1. “Second” Primary Cardiac Sarcoma in a Patient With Ewing Sarcoma
“Second” Primary Cardiac Sarcoma in a Patient With Ewing Sarcoma. Always Expect The Unexpected 
Antonino Di Franco, MD, Mario Gaudino, MD, Jonathan W. Weinsaft, MD, Shawn C. Pun, MD, Navneet Narula, MD, Saadat A. Khan, MD, Zahra M. Malik, MD, Lucas B. Ohmes, MD, Nickolaos J. Skubas, MD, Leonard N. Girardi, MD 
The Annals of Thoracic Surgery 
Volume 103, Issue 2, Pages e131-e133 (February 2017)
DOI: /j.athoracsur
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Pathology images. (A) Hematoxylin and eosin stain of the Ewing sarcoma. (B) CD99 stain of the Ewing sarcoma, showing diffuse positivity. (C) The intracardiac mass is composed of cellular and myxoid areas (original magnification ×10). (D) The cellular areas of the intracardiac mass are composed of spindle cells with mild pleomorphism. No mitoses or necrosis is seen (original magnification ×20). (E) The spindle cells are positive for smooth muscle actin (original magnification ×10). (F) Immunostain of the intracardiac mass for CD34 is negative in tumor cells. Vessels are positive (original magnification ×10).
The Annals of Thoracic Surgery  , e131-e133DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Magnetic resonance imaging (MRI) of the intracardiac mass. (A) Cine-MRI image of ovoid right-ventricular mass (arrow) attached to the interventricular septum. (B) Delayed enhancement MRI tissue characterization demonstrates peripheral enhancement and central hypo-enhancement (consistent with necrosis; arrow).
The Annals of Thoracic Surgery  , e131-e133DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Intraoperative images. (A) Intraoperative transesophageal two-dimensional echocardiogram showing a round echo density filling the right ventricle (RV) apex, without obstruction of the RV inflow or outflow (arrow). (B) The mass was directly visualized in the distal third of the right side of the interventricular septum, protruding through the RV free wall. (C) Specimen submitted to pathology laboratory.
The Annals of Thoracic Surgery  , e131-e133DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions