Acute myocardial infarction caused by coronary tumor embolism from uterine leiomyosarcoma: a case report

Background: Tumor embolism to the coronary arteries is an extremely rare cause of acute myocardial infarction (AMI). It has been reported in lung and breast cancers but not in uterine leiomyosarcoma. Herein, we present a case of AMI caused by a coronary tumor embolism from uterine leiomyosarcoma, which was successfully treated with aspiration thrombectomy. Case presentation: A 51-year-old woman with metastatic uterine leiomyosarcoma underwent surgical resection followed by adjuvant chemotherapy. During her second trabectedin cycle, she developed acute chest pain and dyspnea. Electrocardiography revealed anterior AMI. Emergency coronary angiography demonstrated complete occlusion of the left anterior descending and circumflex arteries. Thrombus aspiration completely restored coronary flow. Histopathological examination of the aspirated material confirmed leiomyosarcoma. Following aspiration, her symptoms subsided and she was discharged and prescribed cardioprotective medications. No recurrent cardiac events occurred. Conclusion: While most AMI events result from thrombotic occlusion and respond to anticoagulation, tumor emboli require mechanical intervention. Aspiration thrombectomy proved effective in this case. Clinicians should recognize that tumor embolism can induce AMI even in previously unreported cancer types, as pulmonary metastases may invade the pulmonary veins enabling tumor fragments to enter systemic circulation. Early recognition and intervention are critical for survival in these patients. Tumor embolism should be considered in the differential diagnosis of patients with cancer presenting with unexplained chest pain or dyspnea.