Introduction
Although liposarcoma is a common soft tissue sarcoma, pleural
liposarcoma has rarely been reported and its prognosis is poor due to
higher incidences of metastasis and recurrence1. We
report the case of a patient who underwent successful complete resection
of a cavoatrial metastatic tumor originating from primary pleural
liposarcoma using cardiopulmonary bypass (CPB) and hypothermic
circulatory arrest (HCA). The patient is surviving without any
metastasis or recurrence.
A 68-year-old man was referred to our department for resection of a
tumor located at the cavoatrial
junction between the inferior vena cava (IVC) and the right atrium (RA).
At the age of 62, he was diagnosed with lung cancer and underwent a left
lower lobectomy. However, the final diagnosis of the resected tumor was
pleural dedifferentiated liposarcoma as the pathological analysis was
positive for murine double minute 2 (MDM2), adipophilin, and perilipin.
In one year, surgical adrenalectomy was performed for the right adrenal
tumor and was repeated one year later for the left-side tumor. The
pathological examination of the bilateral adrenal tumors also showed
dedifferentiated liposarcoma metastasizing from the primary pleural
liposarcoma. Follow-up computed tomography scans after surgery revealed
a new mass in the IVC. Direct oral anticoagulant was administered with
the diagnosis of venous thromboembolism. Repeated computed tomography
revealed enlargement of the mass, which was suspected to be a metastatic
liposarcoma (Fig. 1 ).
The patient was asymptomatic. Blood examinations revealed no significant
abnormality. All tumor markers were negative. Transthoracic
echocardiography revealed a 60-mm, very mobile, right atrial mass
extending into the right ventricle through the tricuspid valve
(Fig. 2 ).