung mass, prompting an echocardiogram that found mild-to-moderate left ventricular systolic dysfunction, with an ejection fraction of 40%-45% and an approximately 5 x 3 cm mass partially obstructing the right pulmonary veins in the left atrium.

CMR confirmed a 120 x 95 mm heterogeneous mass extending from the right lung into the left atrium, along with mildly reduced right ventricular function. A CT scan of the chest then revealed multiple pulmonary metastases, with the largest lesion in the right lung extending directly into the left atrium. The echocardiographic, CMR, and CT findings created a picture of extensive metastatic disease involving both the lungs and heart.

“Integrating various imaging modalities was pivotal in establishing the diagnosis, revealing the extent of the disease, and guiding therapeutic decision-making,” the authors explained.

CMR also showed localized increased T1 signal in the myocardium, which the authors said could point to chemotherapy-induced cardiomyopathy, a common adverse effect in patients with a history of chemotherapy. The paper does not name the regimens the patient received.

How the Case Was Managed

The case was discussed at a tumor board meeting, where the team cited limited surgical options because of the extent of the disease, the authors wrote. Instead, the team continued palliative chemotherapy and considered targeted radiation therapy for symptomatic relief. On follow-up, the patient had reduced symptoms and stabilized cardiac function, which the authors said underscores the importance of early detection and appropriate management, though the disease was already extensive at diagnosis. The report does not state how long the patient was followed or whether a biopsy confirmed the diagnosis.

The previously reported case in 2025 followed a different treatment path. The patient underwent palliative open-heart surgery because of his stroke risk, followed by chemotherapy and radiotherapy, and showed no recurrence over more than a year of follow-up.^2,3

Cardiac metastasis cases are individually rare, and managing them requires input from oncology, cardiology, and radiology, the authors wrote, reflecting the complexity of treating cardiac metastasis.

“This case underscores the urgent need for early diagnosis of cardiac metastasis in patients with known primary tumors prone to such spread,” the authors concluded.

References

1. Alizadehasl A, Akhavan S, Hosseini Jebelli SF, et al. Metastatic soft tissue sarcoma with cardiac involvement: a case study on the role of multimodal imaging in diagnosis and management. Clin Case Rep. 2026;14(9):e72112. doi:10.1002/ccr3.72112
2. AJMC Contributor. Rare case of soft tissue sarcoma spreading to the heart highlights diagnostic, therapeutic challenges. AJMC®. October 31, 2025. Accessed September 30, 2026. https://www.ajmc.com/view/rare-case-of-soft-tissue-sarcoma-spreading-to-the-heart-highlights-diagnostic-therapeutic-challenges
3. Bagheri A, Khani M, Fesharaki MJ, et al. An unusual presentation of metastatic soft tissue sarcoma to the left atrium and pulmonary veins: a case report and comprehensive literature review. Clin Case Rep. 2025:13(10):e70991. doi:10.1002/ccr3.70991