DDLPS is a non-lipomatous malignancy with high cellularity, considerably more aggressive phenotype rising the risk of systemic metastases, and local recurrence . In this case, the patient experienced an in-situ recurrence of the sarcoma within only 3 months after the complete resection which was unusual.
The 5-year survival rate for malignant cardiac tumors following treatment was about 30%. the recurrence rate for liposarcoma was reported in about 40% of the cases even up to 14 years after the initial surgical resection [3, 7]. In primary cardiac DDLPS, most cases are younger than 45 years old and no sex predilection has been seen. The clinical features are generally related to the site of the tumor and the extent of infiltration [8, 9]. According to the data available, the most frequent symptoms in malignant cardiac tumors are dyspnea and chest pain, moreover, fever is also reported with a prevalence of 9% [4, 10]. In the present case, the questionable finding was a LA mass that developed within 79 days after primary surgical resection and resulted in dyspnea. It was crucial to differentiate valvular thrombus from other possibilities such as a remnant or recurrent tumor. The absence of constitutional symptoms was weighting against the recurrent malignant tumor.
On condition that the patient has satisfactory performance status, surgical resection of the intracavitary mass should be done. Even though cardiac tumors seem to be a challenge for cardiac surgeons, complete surgical resection combined with adjuvant chemotherapy and/or local radiotherapy is required to lower the risk of local recurrence and systemic metastasis [3, 10]. It should be pointed out that due to heart failure which is possible in the early course of the left-sided mass, neoadjuvant chemotherapy is generally contraindicated . This case was notable for the short interval to recurrence. Completeness of resection is a helpful feature in disease-free survival and without adjuvant chemotherapy recurrence of cardiac sarcomas increases. Recurrence of primary cardiac sarcomas is a common phenomenon and close surveillance with an oncologist is essential.
Due to the concerns around the COVID-19 pandemic era, misdiagnosis can occur in cardiovascular disorders with COVID-19 infection. In this case, the attempt to be alert in the diagnosis and empiric treatment of COVID-19, resulted in the misdiagnosis. Even though the CT scan and RT-PCR results showed no evidence in the favor of COVID-19, the symptoms of the patient and the TEE results were thought to be related to the thrombosis of the prosthetic valve caused by the infection. Although we need to be vigilant in the diagnosis of COVID-19, we should not forget about the other possible disorders.