Pericardial metastasis of myxoid liposarcoma causing cardiac tamponade

Although myxoid liposarcoma often metastasizes to various organs, cardiac metastasis is rare. We present herein a rare case with pericardial metastasis of myxoid liposarcoma, which expanded the pericardial sac extraordinarily and required an emergency operation because of acute cardiac tamponade. We undertook a review of the English literature regarding liposarcoma.     

Cardiac metastatic liposarcoma.

Metastatic cardiac liposarcoma is extremely rare, with only 2 cases previously reported, to our knowledge; of those, only 5 involved surgical resection of right ventricular liposarcoma. The first such case in Japan involved a 61-year-old woman with metastatic liposarcoma of the right ventricle. Despite emergency resection, the patient died of severe congestive heart failure 6 days after operation. Her history included surgery for liposarcoma in the right knee 11 years previously, although it is very difficult to predict that metastasis would proceed thereafter to the cardiac cavity. This rare case suggests, however, that follow-up including examination for cardiac lesions is necessary long after resection of the primary lesion.     

Surgical Treatment for Epicardial Metastasis of Myxoid Liposarcoma Involving Atrioventricular Sulcus

Abstract   We report the case of a 52-year-old man who presented with a cardiac metastasis of myxoid liposarcoma invading the atrioventricular sulcus. The tumor was arising from the anterior wall of the right atrium and basal right ventricle. After complete resection of the tumor (14 × 7.5 × 6 cm, 279 g), the annulus had no strong supporting tissue because of invasion of the atrioventricular sulcus. The tricuspid valve was reconstructed with reinforcement of the annulus using an autologous pericardial strip. The defect of the right atrial wall was reconstructed with a pericardial patch. After the reconstruction, echocardiography showed grade 1 tricuspid regurgitation. Although the patient had a small metastasis to the lung after surgery, he is doing well after 31-month follow-up. We believe that it is justified to perform aggressive resection with annuloplasty, when it is feasible, for cardiac metastasis of myxoid liposarcoma.     

Primary cardiac synovial sarcoma —A case report—

We report a case of cardiac synovial sarcoma, a very rare primary tumor of the heart. The patient was a 29-year-old man with chief complaint of dyspnea. On echocardiography, a tumor 42 mm in diameter occupying the most space of the left atrium was found. The tumor was obstructed the opening of the mitral valve. He was diagnosed with heart failure due to disturbance of the pulmonary venous return and hemodynamic mitral valve stenosis, and underwent surgery. The tumor was a 5-cm sphere originating in the left atrial posterior wall, and was covered with a sheath and solid. The atrial posterior wall was covered with a peel that appeared to be tumor tissue, and this tissue expanded toward the openings of the pulmonary veins bilaterally and the posterior cusp of the mitral vavle. The tumor was resected together with the posterior wall. On pathologic examination, the tumor was diagnosed as a synovial sarcoma. Since no other primary focus was found, this tumor was judged to be a primary sarcoma of the heart. The patient was discharged with elimination of symptoms. The sarcoma recurred after 4 months, and the patient underwent a second operation. The recurrent tumor began from the site of resection of the previous operation and expanded up to the inferior pulmonary veins bilaterally. A wide area of the left atrial wall including the tumor was resected, and he was discharged again. The sarcoma recurred again, and he died of progression of heart failure and aggravation of general conditions after 8 months from the first operation.     

A lung metastasis from giant cell tumor of bone at eight years after primary resection

We report a case of extensive pulmonary metastasis from a histologically benign giant cell tumor. A 34-year-old woman had undergone tumor resection, curettage and artificial bone grafting for giant cell tumor in the left tibia. At eight years after surgery, a chest radiograph revealed an extensive tumor shadow in the right thoracic cavity. Tumor resection with right upper and middle bilobectomy was performed. Its histological features were consistent with those of the primary tumor of the tibia. Distant metastases from a giant cell tumor of bone are rare, with only 50 reported cases. Metastasis has occurred mainly within 3 years after the primary resection. However, in 20% of reported cases, metastasis occurred after 5 years or longer. Long-term follow-up and careful observation for distant metastasis are necessary for this histologically benign disease.     

A lung metastasis from giant cell tumor of bone at eight years after primary resection.

We report a case of extensive pulmonary metastasis from a histologically benign giant cell tumor. A 34-year-old woman had undergone tumor resection, curettage and artificial bone grafting for giant cell tumor in the left tibia. At eight years after surgery, a chest radiograph revealed an extensive tumor shadow in the right thoracic cavity. Tumor resection with right upper and middle bilobectomy was performed. Its histological features were consistent with those of the primary tumor of the tibia. Distant metastases from a giant cell tumor of bone are rare, with only 50 reported cases. Metastasis has occurred mainly within 3 years after the primary resection. However, in 20% of reported cases, metastasis occurred after 5 years or longer. Long-term follow-up and careful observation for distant metastasis are necessary for this histologically benign disease.     

Malignant fibrous histiocytoma in the chest cavity, report of four resected cases

Case 1: 35-year-old man. Chest X-P showed a mass shadow, which was 6 X 5 cm in size, well defined margin and homogeneous. He underwent enucleation but died 6 months after operation with local recurrence. Case 2: 55-year-old man. A peduncle tumor, which was 5 X 4 cm in size, arising from the left parietal pleura was resected. 2 years after the operation, local recurrence occurred at left parietal pleura and the lesion was resected. 9 years after the first operation, he is still alive free from the disease. Case 3: 62-year-old man. Multiple masses which invaded to the chest wall involving rib, lung and pericardium were situated in the site of left parietal pleura. He underwent partial resection of chest wall, parietal pleura, pericardium and lung, but he died 8 months after the operation with local recurrence. Case 4: 49-year-old man, a mass which completely obstructed the left main pulmonary artery situated at the site of left hilar region. He underwent left pneumonectomy. 2 year after the operation, he is still alive free from the disease. Malignant fibrous histiocytoma in the chest cavity is very rare in frequency. We have experienced recently 4 cases, and discussed with literature.     

Retroperitoneal mixed type liposarcoma: a case report

Primary retroperitoneal tumors are reported to account for 0.2% of all malignancies. Furthermore, 10-20% of all primary retroperitoneal tumors are liposarcomas. Up to 1989, 213 cases of retroperitoneal liposarcoma have been reported in the Japanese literature to our knowledge. Mixed type liposarcomas were rare, and composed 13.8% of all retroperitoneal liposarcomas in this series. We described here a case of retroperitoneal mixed type liposarcoma. A 50-year-old man was admitted to our department with a mass in the left abdomen. Computed tomography and aortography revealed a huge and hypovascular tumor in the retroperitoneal cavity, not containing fat tissue. It was diagnosed as a retroperitoneal tumor and treated surgically. The tumor and the left kidney were encapsulated and could be removed en bloc. The size and weight of the tumor were 28 x 18 x 12 cm and 3,100 g, respectively. Histological examination of the mass proved it to be a mixed type liposarcoma. He was administered OK-432 as adjuvant therapy. After 11 months, bone metastasis to the vertebra appeared. Moreover, lung metastasis also occurred and he died of the disease 15 months after the operation.     

Case with cardiac myxoma causing cerebral metastasis after cardiac tumor resection

We report a case of cardiac myxoma causing cerebral metastasis after cardiac tumor resection. A 68-year-old man with a cerebral infarction was admitted to our hospital. A cardioembolic source was suspected and echocardiography was performed. In that examination, a cardiac tumor was found in the left atrium. Tumor resection was performed urgently and his postoperative course was uneventful. After the operation he had no new episodes of cerebral deficit. However 6 months after the operation, he complained of headaches. The brain computed tomography (CT) showed there were multiple high-density areas. One of the tumors was resected and the tumor was diagnosed pathologically as metastasis of cardiac myxoma. Brain metastases were treated with 40.8 Gy whole-brain radiation therapy. As the result the tumors were effectively treated and reduced.     

Liposarcoma of the breast,review of the literature and a report of a case

A case of gigantic liposarcoma of the breast in a 52-year-old woman was reported. She had a small indolent mass in the left breast for twenty years. The mass grew rapidly from the summer of 1979 and became gigantic and penetrated the skin over the mass. Her general condition on admission was poor but resection, of the tumor was carried out. She suddenly died of cardiac failure with electrolytes imbalance 13 days after the operation. The diagnoses of liposarcoma, predominantly myxoid, was made on the basis of light and electron microscopic findings. Forty cases of liposarcoma of the breast were collected from the literature. The possibility of malignant trans-formation of a benign tumor was suggested.     

A case of intrathoracic giant malignant peripheral nerve sheath tumor in neurofibromatosis type I (von Recklinghausen's disease).

The patient was a 32-year-old woman with neurofibromatosis I (von Recklinghausen's disease), with chief complaints of shortness of breath and back pain. CT and MRI revealed a giant mass occupying the right thoracic cavity almost completely. The mass compressed the mediastinal structure to the left and the liver downwards. She underwent surgery to alleviate respiratory and circulatory disorders caused by compression of the right lung and inferior vena cava due to the giant tumor. Intraoperatively, the tumor was found to have originated from the 5th intercostal nerve. The resected tumor was 20x17x15 cm in size and 2,300 g in weight. It was histologically diagnosed as a malignant peripheral nerve sheath tumor. Her postoperative course was uneventful. All indicators of respiratory function improved, and edema of the lower half of the body disappeared, accompanied by disappearance of shortness of breath. She was discharged 21 days after surgery. Seven months after surgery, however, a recurrent tumor was found in the right thoracic cavity. She died of rapid growth of recurrent tumor 3 months thereafter. This tumor often complicates neurofibromatosis I and has a high frequency of local recurrence and distant metastasis, resulting in poor prognosis. Neither an optimal extent of resection needed for complete resection of this tumor nor an optimal regimen of chemotherapy, radiotherapy, or other therapy for the tumor has yet been established. It is desirable to establish them in the near future.     

Myxoid liposarcoma of the ankle: a case report

Myxoid liposarcoma occurs predominantly in the deep soft tissues of the extremities, and tends to metastasize to a wide range of soft tissue or bone locations. We report a case of myxoid liposarcoma arising in the ankle of a 19-year-old man. A diagnosis of myxoid liposarcoma was made by open biopsy, and a wide resection requiring plastic surgical reconstruction was performed. Cytogenetic analysis of the resected tumor exhibited a reciprocal translocation t(12;16)(q13;p11) as the sole anomaly, which is found in more than 90% of myxoid liposarcoma cases. The patient had no evidence of local recurrence or metastasis within 7 years of follow-up. Although myxoid liposarcoma is rare in the ankle, it should be considered in the differential diagnosis of a painless soft tissue mass in this region.     

Recurrent primary cardiac osteosarcoma: a case report and literature review

Primary malignant cardiac tumors are very rare. Among malignant tumors, sarcomas occupy first place. In particular, primary cardiac osteosarcoma is extremely rare. To the best of our knowledge, only 42 cases have been reported worldwide. Cardiac malignant tumors usually require complex operations due to the difficulty in completely removing the tumor with acceptable free surgical margins and because of the proximity to vital structures. The current multimodality treatment strategies for cardiac sarcoma are still suboptimal, and surgery in particular frequently has unsatisfactory results. We report a case of recurrent primary cardiac osteosarcoma in a young male who underwent trans-sternal right pneumonectomy and a wide resection of the left and right atrium followed by reconstruction with heterologous pericardium under extracorporeal circulation. The patient died 6 months after the operation due to local and systemic disease recurrence.     

Low-grade pulmonary myxoid liposarcoma

Primary pulmonary liposarcoma is extremely rare. There are only 12 cases reported in the literature. We presented a case of low-grade primary pulmonary myxoid liposarcoma, which was diagnosed and underwent surgery in our clinic. The diagnosis was established after imaging investigations (X-ray and CT), histologic and immunohistochemical examinations. The patient was followed up one year after the operation.     

Mandibular bone metastasis of rectal cancer: Report of a case

A 56-year-old man was referred with lower rectal cancer showing anal canal invasion and liver metastasis. He underwent an abdominoperineal resection and a partial hepatectomy. Adjuvant therapy with tegafur-uracil and leucovorin was administered postoperatively. Lung metastasis was detected 2 years later and was resected. Right mandibular metastasis was diagnosed 2 months after the resection of the lung metastasis. A partial mandibular resection was performed after chemoradiotherapy, followed by reconstruction with a titanium frame and oral cavity reconstruction with a greater pectoral musculocutaneous flap. The pathological diagnosis was metastatic rectal cancer, and the therapeutic effect chemoradiotherapy was Grade 2. He is presently alive without any evidence of cancer, and has maintained a good quality of life 3 years after the mandibular resection and more than 5 years after his first operation. Mandibular metastasis from rectal cancer is very rare and the prognosis is poor according to the literature, so this case is considered to be very unusual.     

原发性腹膜后脂肪肉瘤复发和预后的影响因素

目的:探讨原发性腹膜后脂肪肉瘤复发和预后的影响因素。方法:回顾性分析2011年6月至2020年1月郑州大学第一附属医院接受手术治疗的89例原发性腹膜后脂肪肉瘤患者的临床资料,男42例,女47例。中位年龄53(26~78)岁。我院首次手术治疗65例,外院术后复发再次手术治疗24例。初诊临床表现：体检发现腹膜后肿物41例,...     

Liposarcoma of the transverse mesocolon--a case report]

Primary mesenteric liposarcoma is a rare neoplasm. We experienced a case of liposarcoma of transverse mesocolon. In our case, the examination of ultrasonography and CT scan revealed the tumor was solid and encapsulated. Preoperatively we suspected the tumor was malignant by the angiographic findings. Laparotomy revealed that the tumor was located in the transverse mesocolon and it could be removed easily. The histopathological diagnosis was myxoid type liposarcoma. It is said generally that liposarcoma is liable to recur after simple resection, therefore, we reconsider that we should have excised more extensively for this case. The patient is doing well without evidence of recurrence for 17 months after operation.     

腹膜后巨大脂肪肉瘤一例报告并文献复习

目的探讨腹膜后巨大脂肪肉瘤术后腹腔复发患者多学科诊疗模式（MDT）。 方法回顾性分析腹膜后巨大脂肪肉瘤术后腹腔复发患者1例,男,45岁,复发肿瘤大小约10 cm×9 cm的临床病例资料及其两次诊治过程及MDT讨论要点分析,复习总结国内外相关文献。 结果患者行开放腹腔多发肿物切除+胆囊切除+大网膜切除术成功切除肿瘤,术后病理为去分化型脂肪内瘤。经治疗后恢复良好出院。一个半月后复发,继续靶向药物（阿帕替尼500 mg qd）治疗。 结论腹膜后脂肪肉瘤早期诊断困难,手术难度大,MDT及结合影像学检查及临床病理学特征可作出正确诊断,充分评估早期手术治疗可获得一定疗效,但去分化型脂肪内瘤总体预后不良。     

Primary liposarcoma of the mediastinum

Primary mediastinal liposarcomas are extremely rare malignancies that remain asymptomatic until large and, even then, initial symptoms are nonspecific. We report a 48-year-old man followed up for asymptomatic multiple bullae who suffered progressive weight loss and dyspnea on exertion. Radiography and computed tomography of the chest showed a large mass with calcified nodules in the left pleural cavity and giant bullae in the right pleural cavity. Previous computed tomography of the chest showed a small tumor of mediastinal adipose tissue with calcified nodules. Tumor growth was calculated at about 500 times the tumor volume per 3.6 years. We completely resected the mediastinal tumor and conducted a bullectomy through a median sternotomy. The microscopic pathological diagnosis was well-differentiated/sclerosing liposarcoma. The man underwent no postoperative adjunctive irradiation and remains well 8 months after surgery.     

A case of malignant peripheral nerve sheath tumor of the kidney

We report a case of malignant peripheral nerve sheath tumor (MPNST) of the kidney. A 50-year-old man was referred to our hospital because of left back pain. Computed tomographic scan and magnetic resonance imaging revealed a huge left retroperitoneal tumor (30 x 13 x 11 cm), which consisted of a solid tumor with calcification surrounding the cystic component. He underwent resection of the retroperitoneal tumor and additional descending colectomy. Histopathological examination revealed MPNST arising from severely atrophic renal parenchyma of giant hydronephrosis. He died of tumor metastasis to the lungs 3 months after the operation. To our knowledge, this is the fourth case of MPNST of the kidney, moreover the third case arising from the renal parenchyma to be reported in Japan.