Unusual pulmonary lesions: case 3. Pulmonary vein leiomyosarcoma presenting as a left atrial mass

Adjuvant chemoradiation for high-grade cardiac leiomyosarcoma in a child: Case report and review of literature

A 13-year-old healthy girl presented with dizziness and palpitations, found to have a left atrial mass. An 8-cm tumor was removed en bloc. Pathology confirmed grade 3 leiomyosarcoma with multifocal positive margins. She received adjuvant ifosfamide and doxorubicin, followed by concurrent proton radiotherapy and ifosfamide. Radiotherapy included 66 Gy (RBE) in 33 fractions to the operative bed. Prospectively graded toxicities included Grade 2 esophagitis and Grade 1 anorexia, dermatitis, and fatigue. She completed six cycles of ifosfamide. Two years post operation, she had no evidence of disease, intermittent palpitations with normal cardiac function, and no other cardiopulmonary or esophageal symptoms.

An Extemly Rare Case of Left Atrium and Right Pulmonary Vein Leiomyosarcoma

We report a case of a 43-year-old female, presented with complaints of breathlessness for 1 month and had three episodes of syncopal attacks in the past two months. On clinical evaluation, bilateral pedal oedema was noticed. Echo cardiogram revealed large left atrial blood clot measuring 5.7x4.3x4.3 cm. Ultrasound whole abdomen was normal. We received an excised mass with right pulmonary vein end arterectomy speciemen. Histopathology of the mass revealed characteristic features of leiomyosarcoma with grade III, according to FNCCS grading system. The tumour was consistent with substantial amount of poorly differentiated fasicles of pleomorphic spindle cells and brisk atypical mitosis, with marked necrosis. Immunohistochemistry revealed the tumour cells in strong diffuse cytoplasmic positive for smooth muscle actin and Ki-67 showed 15-20% of tumour cells postivity. The prognosis depends on the individual tumour origin for individual site, size of tumour and depth of tumour than histological features. Pulmonary venous leiomyosarcomas were assumed to be misinterpretation of left atrial leiomyosarcomas with growth of the tumour into pulmonary vein lumen. We report this case in view of its extreme rarity.

Leiomyosarcoma of the right inferior pulmonary vein: 2 years survival with multimodality therapy

Primary leiomyosarcoma of the heart is an extremely rare and aggressive tumor. The authors report a case of a 29-year-old man with a leiomyosarcoma of the right inferior pulmonary vein who underwent surgery, chemotherapy, and radiotherapy. The patient experienced two local recurrences and he finally died 2 years after onset of symptoms because of multiple distal metastases.

Primary left atrial leiomyosarcoma: literature review and lessons of a case

Primary cardiac sarcoma is an uncommon disease. In particular, leiomyosarcoma of cardiovascular origin is extremely rare. Half of all cardiac leiomyosarcomas are located in the left atrium. Due to the extreme rarity of left atrial leiomyosarcoma, there is no great experience in its management. This review includes a report of a case of left atrial leiomyosarcoma followed up over 45 months. The literature review examines the distribution of left atrial leiomyosarcoma, the physiological reasons for the tendency of cardiac leiomyosarcoma to be localized to the left atrial cavity, the clinical and physical appearance of this disease, and the key differences between left atrial leiomyosarcoma and the most common left atrial tumor, myxoma. The morphological features, using light and electron microscopy and immunochemical staining, are discussed. Treatment modalities including adjuvant therapy and surgical resection are examined and their effectiveness compared. Opinions regarding the results and optimal treatment of leiomyosarcoma are not always in agreement. This highlights the need for inter-hospital comparison to determine the optimal treatment regimen.

Cardiac intracavitary metastasis of a malignant solitary fibrous tumor: case report and review of the literature on sarcomas with left intracavitary extension

BACKGROUND

Solitary fibrous tumor (SFT) of the pleura with malignant progression occurs uncommonly. Cardiac intracavitary extension of tumors is rarely seen, with left side location being exceptional.

METHODS AND RESULTS

The authors report the first case of a malignant SFT metastatic to the heart occurring in a 74-year-old woman. The tumor first presented as a slow-growing pleural SFT that in 6 years reached a size of 16 cm. Two months after a complete surgical resection, the tumor was found to spread to the left atrium by intracavitary extension from the left upper pulmonary vein, simulating a cardiac myxoma. The primary tumor showed established features of malignancy including size greater than 10 cm; gross findings of necrosis; high cellularity, cytological atypia, and eight mitoses per 10 high-power fields. Immunohistochemical study revealed positivity of the tumor cells for CD34, bcl-2, and CD99. Aside from the present report, 52 previous cases of sarcoma with intracavitary extension to the left side of the heart have been described. Bone sarcoma is the type most frequently found. Peripheral arterial embolism can be a complication of advanced mesenchymal malignancy in 21% (11/53) of reported cases.

CONCLUSION

Accurate histopathologic recognition of this rare type of metastatic disease is important because of the adverse prognosis as compared to cardiac myxoma.

A case of pulmonary vein tumor presenting as a left atrial mass

Primary cardiac tumors are extremely rare and can originate within the heart or be the result of tumor spread from other sites. We report a female patient with a pulmonary vein tumor extending into the left atrium that had a suspicious primary malignant origin with a sacral metastatic carcinoma. The patient was admitted complaining of pain in her buttock area as a result of a sacral tumor. It was believed that the sacral tumor was a metastasis from the imaging study and clinical manifestation. The primary malignant origin was evaluated. The chest CT showed a left atrium thrombus-like lesion without a pulmonary abnormality. After a transesophageal echocardiogram, the patient was diagnosed with a pulmonary vein tumor extending to the left atrium. The patient was given palliative radiotherapy for the sacral pain. Initially, the clinical impression was a metastatic sacral tumor with a thromboembolism of the left atrium. However, this patient was finally diagnosed with a pulmonary vein tumor with a left atrium extension by a transesophageal echocardiogram.

Intracardiac Extension of Metastatic Pulmonary Leiomyosarcoma

Leiomyosarcomas are uncommon malignancies of soft tissue associated with a poor prognosis due to local and metastatic disease. We describe an example of metastatic pulmonary leiomyosarcoma with intracardiac extension in a patient who had previously undergone resection of a primary retroperitoneal mass. Distinguishing metastatic malignancy within the heart from a primary tumour, such as atrial myxoma, may be difficult, with the use of various imaging modalities assisting in diagnosis and management. In this case, the patient's course was complicated by dramatic progression with widespread emboli resulting in peripheral arterial occlusion and stroke.