Mediastinal Liposarcoma with Pericardial Invasion and Cardiac Compression: Case Report
Abstract:
Soft tissue sarcomas are rare malignant neoplasms, with liposarcoma being the most common among them. Its mediastinal location represents less than 1% of all mediastinal tumors. Due to the rarity of mediastinal liposarcomas, documentation in the literature is relatively limited. We describe the case of a 49-year-old patient who complained of pain in the left hemithorax, associated with dyspnea and weight loss of 10 kg in the last 3 months. The transthoracic echocardiogram showed a large volume echogenic image that involved the entire cardiac silhouette, presenting a heterogeneous appearance with cysts in between that determined extrinsic compression of the left ventricle. A thrombus adhered to the pulmonary valve was noted, in addition to a massive thrombosis of the pulmonary artery, generating significant pulmonary arterial hypertension. Computed tomography angiography confirmed the echocardiographic findings, showing a heterogeneous pericardial mass measuring 10x16x11 cm, with dense trabeculations in between, characterizing a solid expansile lesion. Parasternal mediastinotomy with biopsy was performed, which identified a dedifferentiated liposarcoma. The patient developed hemodynamic instability, with immunohistochemistry results after his death, making it impossible to carry out adequate treatment. As it is an insidiously growing tumor, liposarcoma has a diverse clinical presentation, which can delay its diagnosis. In our case, the large pericardial mass invaded vascular structures and the entire cardiac silhouette, leading to great technical-surgical difficulties that made complete resection impossible, resulting in a poor prognosis.
