Primary Ewing Sarcoma in the Right Ventricle in an Adult Patient: A Case Report

Abstract

Ewing's sarcoma, a highly aggressive, round-cell neoplasm of unknown origin, rarely manifests as a primary occurrence in the heart. In this intriguing case, we present a report of primary Ewing sarcoma in the right ventricle of an adult patient.

The patient was a 27-year-old man who presented with epigastric pain, fever, tachycardia, nausea, vomiting, shortness of breath, and dry cough. CT scan and echocardiogram showed an anterior mediastinal mass originating from the free wall of the right ventricle and located in the pericardium. It was causing pressure on the right ventricular outflow tract (RVOT) and pulmonary artery.

Based on the clinical conditions and paraclinical findings, a decision was made for surgical treatment. The mass was carefully separated from the heart tissue, and the RVOT was resected along with the pulmonary valve and the main pulmonary artery. This was repaired with a Dacron composite graft and anastomized to the bifurcation of the main pulmonary artery. The mass near the superior vena cava and the area of the pulmonary vein was also meticulously removed.

The patient was successfully removed from the cardiopulmonary pump in a stable condition and transferred to the intensive care unit. Histopathology results confirmed the presence of small round cell sarcoma and Ewing sarcoma in the patient. The patient was discharged and scheduled for regular follow-up visits.

Following discharge, the patient was referred to the radiotherapy center and underwent radiotherapy. In a re-examination after one year, the absence of any signs of disease recurrence or re-engagement provided a beacon of hope and optimism. This case suggests that timely referral and treatment of Ewing's sarcoma in the heart can lead to a better prognosis.