Abstract
The clinical manifestation of coronavirus disease 2019 (COVID-19) overlap with other disorders especially cardiovascular diseases (CVD). We report a 58 years old female presented with syncope episodes and dyspnea on exertion with the left atrial mass, candidate for surgical removal and mitral valve replacement. Nearly 3 months later, she developed dyspnea, fever, and a sore throat cause to admit her with suspected COVID-19. During diagnostic evaluation, a larger LA mass detected that seemed to be COVID-19 induced organized thrombus with prosthetic mitral valve malfunction. the mass resected and immunohistochemistry revealed liposarcoma. The unusual early recurrence of liposarcoma and misdiagnosis with COVID-19 induced thrombosis are the hallmark of the present case.
Key words: liposarcoma, COVID-19, thrombosis
Introduction
The recent pandemic of COVID-19 has become the most challenging issue worldwide, resulting in more than 40 million identified cases with more than 1 million death. A similar presentation between COVID-19 and CVD has hindered in the diagnosis and management of CVD, especially in patients with prosthetic heart valves. 1-3 Primary cardiac sarcomas are rare, aggressive, and most lethal. The autopsy incidence of the primary cardiac neoplasm is extremely low about 0.2% of all cardiovascular surgical cases. Of the 25% of these tumors that are classified as being malignant, cardiac sarcomas make up 95% of cases.4-6
Depending on the location of the tumor and the range of infiltration into the adherent tissue, a cardiac tumor can cause symptoms which are generally nonspecific. The diagnosis is reached from the clinical history and multimodality imaging. Surgical removal and radiotherapy are used as a basis for local restriction, accompanied by chemotherapy for systemic disease.4, 7 We herein describe a middle-aged female with a Left atrial mass which was suspected as myxoma before surgery. Another LA mass showed up about 3 months after the complete surgical resection. The new mass was suspected COVID-19 infection-induced thrombosis. It was again resected and diagnosed as Dedifferentiated Liposarcoma (DDLPS) by postoperative pathological examination. This case highlights the fact that a precise diagnosis is crucial as the treatment approach and the accompanying risks differ in different conditions.