Cardiac tumors - malignant

Topic Completed: 1 October 2014

Revised: 27 September 2019

Copyright: 2007-2019, PathologyOutlines.com, Inc.

PubMed Search: Fibrosarcoma [title] heart

Nat Pernick, M.D.
Page views in 2018: 244
Page views in 2019 to date: 236
Cite this page: Pernick N. Fibrosarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/hearttumorfibrosarcoma.html. Accessed October 22nd, 2019.
Definition / general
  • Rare; 5% of cardiac sarcomas
  • Often left atrium; may present as congestive heart failure
Gross description
  • Soft, polypoid, gelatinous tumors that fill atrium or infiltrate ventricles or pericardium
  • Often necrotic
Microscopic (histologic) description
  • Herringbone pattern of compact fibroblastic type cells with tapered nuclei in collagenous or myxoid matrix
  • No intracytoplasmic glycogen, no perinuclear vacuoles, no pleomorphism, no histiocytoid cells
Microscopic (histologic) images
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Herringbone pattern of spindle cells

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Spindle cells with tapered nuclei in a collagenous background

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Monomorphous cell population in collagenized background

Positive stains
Electron microscopy description
  • Fibroblasts with granular or amorphic cytoplasm, dilated rough endoplasmic reticulum, sparse cytoplasmic organelles, infrequent nucleoli
  • Extracellular mature and immature collagen
Differential diagnosis
  • Fibroma in infants
  • Leiomyosarcoma: fascicles at sharp right angles but not herringbone, intracytoplasmic glycogen, perinuclear vacuoles, prominent myofilaments, basal lamina with EM, multinucleated giant cells occasionally
  • Malignant fibrous histiocytoma: histiocytoid cells and pleomorphism are prominent
  • Malignant solitary fibrous tumor of pericardium: similar histology but infiltrates pericardial space with little myocardial invasion
  • Mesothelioma: usually is biphasic, spindled areas are cytokeratin+
  • Osteosarcoma: has large areas of fibrosarcoma but also malignant osteoid
  • Synovial sarcoma: monophasic tumors have similar histology but tumor usually has cytokeratin+ epithelioid foci
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