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 ).