Left atrial involvement of a right lung tumour

Excerpt

A 27-yr-old man with a history of a non-seminomatous germ cell tumour and orchiectomy with adjuvant chemotherapy presented to our institution with a giant right lung tumour that extended through the right superior pulmonary vein (RSPV) into the left ventricle (Figure 1A). Biopsy of the lung mass revealed a metastatic germ cell tumour, and the patient underwent urgent chemotherapy with excellent response. A residual 5.3 cm × 4.9 cm × 4.9 cm tumour remained centred in the right middle lobe with extension from the RSPV into the left atrium (LA) (Figure 1B). Once maximal cytoreduction and normalization of tumour markers were achieved, the patient was brought to the operating room for right upper and middle lobe bilobectomy as well as resection of the LA tumour. Intraoperative two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) showed a 1.6 cm × 1.8 cm non-mobile mass in the LA (Figure 1C). The surgeon attempted retraction and manipulation of the tumour; however, TEE showed that the mass remained immobile and too large for excision from the pulmonary vein side without opening the LA. Therefore, cardiopulmonary bypass was initiated, and the patient underwent resection of the intra-atrial portion of the tumour and removal of the entire mass en bloc with the right upper and middle lobe.

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