Giant cardiac metastasis of myxoid liposarcoma causing cardiac tamponade; report of a case

We report a very rare case of cardiac metastasis of myxoid liposarcoma. A 55-year-old man presented with dyspnea. Two and a half years ago, he underwent resection of myxoid liposarcoma in the left thigh. Magnetic resonance imaging (MRI) revealed a giant tumor occupying the pericardiac cavity and pressing the heart and consequently causing cardiac tamponade. The patient underwent surgery through a left thoracotomy approach. The pericardiac cavity was filled with a giant tumor with a stalk from the right ventricle and 2 small nodules on the main pulmonary artery. He was relieved from the symptom: however, he had a recurrence of the tumor at the same site 5 months after the operation. He underwent surgery for the removal of the second tumor; however, he died 49 days after the operation. Although cardiac metastasis is a very rare condition, its awareness is essential for careful long-term follow-up for the early detection of a metastatic cardiac liposarcoma after the resection of the primary tumor.     

Successful resection of cardiac metastatic liposarcoma extending into the SVC, right atrium, and right ventricle

Cardiac metastatic liposarcoma is a rare tumor. We report a case of successful resection of a cardiac metastatic liposarcoma extending into the superior vena cava (SVC), right atrium, and right ventricle. Using cardiopulmonary bypass (CPB) by venous cannulation of the upper portion of the SVC and inferior vena cava (IVC), the intracardiac tumor was completely resected. Surgical resection with the addition of radiotherapy prolonged the patient's life.     

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.     

Renal liposarcoma of the sinus renalis

We report on 42-month follow-up of a case of renal liposarcoma of the sinus renalis with tumour-free survival. It is a rare condition and occurs generally in the 4th and 6th decades of life. Renal liposarcomas are clinically asymptomatic for a long period of time. Symptoms develop only when the tumours become large enough, as in our case. For the differential diagnosis of renal liposarcoma we performed intravenous urography, computerized tomography and colour flow Doppler ultrasonography. After these diagnostic evaluations the patient underwent right radical nephrectomy. Complete surgical resection was performed. Final diagnosis was made by pathological examination. Because of the poor results of either chemotherapy or radiotherapy, we conclude that 42 months of tumour-free survival is related to complete surgical resection with negative surgical margins.     

Giant primary liposarcoma of the chest

Liposarcomas are the most common soft tissue sarcomas in adults, although liposarcomas of the chest are uncommon. We report two cases of giant liposarcoma in the mediastinum and chest wall, respectively. An 82-year-old man presented with a mass in the right upper mediastinum, as seen by computed tomography (CT). He had a past history of subcutaneous lipoma resection on his back (19 years previously). The patient underwent tumor resection with a right thoracotomy. A 58-year-old woman presented with an enlarging mass of the right lateral chest, involving the diaphragm and ribs, as seen by CT. She had a past history of subcutaneous lipoma resection of the right chest (18 years previously). The patient underwent an en bloc resection that included the tumor and a part of the right diaphragm and ribs. Histological examination of both patients’ tumors revealed a well-differentiated liposarcoma, with no pathological relation to the previous lipoma resected in either case.     

Retroperitoneal liposarcoma in a child.

Retroperitoneal liposarcoma is a rare tumor in children and has been reported previously on only three occasions. This is the fourth such case, presenting with a large mass on the left side which displaced the sigmoid and ureters to the right. The patient was treated with surgery, radiotherapy, and chemotherapy. She is alive and well more than four years after therapy was instituted. A review of the pertinent literature cites the need for radio- and chemotherapy especially when surgical removal is incomplete.     

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.     

A case of dedifferentiated liposarcoma of the heart and stomach

IntroductionLiposarcoma of the heart and stomach is rare.Presentaion of caseWe report a case of liposarcoma in both organs with dedifferentiated histology. A patient was referred to our hospital with anorexia and weight loss. Upper gastrointestinal tract endoscopy revealed 5–10-mm elevated lesions, and echocardiography and computed tomography showed tumorous lesions in the left atrium. Tumor resection and mitral valve replacement were performed, and biopsy was performed for the gastric tumor. Both the tumors were diagnosed as dedifferentiated liposarcoma.DiscussionLiposarcoma – a mesenchymal malignant tumor that contains lipoblasts – is the second most common soft tissue sarcoma. The tumor occurs most frequently in the limbs and retroperitoneum and rarely originates in the heart and the stomach.ConclusionChemotherapy and radiotherapy are only adjunctive therapies but not es as standard treatment for cardiac tumors. Therefore, we believe that wide surgical resection was the best choice of treatment in the present case.     

A case of retroperitoneal well-differentiated liposarcoma with metaplastic bone formation

A 43-year-old female was referred to our hospital from a local doctor. Her chief complaints were weight gain and abdominal fullness. Computed tomography and magnetic resonance imaging showed a huge tumor in the right retroperitoneal space, which adhered to the right kidney. It was resected with concomitant resection of the right kidney. It measured 30×15 cm and weighed 3.0 kg. Histological examination revealed well differentiated liposarcoma with metaplastic bone formation. She has survived 22 months since the operation with no evidence of recurrence. A retoroperitoneal liposarcoma with metaplastic bone formation is rare. Twenty cases have been reported in Japan including our case.     

Neuropraxia following resection of a retroperitoneal liposarcoma

BackgroundThis is a unique case of neuropraxia of femoral nerve seen after resection of retroperitoneal liposarcoma which has not been reported before in the literature.IntroductionNeuropraxia, a transient paralysis due to blockage of nerve conduction, commonly associated with athletes and orthopedic procedures, has not been previously reported as a complication following resection of retroperitoneal sarcoma.CaseThis is an 81-year-old female who, on CT for evaluation of her atherosclerosis, was found to have an incidental right-sided retroperitoneal mass extending from the right renal capsule inferiorly through the inguinal canal. At this point, the patient reported mild right sided abdominal pain and right lower back pain, but reported no neuromotor deficits of the right lower extremity. Given the symptoms of the patient as well as the size, location and the density of the lesion, surgical intervention was pursued. On exploration, the lipomatous lesion, suggestive of liposarcoma, was invading the right genitofemoral nerve and ilioinguinal nerve which were sacrificed to ensure a complete oncologic resection. Following complete removal of the mass, she developed right side femoral nerve neuropraxia, suffering complete loss of motor function in the femoral distribution. Pathology revealed the mass to be a low grade liposarcoma.DiscussionThe patient required only physical therapy and oral prednisone following surgery for treatment of the neuropraxia. She responded well and has regained significant neuromotor function of the affected limb. Cases presenting with post-resection neurological sequelae without any known intraoperative nerve injury may respond very well to conservative treatment. Hence, it is very important to collaborate with Neurology and Physical Therapy to achieve best possible outcome.     

Successful thoracoscopic resection of a large mediastinal liposarcoma

We report a case of a rare, large mediastinal liposarcoma diagnosed in a 74-year-old woman after a syncopal episode. Chest roentgenogram and computed tomographic scan showed a large mass occupying most of the right chest and abutting the great vessels and pericardium. A thoracoscopic approach was used for exploration and surgical excision of this large mediastinal mass. Despite the large size of the mass, the thoracoscopic approach offered excellent visualization of all the mass attachments and required only a small extension of the access incision for tumor removal. The mass was a well-differentiated liposarcoma, which was completely resected with clear margins. The patient remains disease-free almost 3 years after the resection.     

Primary Cardiac Liposarcoma Causing Cardiac Tamponade: Report of a Case

The intracardiac growth and extension of liposarcoma was observed in a 60-year-old woman. The epicardial tumor was identified to originate from the anterior wall of the right ventricle. She initially showed symptoms associated with cardiac tamponade. A surgical operation was performed but it resulted in incomplete resection due to massive invasion and dissemination. The recurrence of the tumors led to congestive heart failure. Finally, she died of heart failure and liver dysfunction as a result of tumor metastasis and invasion. An autopsy detected the primary cardiac liposarcoma. Only a few cases of cardiogenic liposarcoma have so far been reported. A further elucidation of cardiac liposarcoma could reveal mechanisms of the disease, and thus contribute to development of complementary therapies after surgical intervention.     

Pleomorphic spermatic cord liposarcoma: A case report and review of management

Liposarcoma of the spermatic cord is very rare, representing about 7% of para testicular sarcomas. It is considered to be one of the highest malignancy grades.We present a case of a liposarcoma of the spermatic cord in a 45-year-old male complaining of a progressive painless swelling in the right inguinoscrotal region. Ultrasonography and computed tomography findings were compatible with liposarcoma of the spermatic cord. We performed a right radical orchiectomy with a wide resection of the mass. Histological examination confirmed the diagnosis and showed a pleomorphic subtype.The mainstay of management of spermatic cord liposarcoma is wide excision with radical orchiectomy. The most important factors for prognosis are the histologic subtype and surgical margin status. Adjuvant radiotherapy should be considered in cases at high risk for local recurrence. Long-term surveillance is mandatory.Liposarcoma of the spermatic cord is an uncommon para testicular tumor which should be part of the differential diagnosis of inguinoscrotal mass. A radical inguinal orchiectomy with wide resection of the soft tissue mass and the spermatic cord are the key to longest local and systemic disease-free survival.     

Sinoatrial nodal artery to right atrium fistula after myxoma excision

Acquired coronary artery to cardiac chamber fistulas are rare. Angiographically detectable neovascularization associated with a cardiac myxoma occurs frequently. These vessels are incorporated into the atrial suture line during surgical excision. We describe the case of a patient with a symptomatic right coronary artery to right atrial fistula that had occurred 4 years after left atrial myxoma resection. These large vessels should be considered for ligation during the myxoma resection.     

Metastatic liposarcoma of the brain: case report and review of the literature

A 74-year-old woman presented with an acute left hemiplegia. CT demonstrated an irregular mass in the right parietal region of the brain. Two years previously, she had undergone wide local excision of a liposarcoma from her thigh. Craniotomy was performed and the lesion removed. Subsequent histology confirmed a liposarcoma. The brain is an exceptionally rare site of first recurrence of a liposarcoma. This case report presents a pathological rarity and briefly reviews the literature relevant to clinicians.     

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.     

Pituitary apoplexy with third cranial nerve palsy after off-pump coronary artery bypass grafting

We present a rare case with pituitary apoplexy after three-vessel off-pump coronary artery bypass grafting (OPCAB). The patient exhibited right third cranial nerve palsy; ptosis of the right eye with completely dilated pupils and a loss of reflex to light after the effects of anesthesia completely subsided. The patient underwent endonasal transsphenoidal resection of the pituitary gland 14 days after the OPCAB, and the symptoms completely disappeared 40 days after the resection. OPCAB is recommended for patients with known pituitary tumor who require coronary artery bypass grafting, but OPCAB also has a risk of pituitary apoplexy. The present case report is the first to describe pituitary apoplexy after OPCAB. Pituitary apoplexy is a very rare complication after cardiac surgery, but cardiac surgeons should know the disease and quickly diagnose it to avoid severe brain injury.     

Large liposarcoma developing in the ischiorectal fossa: Report of a rare case

INTRODUCTIONWe herein report an extremely rare case of a liposarcoma developing in the ischiorectal fossa that was completely resected using a transsacral approach.PRESENTATION OF CASEA 74-year-old man was admitted to our institute because of a large perianal tumor. A pelvic magnetic resonance imaging (MRI) revealed an 8 cm × 7 cm × 5 cm sized encapsulated heterogeneous tumor on the right side of the ischiorectal fossa. Transsacral excision was performed under a diagnosis of liposarcoma. The tumor was partially fixed to the external sphincter and puborectalis. Therefore, the muscles were partially resected to ensure sufficient margins. Histopathological examination revealed a well differentiated liposarcoma and negative surgical margins.DISCUSSIONThe basic treatment strategy of liposarcoma is surgical resection, whereas the effects of chemotherapy or radiotherapy remain limited. Although no postoperative adjuvant therapy has been performed in our case, no recurrences have occurred for 1 year after surgery.CONCLUSIONAlthough the curative resection of large tumors located in the ischiorectal fossa is usually difficult, the complete resection of liposarcoma is the main potentially curative treatment. A transsacral approach is useful for a complete resection.     

A case of inflammatory myofibroblastic tumor of the retroperitoneum

Here we report a rare case of inflammatory myofibroblastic tumor of the retroperitoneal space. A 46-year-old woman had had microscopic hematuria for 5 years. Ultrasonographic examination for screening revealed two solid tumors adjacent to the right kidney. These tumors were suspected to be malignant fibrous histiocytoma or liposarcoma by computed tomography and magnetic resonance imaging. She underwent resection of these retroperitoneal tumors and additional right nephrectomy because these tumors were adhered to the kidney and liposarcoma was highly suspected on frozen sections. Histopathologic examination finally revealed that the tumors were inflammatory myofibroblastic tumor arising within Gerota's fasia. She has been followed up for 9 months without any evidence of local recurrence.     

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.