Removal of the left atrium and left ventricle tumour: a case report Figure 1. Preoperative echocardiogram dedifferentiated to undifferentiated sarcoma with a marked mitotic activity of tumour cells. Within the lymph nodes granulation tissue of a sarcoid type was detected. The patient was referred for consultation and further oncological treatment, during which a neo- plastic osteolytic focus measuring 91 mm × 64 mm in the left ilium bone and pathomorphologically pleomorphic sarcoma malignant fibrous histio- cytoma (MFH) was diagnosed. The conducted PET also did not allow exclusion of the presence of a neoplastic focus in the right iliac bone. There were detected metastases in the corpora of vertebrae Th12 and L2 and in the transverse processes of vertebra L5. The patient underwent subsequent cycles of chemotherapy. Within the 6-month follow-up the patient was hospitalized in the Department of Cardiology of the Medical University of Lodz, due to anemia and exacerbation of the heart failure to NYHA grade 4. The echocardiogram revealed further progression of the cardiac lesions. The tumour had already occupied 1/3 of the left ventricle area. The spreading neoplasm had caused the restriction of the posterior leaflet of the mitral valve and increased the mitral insufficiency to severe. A torn tendinous chorn was detected. In additional tests the CRP had still not been normalized, despite the lack of inflammatory symptoms. After conservative treatment was carried out, achieving an improvement of the morphological parameters, the patient, in NYHA grade 2/3, was discharged from the hospital with a recommendation of further ambulant treatment. Discussion Fibrohistiocytoma can be located in any part of the body [9]. This is the most common soft tissue sarcoma in adults [10], a neoplasm of particularly high malignancy and metastasizing in the early stages of the disease [11]. The mitotic count and nuclear pleomorphism remain the most valuable Figure 2. Postoperative echocardiogram with recur- rence of the tumour features for evaluting the sarcoma’s advancement [12]. So far, in the literature there have been reported only a few dozen cases of cardiac localization of this sarcoma, while a significant majority arose from the left atrium. To our knowledge, the above-described case is the first in which the sarcoma occupies both the left atrium and the left ventricle. In the literature there are only two reported cases of left ventricular MFH [13, 14]. The particular localization of the lesion within the heart and, consequently, less specific clinical presentation further delayed the diagnosis, resulting in a highly advanced neoplastic process. Thus the inability to perform complete resection resulted in the rapid development of the recurrence. The TTE and TEE allowed for precise visualization of the intracardiac mass. Computed tomography (CT) and magnetic resonance imaging (MRI) were not done, because the relatively good condition of the patient and the echocardiographic image suggested a benign lesion. Furthermore, the patient was qualified for an urgent operation due to the large size of the tumour resulting in bad haemodynamic parameters. The tumour size was a consequence of a long-lasting growth and a developed compensation. The intraoperative assessment and the rapid local recurrence suggested malignancy, which was histopatho- logically confirmed. Considering that, the patient was ordered a positron emission tomography (PET) scan to define the primary origin and plan further treatment. On the basis of a poor prognosis and palliative character of the operation, the decision to retain the native valve seemed to be the only suitable procedure. Although a prosthesis or bioprosthesis is usually implanted [15], a rapidly growing tumour mass would be a cause of prosthesis dysfunction and an unavoidable reoperation. Moreover, despite the markedly large tumour mass, the ejection fraction remained fairly good. This suggests the possibility of an Arch Med Sci 5, October / 2011 911