Successful multidisciplinary clinical approach and molecular characterization by whole transcriptome sequencing of a cardiac myxofibrosarcoma: A case report

Figure 1 Histology of the cardiac mass showing a uniform proliferation of spindle cells on a collagenous myxoid background, with medium cellularity, mild to moderate pleomorphism and prominent vascularization. Haematoxylin-eosin, original magnification: A: 100 ×; B: 200 ×; C: 400 ×; Diffuse immunostaining for vimentin, D: 200 ×; and multifocal immunostaining for smooth muscle actin, E: 200 ×; Ki-67 labeling index: ca 35% of tumor cells, F: 200 ×.

Figure 2 Whole-Transcriptome Sequencing analysis of myxofibrosarcomas (yellow) compared to intimal sarcomas (green) and angiosarcomas (cyan). A: Hierarchical clustering analysis, performed on the specific gene signature, differentially expressed between angiosarcomas and intimal sarcomas, highlight the similarity of myxofibrosarcomas with angiosarcomas; B: Principal component analysis shows the clustering of myxofibrosarcomas closer to angiosarcomas.

Figure 3 ¹⁸F-FDG PET/CT transaxial images of left atrial sarcoma. A: Faint fluorodeoxyglucose uptake at primary staging (SUVmax = 4.8); B: Complete metabolic normalization after three cycles of doxorubicin.

Figure 4 Expression of genes in myxofibrosarcomas (yellow), intimal sarcomas (green) and angiosarcomas (cyan). A: Expression profiles of IFI6, LGALS3, ANXA1 and ASS1 genes defined as up-regulated in gemcitabine resistance by Tooker et al[4]; B: Expression profiles of CYB5A, SCD, ADD3, HSPB1, SMS, WWTR1, and RHOB genes defined as down-regulated in gemcitabine resistance by Tooker et al[4]. Asterisk: Log2 cpm was previously centered by subtracting the average expression value.

Figure 5 ¹⁸F-FDG PET/CT transaxial images of left atrial sarcoma. A: Faint fluorodeoxyglucose uptake of tumor relapse (SUVmax = 3.5); B: Complete metabolic normalization after six cycles of gemcitabine.