{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T19:18:18Z","timestamp":1787685498968,"version":"build-2784847793"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Primary cardiac tumours are rare. When patients present with both cardiac and extracardiac masses, clinicians may opt to biopsy accessible peripheral lesions to guide diagnosis, but benign findings can provide false reassurance. This case demonstrates the diagnostic pitfall of this approach when multiple concurrent pathologies coexist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 79-year-old male presented with progressive peripheral oedema, dyspnoea, and chest pain. Echocardiography revealed a 6.5\u2005cm mobile intracardiac mass originating from the right atrial appendage. Pericardiocentesis drained 1100\u2005cc of haemorrhagic fluid with negative cytology. PET-CT showed FDG uptake in the cardiac mass as well as multiple extracardiac lesions. Biopsy of a left upper arm lesion revealed a benign peripheral nerve sheath tumour. Photon-counting CT deemed angiosarcoma less likely due to limited contrast enhancement. These findings combined initially lowered suspicion for cardiac malignancy. The patient underwent surgical resection via median sternotomy. Histopathology revealed a high-grade angiosarcoma with positive resection margins (CD31+, CD34+, ETS-Related Gene [ERG]+, Ki-67 40%\u201360%). The postoperative course was uncomplicated, and the patient was transferred to the referring hospital on postoperative day four.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case demonstrates that benign pathology from peripheral lesions should not eliminate suspicion for cardiac malignancy when clinical features such as haemorrhagic pericardial effusion, right heart failure, and thromboembolic complications are present. Multiple concurrent pathologies can coexist, underlining the limitations of extrapolating peripheral biopsy results to cardiac masses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag591","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:16:49Z","timestamp":1786965409000},"source":"Crossref","is-referenced-by-count":0,"title":["Coexisting benign and malignant tumours: a cardiac angiosarcoma case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9105-7835","authenticated-orcid":false,"given":"Tiemen E T","family":"Holtrop","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Erasmus MC Rotterdam , Dr. Molewaterplein 40, Rotterdam 3015GD ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2519-991X","authenticated-orcid":false,"given":"Sulayman","family":"el Mathari","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Erasmus MC Rotterdam , Dr. Molewaterplein 40, Rotterdam 3015GD ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3960-8035","authenticated-orcid":false,"given":"Jonathan","family":"Etnel","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Erasmus MC Rotterdam , Dr. Molewaterplein 40, Rotterdam 3015GD ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3480-634X","authenticated-orcid":false,"given":"Loudy P","family":"Priesterbach-Ackley","sequence":"additional","affiliation":[{"name":"Department of Pathology, Erasmus MC Rotterdam , Dr. Molewaterplein 40, Rotterdam 3015GD ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5942-4727","authenticated-orcid":false,"given":"Jolanda","family":"Kluin","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Erasmus MC Rotterdam , Dr. Molewaterplein 40, Rotterdam 3015GD ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"2026082514271145100_ytag591-B1","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.athoracsur.2015.07.087","article-title":"Surgical treatment of primary cardiac sarcomas: review of a single-institution experience","volume":"101","author":"Ramlawi","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2026082514271145100_ytag591-B2","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1136\/heartjnl-2014-306364","article-title":"Cardiac masses and tumours","volume":"102","author":"Basso","year":"2016","journal-title":"Heart"},{"key":"2026082514271145100_ytag591-B3","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jaccao.2020.05.009","article-title":"Cardiac tumors: JACC CardioOncology state-of-the-art review","volume":"2","author":"Tyebally","year":"2020","journal-title":"JACC CardioOncol"},{"key":"2026082514271145100_ytag591-B4","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ejca.2013.09.012","article-title":"Primary cardiac sarcomas: a retrospective study of the French Sarcoma Group","volume":"50","author":"Isambert","year":"2014","journal-title":"Eur J Cancer"},{"key":"2026082514271145100_ytag591-B5","first-page":"e41947","article-title":"Primary cardiac angiosarcoma: a review","volume":"15","author":"Kumari","year":"2023","journal-title":"Cureus"},{"key":"2026082514271145100_ytag591-B6","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1055\/s-2007-989292","article-title":"Angiosarcoma of the right atrium masquerading as recurrent pulmonary embolism","volume":"56","author":"O\u2019Callaghan","year":"2008","journal-title":"Thorac Cardiovasc Surg"},{"key":"2026082514271145100_ytag591-B7","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1136\/heart.85.2.218","article-title":"Cardiac tumours: diagnosis and management","volume":"85","author":"Shapiro","year":"2001","journal-title":"Heart"},{"key":"2026082514271145100_ytag591-B8","first-page":"39","article-title":"Primary cardiac angiosarcoma: a diagnostic challenge in a young man with recurrent pericardial effusions","volume":"17","author":"Riles","year":"2012","journal-title":"Exp Clin Cardiol"},{"key":"2026082514271145100_ytag591-B9","doi-asserted-by":"crossref","first-page":"e04582","DOI":"10.1002\/ccr3.4582","article-title":"Primary cardiac angiosarcoma directly invading the right lung: an autopsy report","volume":"9","author":"Kiwaki","year":"2021","journal-title":"Clin Case Rep"},{"key":"2026082514271145100_ytag591-B10","first-page":"2053","article-title":"18F-FDG PET\/CT imaging features of benign schwannomas","volume":"60","author":"Monson","year":"2019","journal-title":"J Nucl Med"},{"key":"2026082514271145100_ytag591-B11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4274\/mirt.02486","article-title":"18F-FDG PET-CT for evaluation of cardiac angiosarcoma: a case report and review of literature","volume":"24","author":"Dhull","year":"2015","journal-title":"Mol Imaging Radionucl Ther"},{"key":"2026082514271145100_ytag591-B12","doi-asserted-by":"crossref","first-page":"102867","DOI":"10.1016\/j.jaccas.2024.102867","article-title":"Unveiling cardiac mysteries: the role of endomyocardial biopsy in diagnosing heart masses","volume":"30","author":"Al-Dalakta","year":"2025","journal-title":"JACC Case Rep"},{"key":"2026082514271145100_ytag591-B13","doi-asserted-by":"crossref","first-page":"e22536","DOI":"10.1200\/JCO.2017.35.15_suppl.e22536","article-title":"The role of endomyocardial biopsy in cardiac tumors diagnosis","volume":"35","author":"Ionescu","year":"2017","journal-title":"J Clin Oncol"},{"key":"2026082514271145100_ytag591-B14","first-page":"197","article-title":"Cardiac angiosarcoma: two cases and a review of the literature","volume":"16","author":"Butany","year":"2000","journal-title":"Can J Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag591\/70675288\/ytag591.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/8\/ytag591\/70675288\/ytag591.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/8\/ytag591\/70675288\/ytag591.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:27:19Z","timestamp":1787682439000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag591\/8763025"}},"subtitle":[],"editor":[{"given":"Takeshi","family":"Kitai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Marco","family":"Angelillis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Mattia","family":"Alberti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Muhammad Junaid","family":"Ahsan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":14,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,7,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag591","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,31]]},"article-number":"ytag591"}}