Uterine sarcoma with extensive cardiac metastatic involvement: A rare cardio oncology presentation

Abstract

A 67-year-old postmenopausal woman presented with chest pain and progressive exertional dyspnea. Multimodality cardiac imaging revealed large intracardiac masses involving the right ventricle (RV) and left ventricle with pericardial involvement, RV outflow tract obstruction, impaired RV systolic function, and moderate-gross pericardial effusion. Positron emission tomography/Computed tomography demonstrated widespread fluorodeoxyglucose-avid disease, including mediastinal and supraclavicular nodes, bilateral pulmonary nodules, and a bulky uterine subserosal mass. Ultrasound-guided uterine biopsy confirmed a high-grade spindle cell sarcoma (SMA positive, PanCK negative) with oncogenic alterations in PTEN and TP53 and CCND1 amplification. The patient received symptom-directed cardiac care and dose-adjusted palliative chemotherapy with clinical improvement in oxygen requirement and performance status. This case highlights diagnostic challenges and the need for coordinated cardio-oncology management when uterine sarcoma metastasizes to the heart.