This is an angiosarcoma arising in the epicardium in the groove between the right atrium and right ventricle. Though rare, it is one of the most common primary malignancies involving the heart. (The most common primary cardiac neoplasm is an atrial myxoma). Grossly, it is a variegated, hemorrhagic mass. The neoplastic cells in this case are oblong to spindle-shaped and form ill-defined vascular spaces. Immunoperoxidase staining was positive for vimentin and CD-34, but negative for cytokeratin. In the differential diagnosis is Kaposi sarcoma, which usually is manifested by multiple nodules that rarely exceed 2 cm in size. Mesotheliomas tend to encase the heart and are CD-34 negative. In this case, complete resection along with orthotopic cardiac transplantation was performed. However, there is a great tendency for cardiac sarcomas to recur locally.
There were 32 correct responses out of 165 total entries for case 45.
| Our winner is: Irma Eraña of Monterrey, Nuevo Leon, MEXICO
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