A rare case of primary cardiac sarcoma with both intracranial metastasis and embolic infarction in a pediatric patient.

An 18-year-old Hispanic male with an unremarkable medical history presented with a 1-month history of progressive, intermittent headaches, nausea, and diplopia. Upon seeking care, a head CT revealed a solid right frontal lesion and a large, complex cystic parieto-occipital lesion exerting significant mass effect on surrounding structures. The patient initially underwent a left parietal craniotomy for tumor resection, followed by resolution of his neurological symptoms. However, surveillance imaging 1 month later identified a known left atrial cardiac mass and new intracranial embolic infarcts, alongside a 6-cm recurrence at the primary resection site. The patient subsequently underwent a sternotomy for resection of the primary cardiac sarcoma and reconstruction of the left atrium. Shortly after, a second craniotomy was required for resection due to rapid cystic recurrence of the brain metastasis causing midline shift and new focal neurological deficits. Following successful gross-total re-resection, the patient underwent hypofractionated Gamma Knife radiosurgery. He is also undergoing chemotherapy. Six-week follow-up imaging confirmed a positive response to treatments, showing no new metastatic growth and a reduction in the size of existing lesions. This case highlights the aggressive nature of primary cardiac sarcoma and the necessity of multimodal, repeat surgical intervention for CNS involvement.