A RARE CASE OF MYOCARDIAL INFARCTION DUE TO INTIMAL SARCOMA OF THE AORTIC ARCH

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Intimial sarcoma (IS) of the large systemic arteries are an extremely rare class tumors with only 81 reported cases in literature, most commonly arising abdominal aorta (1). Due to its nonspecific clinical presentation, IS is frequently diagnosed late disease process when metastasis has already developed, specifically lungs, organs, vertebral bone, and skin (2). Accurate diagnosis made immunohistochemical (IHC) staining positive for CD31, Fli-1, ERG1. We present a case aortic arch resulting fatal tumor embolism left coronary artery (LCA), as on autopsy. CASE PRESENTATION: A healthy 51-year-old male presented severe sharp pain thoracic spine. Physical exam was tenderness palpation mid-thoracic spine bilateral lower extremity (LE) neurological deficits. Magnetic resonance imaging (MRI) revealed bone lytic lesions from T5 T7 T6 compression fracture. computed tomography (CT) scan chest, abdomen, pelvis showed no evidence primary site. Biopsy metastatic unknown origin. The patient underwent palliative radiation therapy two weeks. One month after completion treatment, re-admitted worsening back pain. Repeat CT fractures extraosseous extension into prevertebral space. Subsequently, spinal cord decompression surgery. On post-operative day 4, he developed chest refractory ventricular fibrillation leading his death. Autopsy extending valve vertebrae thyroid gland. Ultimately, cause death due embolus that occluded LCA. DISCUSSION: Aortic neoplasm typically presents process. initial manifestation our other site radiologic modalities, despite retrospective analysis. It important be included differential origin order better understand course. To knowledge, this first metastases resulted myocardial infarction findings CONCLUSIONS: can classified as: Angiosarcoma, expressing endothelial-specific antigens, Myofibroblast, mesenchymal-specific antigens. Diagnosis tricky easily missed MRI. Definitive requires IHC Prognosis quite poor, mean survival period one year. REFERENCE #1: Sebenik, M., et al. (2005). Undifferentiated Intimal Sarcoma Large Systemic Blood Vessels. American Journal Surgical Pathology, 29(9), 1184-1193. #2: Staats, P., (2014). sarcomas iliofemoral arteries: clinicopathological study 26 cases. Pathology,46(7), 596-603 DISCLOSURES: No relevant relationships by Daniel Rushing, source=Web Response Amjed Zidan,