Primary leiomyosarcoma of the anterior mediastinum

A 76-year-old woman with hypertension presented with a 3-day history of progressive dyspnea. Physical examination revealed decreased breathing sounds in her right chest. Her routine blood investigations were unremarkable; cytology evaluation of the pleural fluid revealed no malignant cell. Chest radiography demonstrated right massive pleural effusion and a mass lesion disclosed over right heart border after adequate drainage and pigtail insertion. Computed tomography (CT) demonstrated a 11.4 x 8.4 x 13 cm well-defined heterogeneous mass with cystic and nodular areas encasing the right heart border with no mediastinal lymphadenopathy (Figure 1a). No metastatic lesion was detected on CT of abdomen.