2 Case Reports in Medicine Figure 1: H & E stain of renal biopsy: Light micrograph suggestive of membranoproliferative glomerulonephritis showing hypercellu- lar glomeruli with prominence of mesangial matrix. Figure 2: Computed tomography scan of the chest showing the right atrial mass and pericardial eﬀusion. suspicious for metastasis. In addition, a heterogeneously enhancing mass with features of central necrosis was present in the right atrioventricular groove invading the wall of the right atrium (Figure 2). An ultrasound-guided needle core biopsy of a hepatic lesion revealed an angiosarcoma (Figure 3). This was presumed to be of cardiac origin based on the imaging features. Patient opted for palliative treatment with hospice care. 3. Discussion Primary tumors of the heart are rare with the incidence varying from 0.001% to 0.03% [2]. Further malignant tumors account for just 25% of the primary cardiac tumors [3]. Angiosarcomas account for around 33% of all primary malignant cardiac tumors. They are however exceedingly rare with an incidence of only 0.0001% in autopsy series [4]. Primary cardiac angiosarcomas rarely cause symptoms until late in the clinical course. Most of the symptoms are due to either pericardial eﬀusion with or without cardiac tamponade, venal caval obstruction, arrhythmias, or related to metastases to other organs [5]. In fact, 66% to 89% of patients have metastatic disease at presentation [6]. Common sites of metastases include the pericardium, lungs, liver, mediastinal lymph nodes, and bone [5]. Figure 3: H & E stain of the liver biopsy—angiosarcoma with hyperchromatic spindle cells. Paraneoplastic glomerulopathies are rare manifestations of neoplastic disease. Nephrotic syndrome is the most com- mon presentation of these paraneoplastic glomerulopathies. Diﬀerent glomerular diseases are associated with diﬀerent neoplasia, such as membranous nephropathy in patients with solid tumors and minimal changes disease which is strongly associated with Hodgkin’s lymphoma [7]. Sarcomas have rarely been associated with paraneoplastic glomerulopathy. In a recent review of the literature by Bacchetta et al. [1], 6 cases of sarcoma with paraneoplastic glomerulonephritis were identiﬁed [1]. Pathology in three of them was consistent with membranous nephropathy where as there was one case each associated with minimal change disease, focal and segmental glomerulosclerosis, and with mesangiocapillary glomerulonephritis. To our knowledge, no cases of glomeru- lopathy associated with cardiac angiosarcoma have been reported in the literature. A temporal relationship between the glomerulopathy and the cancer is suspected when kidney dysfunction develops 6 months before or after the diagnosis of malignancy [8]. The syndrome often precedes discovery of tumor by several months. This is illustrated by a study which showed protein- uria preceded or occurred at the same time as cancer in 80% of patients [9]. Although the pathological mechanism for paraneoplastic glomerulopathy remains unknown, tumor- associated immune complexes and deposit nephritogenicity have been implicated in glomerular injury and overt neoplas- tic renal disease [10]. In our patient, membranoproliferative glomerulonephri- tis developed almost ﬁve months before the diagnosis of metastatic angiosarcoma. The initial diﬀerential diagnosis of the glomerulopathy included vancomycin-induced or postinfectious etiologies. There were, however, no features of drug toxicity on kidney biopsy and no evidence of supratherapeutic levels during drug monitoring. There was no convincing evidence of a postinfectious etiology either. Though the patient was treated as presumptive bacterial pericarditis, the clinical presentation was not consistent with the diagnosis. The coagulase negative staphylococcus may have been a contaminant and was not isolated in any other body ﬂuid. In addition, bacteria rarely cause hem- orrhagic pericardial eﬀusion; iatrogenesis and malignancy