Heart tumor
Cardiac tumors - malignant
Leiomyosarcoma

Authors: Nat Pernick, M.D. (see Authors page)

Revised: 27 September 2016, last major update May 2007

Copyright: (c) 2007-2016, PathologyOutlines.com, Inc.

PubMed Search: Leiomyosarcoma heart
Definition / General
Radiology Images

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Contributed by Dr. Shaesta Naseem Zaidi, King Khalid University Hospital (Saudi Arabia) - with heterologous differentiation:

CT - pulmonary angiogram

Case Reports
Treatment
Clinical Images

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Tumor over ventricle

Gross Description
  • 75% in left atrium, may appear to arise from pulmonary vein, sessile lesions may be grossly myxoid (Can J Cardiol 2001;17:331)
  • 30% are multiple
Gross Images

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Myxoid tumor



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Pleomorphic leiomyosarcoma

Micro Description
  • Compact bundles or fascicles oriented at right angles to each other
  • Spindled or epithelioid smooth muscle cells with cytoplasmic glycogen, blunted nuclei with moderate/marked pleomorphism, necrosis, mitotic activity
  • Occasionally giant cells, perinuclear vacuoles
  • May be low grade with few mitotic figures
Micro Images

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Images hosted on PathOut server:

Contributed by Dr. Shaesta Naseem Zaidi, King Khalid University Hospital (Saudi Arabia) - with heterologous differentiation:

H&E images

h-Caldesmon

Ki-67

SMA



Other images:

Low power shows border with normal cardiac muscle

Fascicles intersect at sharp angles and are composed of cells with blunt ended nuclei;
#3-also slight vacuolar appearance

Epithelioid appearance with round/oval nuclei

High power shows hyperchromatic ovoid nuclei with blunt ends

PAS shows diffuse punctate droplets of glycogen

Smooth muscle actin

Desmin



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Epithelioid and spindled areas

Various images

Positive Stains
  • PAS for intracytoplasmic glycogen, trichrome shows longitudinal fibers
  • Actin, desmin (usually)
Negative Stains
  • Cytokeratin (may be positive in epithelioid areas), S100
Electron Microscopy Description
  • Notched or infolded nuclei, thin actin filaments with focal densities, micropinocytotic vesicles, thin but distinct external lamina, dispersed glycogen, rare mitochondria or endoplasmic reticulum
Electron Microscopy Images

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Various images

Differential Diagnosis