A Rare Case of Mediastinal Rhabdomyosarcoma Feeding of the Left Anterior Descending Artery

Objectives: Embryonic rhabdomyosarcomas are the most common malignant tumors of soft and muscle tissue in young adults. We here report the successful removal of a rhabdomyosarcoma from the mediastinum with blood supply from the left anterior descending artery (LAD) in a 51-year-old patient.

Methods: The patient was admitted to the hospital because of dyspnea at rest, dry cough, and increasing peripheral edema. At the age of 20 years, the patient was diagnosed with an embryonic rhabdomyosarcoma in the left leg, which was successfully treated by amputation. Now, echocardiography revealed hemodynamically relevant hemorrhagic pericardial effusion, which was drained by pericardiocentesis (1,400 mL). CT scan showed a large mass including the pericardium with extensive contact to the epicardium compressing heart and left lung. MRI confirmed the suspicion of a solid tumor without visible signs of myocardial or lung tissue infiltration. Coronary angiography showed arterial vessels originating from the LAD supplying the tumor. Tumor board reached the decision for surgical removal.

Result: Median sternotomy revealed a 15-cm tumor located between the heart and the left lung with pericardial infiltration. The tumor could be dissected from the left lung without the need for lung tissue resection. Blunt dissection from the heart up to the coronary vessels feeding the tumor was also possible. Using off-pump stabilizers, the tumor-feeding vessels could be ligated and resection completed without affecting the LAD. The pericardium was generously resected and reconstructed with a bovine patch. The histological examination revealed the morphology of a spindle cell rhabdomyosarcoma with R0 resection. The patient was extubated the first postoperative day and recovery was uneventful. Follow-up at 3 months showed the patient in good general condition.

Conclusion: This case is the first description of a rhabdomyosarcoma with blood supply from the left anterior descending artery (LAD). It remains unclear whether the tumor is a metastasis of the patient's previous leg sarcoma. However, off-pump coronary surgery techniques allowed the complete removal of this complex tumor.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021