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