Resection of Left Atrial Leiomyosarcoma in an Adolescent

Isolated cardiac leiomyosarcoma is exceedingly rare, with 75-100 cases reported in the published literature. Even with resection, survival prognosis is dismal. Here, the authors present the surgical resection of a large leiomyosarcoma from the posterior left atrial wall in an adolescent patient. This 13-year-old patient presented to her primary pediatrician with palpitations and an event monitor showed occasional atrial arrhythmias. As such, she was sent to the emergency room where a transthoracic echocardiogram showed a large mass in the left atrium, with near complete obstruction of mitral valve inflow. Cardiac magnetic resonance imaging suggested an atrial myxoma, and given the size, she was recommended to undergo surgical resection. The operation was carried out on cardiopulmonary bypass via a transeptal approach. The entire left atrial posterior wall was excised en bloc with the mass and was re-endothelialized with a patch of fresh autologous pericardium. Final pathology showed high grade leiomyosarcoma with myxoid features. She will undergo adjuvant chemotherapy for further treatment.

Reference

Wang JG, Cui L, Jiang T, Li YJ, Wei ZM. Primary cardiac leiomyosarcoma: An analysis of clinical characteristics and outcome patterns. Asian Cardiovasc Thorac Annals. 2015;23(5):623-630.