title: Cardiac metastases and tumor embolization: A rare sequelae of primary undifferentiated liver sarcoma.
abstract: BACKGROUND
  Primary hepatic sarcomas are uncommon malignant neoplasms; prognostic features, natural history, and optimal management of these tumors are not well characterized.
  
  
  METHODS
  This report describes the management of a 51-year-old patient that underwent a right trisectionectomy for a large hepatic mass found to be a liver sarcoma on pathology. He subsequently developed tumor emboli to his lungs and was discovered to have cardiac intracavitary metastases from his primary tumor. The patient underwent cardiopulmonary bypass and resection of the right-sided heart metastases to prevent further pulmonary sequela of tumor embolization.
  
  
  CONCLUSIONS
  The lack of distinguishing symptoms or imaging characteristics that clearly define hepatic sarcomas makes it challenging to achieve a diagnosis prior to pathologic examination. Metastatic spread is frequently to the lung or pleura, but very rarely seen within the heart. Failure to recognize cardiac metastatic disease will ultimately lead to progressive tumor embolization and cardiac failure if left untreated.
  
  
  CONCLUSIONS
  The most effective therapy for primary liver sarcomas is surgery; radical resection should be performed if possible given the aggressive nature of these tumors to progress and metastasize.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1). Electronic address: mdua@stanford.edu.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1). Electronic address: jcloyd@stanford.edu.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Cloyd
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, 870 Quarry Road, Stanford, CA 94305, United States. Electronic address: fhaddad@stanford.edu.
authors.forename: Francois
authors.initials: F
authors.lastname: Haddad
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Stanford University School of Medicine, Falk Cardiovascular Research Center, 870 Quarry Road, Stanford, CA 94305, United States. Electronic address: rbeygui@stanford.edu.
authors.forename: Ramin E
authors.initials: RE
authors.lastname: Beygui
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1). Electronic address: janorton@stanford.edu.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States(1). Electronic address: bvisser@stanford.edu.
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
keywords: Cardiac metastases; Hepatectomy; Liver sarcoma; Tumor emboli