Liposarcoma Causing Left Ventricular Outflow Tract Obstruction and Syncope: a Case Report and Review of the Literature

Abstract

Metastatic cardiac myxoid liposarcoma is rare. We present the case of a 56-year-old woman who was admitted for angina and syncope, and in whom a mobile intracardiac mass obstructing the left ventricular outflow tract and protruding into the aortic root during systole was detected by transesophageal echocardiography (TEE). She reported an antecedent of the complete excision of a myxoid liposarcoma of the thigh 12 years before. A surgical resection procedure was performed through an excision of the anterior wall of the left ventricle. The histopathological analysis of the specimens obtained during surgery revealed a low-grade malignancy myxoid liposarcoma, similar to the one resected in the thigh 12 years before. The present case is the first one to report syncope due to left ventricular outflow tract as a cause for admission. TEE was able to visualize the metastatic tumor to the heart, accurately localize its position and allow for prompt surgical treatment that produced relief of the symptoms.

Metastatic Shoulder Liposarcoma to the Right Ventricle

“…When the tumor involves the left ventricle, angina and dyspnea can be the presenting symptoms and syncope if the tumor involves the outflow tract. 4 In general, cardiac symptoms are slow in onset though, this was not the case in our patient who presented with a 10-day history of dyspnea. Because these tumors can be large at the time of diagnosis, 2D echocardiogram is often sufficient to establish the diagnosis and the need for surgical treatment.…”

“…There have been only 3 reported cases of isolated cardiac metastasis from liposarcoma, 5 and only 18 reports of metastatic cardiac liposarcoma in total documented in the literature. 4 In this review, there was an increased prevalence in males, the primary liposarcoma was usually in the lower extremities, and there was long interval between the occurrence of the primary tumor and the metastasis, indicating slow growth of the tumor. 4 Clinically, the symptoms of cardiac and pericardial metastases are not characteristic and serious complications including stroke, myocardial infarction, and even sudden death from arrhythmia may be the first signs of tumor.…”

“…4 In this review, there was an increased prevalence in males, the primary liposarcoma was usually in the lower extremities, and there was long interval between the occurrence of the primary tumor and the metastasis, indicating slow growth of the tumor. 4 Clinically, the symptoms of cardiac and pericardial metastases are not characteristic and serious complications including stroke, myocardial infarction, and even sudden death from arrhythmia may be the first signs of tumor. 6 Symptoms are related to the location and size of the tumor with heart failure a common clinical feature although, this is nonspecific.…”

“…3 The diagnosis of an isolated cardiac metastasis is unusual as generally, cardiac metastases are infiltrative and associated with the involvement of other organs. 4 Sarcoma metastasis to the heart is a rare diagnosis, with an incidence of 0.6% in one autopsy series of patients with malignancy. There have been only 3 reported cases of isolated cardiac metastasis from liposarcoma, 5 and only 18 reports of metastatic cardiac liposarcoma in total documented in the literature.…”

A Case of Stroke due to Tumor Emboli Associated with Metastatic Cardiac Liposarcoma

“…We were able to refer 17 cases with metastatic cardiac liposarcoma confirmed by microscopic histology (10). Metastatic tumor was found at the right atrium and/or ventricle in 8 cases and on the left side in 8 cases.…”