Discussion
DDLPS is a non-lipomatous malignancy with high cellularity, considerably
more aggressive phenotype rising the risk of systemic metastases, and
local recurrence.8 In this case, the patient
experienced an in-situ recurrence of the sarcoma within only 3 months
after the complete resection which was unusual.
The 5-year survival rate for malignant cardiac tumors following
treatment was about 30%. the recurrence rate for liposarcoma was
reported in about 40% of the cases even up to 14 years after the
initial surgical resection.4, 8 In primary cardiac
DDLP, most cases are younger than 45 years old and no sex predilection
has been seen. The clinical features are generally related to the site
of the tumor and the extent of infiltration.9, 10According to the data available, the most frequent symptoms in malignant
cardiac tumors are dyspnea and chest pain, moreover, fever is also
reported with a prevalence of 9%.5, 11 In the present
case, the questionable finding was a LA mass that developed within 79
days after primary surgical resection and resulted in dyspnea. It was
crucial to differentiate valvular thrombus from other possibilities such
as a remnant or recurrent tumor. The absence of constitutional symptoms
was weighting against the recurrent malignant tumor.
On condition that the patient has satisfactory performance status,
surgical resection of the intracavitary mass should be done. Even though
cardiac tumors seem to be a challenge for cardiac surgeons, complete
surgical resection combined with adjuvant chemotherapy and/or local
radiotherapy is required to lower the risk of local recurrence and
systemic metastasis.4, 11 It should be pointed out
that due to heart failure which is possible in the early course of the
left-sided mass, neoadjuvant chemotherapy is generally
contraindicated.12 This case was notable for the short
interval to recurrence. Completeness of resection is a helpful feature
in disease-free survival and without adjuvant chemotherapy recurrence of
cardiac sarcomas increases. Recurrence of primary cardiac sarcomas is a
common phenomenon and close surveillance with an oncologist is
essential.