Multiple Primary Leiomyomas in the Right Ventricle: A Rare Form of Leiomyoma

Primary intracardiac leiomyoma: rare case report and literature review

Benign cardiac neoplasms are relatively uncommon. Cardiac leiomyomas are usually diagnosed as a benign metastasizing leiomyoma or as a part of intravenous leiomyomatosis spectrum. Primary cardiac leiomyomas are extremely rare and should be diagnosed after ruling out the involvement of systemic leiomyomas. Only nine cases were found in the literature that described De novo occurrence of primary intra-cardiac leiomyoma. In this study, we present a case of 60-year-old female patient with a large pedunculated mass located in the left ventricle. Histopathology examination and immunohistochemistry aid confirmed the diagnosis of benign leiomyoma. No evidence of extra cardiac lesions was detected in the patient. The patient remained healthy with no signs of recurrence four years after the surgical resection. Benign cardiac tumors are not often seen, but when they do occur, they can present a serious risk to life. This is particularly significant because these tumors can detach and cause embolization, leading to the development of strokes. Moreover, these individuals do not show any clinical symptoms, making their detection quite challenging. When there is a suspicion, it is advised to utilize echocardiography and other imaging techniques to verify the presence of a tumor. In this report, we present a rare case and provide differential diagnoses, along with a review of the literature.

Primary leiomyoma of the left ventricle leading to sudden and unexpected death in a 74-year-old male: a case report

Background

Primary cardiac tumours arising from smooth muscle cells are said to be very rare in the literature. Primary leiomyoma of the heart particularly in men is extremely rare. To the best of my knowledge, there are only two reported cases of boys with primary leiomyoma of the heart in the English literature. Most of leiomyoma tumours involving the heart reported in the literature are a result of cardiac extensions of intravenous leiomyomatosis through the inferior vena cava.

Case presentation

A case of left ventricular primary leiomyoma in a 74-year-old male is reported. He had no known previous history of heart disease but he died suddenly and unexpectedly. At autopsy, the heart measured 420 gm and when it was opened, a solid tumour of size 4 × 3 × 2 cm involving the lower left ventricle on the anterior aspect of the heart was found. The tumour was extending to the left ventricular septum and was growing by protruding into the left ventricle chamber which finally was confirmed histopathologically to be a leiomyoma.

Conclusion

Cardiac benign tumours are rare and can be life threatening because of embolization following their detachment which is manifested clinically by stroke. Additionally, they are clinically asymptomatic; therefore, they cannot be easily detected. In case of clinical suspicion, echocardiography and other imaging diagnostic tests should be used to confirm presence of a tumour.