Cardiac sarcoma presenting as paraneoplastic arthritis and clubbing: a case report and literature review

Natasha Ung; Carmella Gunasingam; Ken Cai; Nicholas Manolios; Angela Bayly; Phuong Dinh; Yishay Orr; Preeti Choudhary; Peter Wong

doi:10.1186/s41927-023-00350-x

Cardiac sarcoma presenting as paraneoplastic arthritis and clubbing: a case report and literature review

BMC Rheumatol. 2023 Sep 15;7(1):30. doi: 10.1186/s41927-023-00350-x.

Authors

Natasha Ung^{1

2}, Carmella Gunasingam¹, Ken Cai^{1

2}, Nicholas Manolios^{1

2}, Angela Bayly³, Phuong Dinh⁴, Yishay Orr^{2

5}, Preeti Choudhary^{2

6}, Peter Wong^{7

8

9}

Affiliations

¹ Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
² Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia.
³ Department of Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Westmead, NSW, Australia.
⁴ Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia.
⁵ Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW, Australia.
⁶ Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia.
⁷ Department of Rheumatology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia. Peter.Wong2@health.nsw.gov.au.
⁸ Westmead Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia. Peter.Wong2@health.nsw.gov.au.
⁹ Rural Clinical School, University of New South Wales, Coffs Harbour, NSW, Australia. Peter.Wong2@health.nsw.gov.au.

Abstract

Background: Cardiac tumours are rare, and clinical manifestations depend on the anatomical location. Symptoms can be the result of cardiac outflow anomalies, constitutional features such as fever, loss of weight, and/or paraneoplastic manifestations such as arthritis. To date, there has only been one other case report in the literature of cardiac sarcoma presenting as paraneoplastic arthropathy.

Case presentation: A 52-year-old woman presented with acute onset corticosteroid-resistant inflammatory polyarthralgia, clubbing and a systolic murmur. Transthoracic echocardiogram revealed a dilated left atrium with an echogenic mass and brain magnetic resonance imaging revealed multiple embolic infarcts. Histopathology following emergency resection showed a Grade 3 left atrial intimal sarcoma. The polyarthralgia and clubbing resolved soon after tumour removal. The patient went on to receive chemotherapy and remains in remission.

Conclusions: This case highlights the rare paraneoplastic association of cardiac sarcoma and arthropathy.

Keywords: Arthritis; Cardiac sarcoma; Paraneoplastic syndrome.