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J Thorac Cardiovasc Surg 1998;115:460-461
© 1998 Mosby, Inc.

BRIEF COMMUNICATIONS

Pulmonary leiomyosarcoma extending into left atrium or pulmonarytrunk: complete resection with cardiopulmonary bypass

Tsu, Japan

From the Department of Thoracic and Cardiovascular Surgery,Mie University, School of Medicine, Tsu, Japan.

Received for publication April 30, 1997 Accepted for publication June 6, 1997. Address for reprints: Takatsugu Shimono, MD, Department of Thoracicand Cardiovascular Surgery, Mie University, School of Medicine, 2-174 Edobashi,Tsu, Mie 514, Japan.

Primary pulmonary leiomyosarcoma is a rare tumor. Few cases have beentreated surgically because of its rapid invasion into the pulmonary trunk orheart and tendency toward massive intrapulmonary metastases. We report the casesof two patients with leiomyosarcoma originating in a pulmonary artery or veinthat involved the pulmonary trunk or left atrium, both of whom underwentcomplete surgical resection with cardiopulmonary bypass (CPB). Since theiroperations, these patients have shown no evidence of recurrent tumor.

PATIENT 1. A 72-year-old woman with persistent cough, chest pain, andhemoptysis was referred to our hospital for evaluation and treatment of presumedpulmonary thromboembolism. An angiogram revealed filling defects in thepulmonary trunk, absence of filling of the left main pulmonary artery, anddecreased arterial filling in the left lung. A biopsy specimen was obtained froma tumor in the left main pulmonary artery by means of a suction catheter, andthe pathologic diagnosis of sarcoma was made. Computed tomography disclosed amass occluding the left main pulmonary artery and densely filling pulmonaryartery branches.

Median sternotomy was performed and CPB was applied. The left pulmonaryveins were ligated and the left main pulmonary artery was incised. A large tumorcompletely filled the left main pulmonary artery. Extension of the incision intothe pulmonary trunk disclosed that the tumor invaded its wall laterally on theleft. The portion of tumor located in the left main pulmonary artery andpulmonary trunk, including the left main pulmonary artery and the left lateralwall of the trunk, was excised. Direct suture closure of the pulmonary trunk wascarried out and CPB was terminated. The left main bronchus was transected andleft pneumonectomy was completed.

Fig. 1 shows the resected left lung and pulmonary artery. Tumor in the main pulmonary arteryextended intraluminally into its branches. The tumor was diagnosedhistologically with the aid of immunohistochemical staining as a leiomyosarcoma.The patient had an uncomplicated postoperative course and was discharged withoutadditional therapy. She is doing well 17 months after the operation, with noevidence of recurrence.

View larger version (118K): [in this window] [in a new window]   Fig. 1. Left pneumonectomyspecimen, with the pulmonary arteries occluded by a rubbery tumor mass.

View larger version (87K): [in this window] [in a new window]   Fig. 2. Preoperative computedtomography shows a solid mass (arrows)involving pericardium and filling the left atrium.

On pathologic examination, the tumor was found to arise in the leftinferior pulmonary vein. As in the case of patient 1, it was determined byhistologic and immunohistochemical methods to be a leiomyosarcoma. The patienthad left hemiplegia after the operation. He was discharged without additionalantineoplastic therapy and is alive, without evidence of recurrence, 7 monthsafter the operation.

Discussion. Primary pulmonaryleiomyosarcoma is rare tumor that is difficult to diagnose in its early stages.Miller and Allen ¹ reportedonly three such cases among 10,134 patients treated for various primary lungcancers. Redmond and colleagues ²suggested that the possibility of pulmonary artery neoplasm should be seriouslyentertained in unilateral pulmonary artery occlusion, especially with evidenceof progression. Weinreb and coworkers ³found that magnetic resonance imaging can differentiate between pulmonary arterysarcoma and embolus by contrast enhancement of the tumor with gadolinium-labeleddiethylenetriaminepentaacetic acid. Most reports describe radical surgicalresection as the only effective therapy, with no benefit from adjuvant therapyor nonradical resection. However, these tumors usually invade the pulmonarytrunk, pulmonary valve, or right ventricular outflow tract, necessitatingaggressive resection that may include the use of a homograft. ^4,5

The second patient described here represents the second report of leftatrial wall resection combined with pneumonectomy for a pulmonary veinleiomyosarcoma, and the first report of the resection by thoracotomy through therib bed. Leiomyosarcoma of pulmonary vein origin is extremely rare; we havefound only three cases previously reported worldwide. ^6-8To our knowledge, this is also the first reported case of pulmonary veinleiomyosarcoma in a patient younger than 40 years.

Unlike less radical operations, complete resection with CPB appears tooffer a good prognosis in the treatment of primary leiomyosarcoma of the lunginvolving the heart or great arteries.

References

1. Miller DL, Allen MS. Rare pulmonaryneoplasms. Mayo Clin Proc 1993;68:492-8.[Medline]
   
2. Redmond ML, Shepard JW, Gaffey TA, Payne WS.Primary pulmonary artery sarcoma: a method of resection. Chest 1990;98:752-3.[Abstract/Free Full Text]
   
3. Weinreb JC, Davis SD, Berkmen YM, Isom W,Naidich DP. Pulmonary artery sarcoma: evaluation using Gd-DTPA. J ComputAssist Tomogr 1990;14:647-9.
   
4. Dossche K, Wellens F, Goldstein JP, Deferm H.Pulmonary homograft replacement for primary leiomyosarcoma of the pulmonaryartery. J Thorac Cardiovasc Surg 1992;104:844-6.[Medline]
   
5. Zerkowski HR, Hofmann HS, Gybels I, Knolle J.Primary sarcoma of pulmonary artery and valve: multimodality treatment bychemotherapy and homograft replacement. J Thorac Cardiovasc Surg 1996;112:1122-4.[Free Full Text]
   
6. Gonzalez-Campora R, Rubin-Uria J, Mora-MarinJ, Hevia A, Galera-Davidson H. Pulmonary vein myxoid leiomyosarcoma. Pathol ResPract 1989;185:900-4.
   
7. Tsutsumi Y, Deng YL. Alveolar soft partsarcoma of the pulmonary vein. Acta Pathol Jpn 1991;41:771-7.[Medline]
   
8. Gyhra AS, Santander CK, Alarcon EC, MucientesFH, Carfillo H. Leiomyosarcoma of the pulmonary veins with extension to the leftatrium. Ann Thorac Surg 1996;61:1840-1.[Abstract/Free Full Text]
   

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