Discussion
Primary cardiac tumours are exceedingly rare neoplasms comprising less
than 1% of the 0.001-0.28% of all reported cardiac malignancies. The
left atrium is the most common site reported in literature with the left
ventricle being the rarest cardiac site2,3. We note
that our report may be the fifth in the global literature in any form
describing a primary left ventricular leiomyosarcoma.
Diagnosis has been reported to be straightforward with echocardiography,
CT and MRI having very high sensitivity.3Unfortunately as is highlighted by our case, vague symptoms with the
differential diagnosis cofounded by the presence of chronic disease can
lead the clinician into ordering imaging that does not focus on the
heart. In a particularly unfortunate turn of events in this case, a
biopsy of the mass via VAT returned inflammatory tissue. Regardless, we
recommend the use of echocardiography and CT to aid in the diagnosis if
vague cardiac symptoms are reported.
Wang et al. reported that surgery was the most common therapy provided
followed by adjuvant chemotherapy. Incomplete resection was a feature of
many of these cases due to the invasive nature of the tumour.
Prognosis has been universally reported as poor with Wang et al noting
that the five year survival rate was 25.4%. Adjuvant chemotherapy was
also noted to improve outcomes in many studies.2,3