A Primary High-Grade Pleomorphic Pericardial Liposarcoma Presenting as Syncope and Angina

Abstract

he incidence of liposarcoma has been estimatedto be one in 2.5 million people, and pleomorphicsarcoma represents approximately 10%–15% ofall liposarcomas (1). Liposarcomas develop later inadulthood and are usually located in the retroperito-neum or deep soft tissues of extremities. Primary li-posarcoma of the pericardium is, however, exceed-ingly rare (1). A 74-yr-old male, with a history of aorticvalve replacement and three-vessel coronary arterybypass grafting (CABG), left carotid endarterectomy,and abdominal aortic aneurysm repair was admittedwith complaints of syncope, diaphoresis, and angina.Cardiac catheterization demonstrated a 80% occlu-sion of the left anterior descending artery. Trans-esophageal echocardiography (TEE) showed a largeposterior, cystic mass impinging on the left and rightatria, increased left atrial pressure, and diminished leftventricular filling pressure. The patient was scheduledfor an elective CABG of the left anterior descendingartery and possible excision of the pericardial mass.Intraoperative TEE confirmed a 7 7 cm cystic intra-pericardial mass, posterior to the left and right atria(Figs. 1, 2) (please see video clip at www.anesthesia-analgesia.org). The mass obstructed left ventricularinflow, invaginated the right atrium posteriorly, andencircledthedescendingthoracicaorta.Frozensectionbiopsy revealed a poorly differentiated, aggressive li-posarcoma. Because of the extent of the mass and itsaggressive nature, the CABG surgery was aborted.Cardiac function dramatically improved after surgicalevacuation of the cystic fluid. The resultant flaccidmass was excised, but a large adherent, invasive in-tracardiac portion of the mass could not be resected.