A huge primary pleomorphic liposarcoma of the left atrium

Primary cardiac tumors are exceptionally rare. Metastases of the heart occur 20–40 times more frequently than primary neoplasms [1]. Among primary cardiac tumors in adults, approximately 25% are malignant, and nearly all are sarcomas. Primary cardiac sarcomas are much more commonly reported than primary liposarcomas [2]. Primary liposarcomas of the heart are extremely rare neoplasms found in only about 1% of all primary malignant cardiac tumors. Only a few cases of primary cardiac liposarcoma have been reported [3–5].
We report a case of resection of left atrial primary liposarcoma.
A 21-year-old woman (gravida 1, para 1, 0 Rh plus) was admitted with a presumptive diagnosis of acute endocarditis and mitral valve vegetations. On admission she presented an 8-week history of progressive dyspnea, malaise, fever, cough and sore throat. During this time she was treated with antibiotics without results. She was free of cardiovascular disease or other symptoms until fever developed. Auscultation revealed tachycardia, continuous murmur (Levine 4/6) over the apex and rales over all pulmonary fields. Electrocardiography showed tachycardia with normal 12-lead ECG. Chest roentgenogram showed a small tent-shaped adhesion over the left diaphragm dome. Other X-ray findings were within the normal range. The laboratory examination on admission revealed anemia (with Hb 9.1 g/dl and Hct 29.6%) and thrombocytopenia (with Plt 57.5 × 103/l). Transthoracic two-dimensional echocardiography revealed a large mass extending from the left atrium through the mitral valve to the left ventricular outflow tract (Fig. 1).
The patient underwent an emergency operation. Surgery was performed through a median sternotomy with cardiopulmonary bypass and mild hypothermia. The tumor originated from the wall of the left atrium, between the right superior and right inferior pulmonary veins. It extended to the left ventricle outflow tract and almost completely blocked the mitral valve orifice. En bloc resection was performed and the tumor pedicle was shaved from the atrial myocardium. The tumor was a 25 cm long, cone-shaped structure with a 4 cm diameter base and 0.5 cm diameter apex (Fig. 2). Aorta cross clamping time was 45 min and time of extracorporeal circulation was 70 min.
Pathologic analysis of the resected specimen revealed neoplasma malignum anaplasticum mesenchymale–differentiated pleomorphic liposarcoma (Fig. 3). Bacteriological examinations of the tumor and...


View full text...