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Jiang Z, Kang Q, Qian H, Xu Z, Tong H, Yang J, Li L, Li R, Li G, Chen F, Lin N, Zhao Y, Shi H, Huang J, Ma X. Revealing the crucial roles of suppressive immune microenvironment in cardiac myxoma progression. Signal Transduct Target Ther 2024; 9:193. [PMID: 39090109 PMCID: PMC11294589 DOI: 10.1038/s41392-024-01912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024] Open
Abstract
Cardiac myxoma is a commonly encountered tumor within the heart that has the potential to be life-threatening. However, the cellular composition of this condition is still not well understood. To fill this gap, we analyzed 75,641 cells from cardiac myxoma tissues based on single-cell sequencing. We defined a population of myxoma cells, which exhibited a resemblance to fibroblasts, yet they were distinguished by an increased expression of phosphodiesterases and genes associated with cell proliferation, differentiation, and adhesion. The clinical relevance of the cell populations indicated a higher proportion of myxoma cells and M2-like macrophage infiltration, along with their enhanced spatial interaction, were found to significantly contribute to the occurrence of embolism. The immune cells surrounding the myxoma exhibit inhibitory characteristics, with impaired function of T cells characterized by the expression of GZMK and TOX, along with a substantial infiltration of tumor-promoting macrophages expressed growth factors such as PDGFC. Furthermore, in vitro co-culture experiments showed that macrophages promoted the growth of myxoma cells significantly. In summary, this study presents a comprehensive single-cell atlas of cardiac myxoma, highlighting the heterogeneity of myxoma cells and their collaborative impact on immune cells. These findings shed light on the complex pathobiology of cardiac myxoma and present potential targets for intervention.
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Affiliation(s)
- Zedong Jiang
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, Sichuan, China
| | - Qianlong Kang
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Qian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huan Tong
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaqing Yang
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Li
- Institute of Clinical Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Renwei Li
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guangqi Li
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fei Chen
- Institute of Clinical Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Nan Lin
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunuo Zhao
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huashan Shi
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Juan Huang
- Department of Hematology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xuelei Ma
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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2
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Zhang J, Guan X, Zhang G, Yin Y, Sha Z, Zhao Y, Li J, Li B, Qiu X. Two cerebral infarctions caused by thrombus and myxomatous embolus in a patient with cardiac myxoma: A case report. Heliyon 2024; 10:e30199. [PMID: 38737257 PMCID: PMC11088245 DOI: 10.1016/j.heliyon.2024.e30199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
An increasing number of cases of cerebral embolism caused by cardiac myxoma have been reported. However, cerebral infarction caused by different types of emboli obstructing different vascular regions within a short period of time has not been reported. This is the first report to histologically confirm cerebral infarctions independently caused by thrombus and myxomatous embolus in a patient with cardiac myxoma within a period of 23 days. The first cerebral infarction was due to embolization of thrombus to the right middle cerebral artery, whereas the second was due to embolization of tissue from a mucinous tumor to the left middle cerebral artery. Both cerebral infarctions underwent mechanical thrombectomy, but unfortunately, we ultimately failed to save the patient's life. Therefore, further attention should be paid to the surgical resection and treatment of cardiac myxoma.
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Affiliation(s)
- Ju Zhang
- Shandong Second Medical University, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Xiangfeng Guan
- Shandong Second Medical University, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Guanzhao Zhang
- Department of Cardiology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Yingchun Yin
- Department of Pathology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Zuowei Sha
- Department of Pathology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Yunhe Zhao
- Department of Cardiology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Jing Li
- Department of Pathology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Bo Li
- Department of Cardiology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Xueliang Qiu
- Department of Neurology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
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Sega M, Yamashita M, Maruyama H, Taya Y, Ohgi K, Haraoka R, Hirayama K. Renal Embolism Associated with the Atrial Myxoma: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:694. [PMID: 38792877 PMCID: PMC11123329 DOI: 10.3390/medicina60050694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
Renal embolisms due to cardiac myxomas are extremely rare; the clinical course, treatment, and prognosis of this disease are not established. A 69-year-old Japanese woman who underwent a nephrectomy for renal cell carcinoma 3 years earlier was hospitalized with a right occipital lobe cerebral infarction. Her renal function suddenly worsened 3 days post-admission: her serum creatinine rose from 1.46 mg/dL to 6.57 mg/dL and then to 8.03 mg/dL the next day, and hemodialysis therapy was started. Abdominal computed tomography (CT) scans showed patchy non-contrasted low-density areas in the right kidney, and chest CT scans and transesophageal ultrasonography revealed a left atrial tumor. We diagnosed renal infarction due to a left atrial myxoma. Hemodialysis and anticoagulant therapy (heparin) were continued, followed by the cardiac myxoma's resection. The patient's renal function gradually improved post-surgery, and the hemodialysis was discontinued. Considering our patient and 19 other case reports of renal infarction associated with cardiac myxoma, the treatment for such a renal infarction and the outcomes differ depending on the embolus site. The poor outcome of abdominal aortic embolism requires a prompt embolectomy, whereas a branch renal artery embolism requires anticoagulation therapy to prevent thrombosis formation around the myxoma.
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Affiliation(s)
- Masatoshi Sega
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Marina Yamashita
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Hiroshi Maruyama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Yuji Taya
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Kentaro Ohgi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
- Department of Intensive Care Medicine, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Rei Haraoka
- Department of Neurosurgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
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Lao A, Silva J, Chiu B, Sergi CM. Carney complex: A clinicopathologic study on a single family from several Canadian provinces. Cardiovasc Pathol 2024; 69:107599. [PMID: 38072094 DOI: 10.1016/j.carpath.2023.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023] Open
Abstract
Carney syndrome is an autosomal dominant complex involving endocrinopathy, mucocutaneous hyperpigmentation, and different tumors, including cardiac myxomas. We report on a single family with several members affected with Carney syndrome. Family and individual medical histories were investigated in several Canadian provinces. The histology slides were also reviewed. Four family members (two young women, both sisters, their mother, and maternal grandmother) were found to harbor Carney syndrome. Everyone was presented with multiple and recurrent atrial myxomas of the heart, requiring multiple open cardiac surgeries. Breast myxomas and cutaneous hyperpigmentation were also revealed in one of the sisters and their mother. Interestingly, genetic testing was positive for the female family members and negative for the father and brother. We cannot rule out that the brother may have had a new mutation or harboring a mosaic. The young woman's brother did not have cardiac myxoma but developed a unilateral Sertoli cell tumor of testis. Carney syndrome is a rare complex multisystemic genetic disorder, including multiple and recurrent cardiac myxomas. We strongly suggest that reporting familial Carney syndrome is still critical in the 21st century to augment the awareness of this situation among clinicians and pathologists.
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Affiliation(s)
- Alexandra Lao
- Department of Laboratory Medicine and Pathology, Hôpital de Saint-Georges; CISSS - Chaudière-Appalaches, Quebec, Canada
| | - Julio Silva
- Medicine Hat Regional Hospital, Alberta Precision Laboratories Ltd. (APL) - South Sector, Alberta, Canada
| | - Brian Chiu
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Consolato M Sergi
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada; Anatomic Pathology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
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Tang C, Gao X, Chen T, Shao J, Zhu T, Zheng X, Ren C. Case Report: Acute cerebral infarction caused by left atrial and right ventricular myxoma received emergency operation. Front Cardiovasc Med 2024; 10:1316063. [PMID: 38283175 PMCID: PMC10811181 DOI: 10.3389/fcvm.2023.1316063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Cardiac myxoma is a rare etiology of ischemic stroke, especially in young people. We report a case of multiple myxomas in left atrium and right ventricle inducing acute cerebral infarction. No significant abnormalities were detected in the patient's preoperative laboratory examination. Following emergency surgery, the patient's prognosis was satisfactory, providing valuable empirical insight for the surgical management of acute cerebral infarction in individuals diagnosed with cardiac myxoma. Our objective is to heighten awareness regarding the evaluation and treatment of patients with acute cerebral infarction subsequent to early diagnosis of cardiac myxoma.
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Affiliation(s)
- Chengbin Tang
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Xianglong Gao
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Tao Chen
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Jun Shao
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Tao Zhu
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Xucai Zheng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Chuanli Ren
- Department of Laboratory Medicine, Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
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Pálla S, Tőke J, Bozsik A, Butz H, Papp J, Likó I, Kuroli E, Bánvölgyi A, Hamar M, Bertherat J, Medvecz M, Patócs A. Whole genome sequencing resolves 10 years diagnostic odyssey in familiar myxoma. Sci Rep 2023; 13:14658. [PMID: 37670105 PMCID: PMC10480295 DOI: 10.1038/s41598-023-41878-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
Carney complex (CNC) is an ultrarare disorder causing cutaneous and cardiac myxomas, primary pigmented nodular adrenocortical disease, hypophyseal adenoma, and gonadal tumours. Genetic alterations are often missed under routine genetic testing. Pathogenic variants in PRKAR1A are identified in most cases, while large exonic or chromosomal deletions have only been reported in a few cases. Our aim was to identify the causal genetic alteration in our kindred with a clinical diagnosis of CNC and prove its pathogenic role by functional investigation. Targeted testing of PRKAR1A gene, whole exome and whole genome sequencing (WGS) were performed in the proband, one clinically affected and one unaffected relative. WGS identified a novel, large, 10,662 bp (10.6 kbp; LRG_514t1:c.-10403_-7 + 265del; hg19, chr17:g.66498293_66508954del) deletion in the promoter of PRKAR1A in heterozygous form in the affected family members. The exact breakpoints and the increased enzyme activity in deletion carriers compared to wild type carrier were proved. Segregation analysis and functional evaluation of PKA activity confirmed the pathogenic role of this alteration. A novel deletion upstream of the PRKAR1A gene was proved to be the cause of CNC. Our study underlines the need for WGS in molecular genetic testing of patients with monogenic disorders where conventional genetic analysis fails.
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Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Judit Tőke
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary
| | - Anikó Bozsik
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - Henriett Butz
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - János Papp
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - István Likó
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Mátyás Hamar
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- ERN-Skin Semmelweis University, Budapest, Hungary
| | - Attila Patócs
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary.
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary.
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary.
- National Tumorbiology Laboratory, Budapest, Hungary.
- National Institute of Oncology, Oncology Biobank Center, Budapest, Hungary.
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
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Shalata W, Massalha I, Ishay SY, Chernomordikova E, Jama AA, Rouvinov K, Dudnik Y, Yakobson A. Radiotherapy-Induced Atrial Myxoma: A Case Report and Literature Review. Life (Basel) 2023; 13:1585. [PMID: 37511961 PMCID: PMC10381263 DOI: 10.3390/life13071585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
In this particular case study, we present a 66-year-old male who was diagnosed with an atrial myxoma eight years after receiving treatment for non-small cell lung cancer. The patient underwent chemo-radiotherapy (mediastinal area) in 2012 to address stage III-A adenocarcinoma of the lung. During follow-up imaging in 2020, a left atrial mass displaying characteristic features of a cardiac myxoma was detected. Upon reviewing a computed tomographic (CT) scan from 2017 within the previously irradiated mediastinal region, the cardiac mass was retrospectively identified. The surgical excision of the cardiac mass was performed, and a subsequent pathological examination confirmed the diagnosis of myxoma. To the best of our knowledge, this is the first reported case of a left atrial myxoma in a patient previously treated for adenocarcinoma of the lung and the first instance of an atrial myxoma occurring in a site that had undergone prior radiation therapy.
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Affiliation(s)
- Walid Shalata
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Ismaell Massalha
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Shlomo Yaron Ishay
- Department of Cardio-Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Elena Chernomordikova
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Ashraf Abu Jama
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Keren Rouvinov
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Yulia Dudnik
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Alexander Yakobson
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
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Sun Y, Li Z, Sun J, Ma D, Shan X, Chen X. Somatic Mutation of PRKAR1A in Four Cases of Sporadic Cardiac Myxoma. ARCHIVES OF IRANIAN MEDICINE 2023; 26:346-354. [PMID: 38310436 PMCID: PMC10685830 DOI: 10.34172/aim.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/02/2022] [Indexed: 02/05/2024]
Abstract
BACKGROUND Inactivating mutations of the protein kinase A regulatory subunit 1 alpha (PRKAR1A) gene have been reported in familial cardiac myxoma. However, the role of PRKAR1A mutation in sporadic cardiac myxoma remains unknown. METHODS Targeted next-generation sequencing (NGS) was performed to identify mutations with the PRKAR1A gene in seven cases of sporadic cardiac myxomas. Sanger sequencing of DNA from cardiac myxoma specimens and matched peripheral blood samples was performed to verify the identified mutations. RESULTS Targeted NGS of myxoma DNA revealed 232 single nucleotide variants in 141 genes and 38 insertion-deletion mutations in 13 genes. Six PRKAR1A mutations were identified in four of the seven cardiac myxoma cases, and thus, the PRKAR1A inactivating mutation rate was 57.2% (4/7, 95% CI=0.44-0.58, P<0.05). The PRKAR1A variants identified by Sanger sequencing analysis were consistent with those from the NGS analysis for the four myxoma specimens. All of the pathogenic PRKAR1A mutations led to premature termination of PRKAR1A, except for one synonymous mutation. Moreover, none of the nonsense and missense mutations found in the myxoma specimens were found in the matched peripheral blood samples. CONCLUSION Pathogenic mutations of the PRKAR1A gene were identified in tumor specimens from four cases of sporadic cardiac myxoma, and the absence of these mutations in peripheral blood samples demonstrated that they were somatic mutations.
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Affiliation(s)
- Yunpeng Sun
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Zhiping Li
- Department of Pharmacology, Basic Medical College of Jilin University, Changchun, Jilin, 130021, China
| | - Jingnan Sun
- Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Dashi Ma
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xue Shan
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xia Chen
- Department of Pharmacology, Basic Medical College of Jilin University, Changchun, Jilin, 130021, China
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Zhao S, Li H, Wu C, Pan Z, Wang G, Dai J. Surgical treatment of rare pediatric cardiac myxomas:12 years clinical experience in a single institution. BMC Cardiovasc Disord 2023; 23:219. [PMID: 37118677 PMCID: PMC10147350 DOI: 10.1186/s12872-023-03255-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Primary cardiac tumors are rare, and cardiac myxoma (CM) accounts for the majority of these tumors. Most of the reports in the literature are case reports. This study summarizes our clinical experience in the surgical treatment of CM over the past 12 years. METHODS We retrospectively analyzed the clinical data of 23 children with CM(8 boys, 15 girls; median age: 8.92 months, range: 2 years 5 months-12 years 9 months; body weight: 11-45 kg, median body weight: 28.21 kg) admitted to our hospital in the previous 12 years, and we statistically analyzed their clinical manifestations and surgical methods. RESULTS 23 cases underwent myxoma excision under cardiopulmonary bypass(CPB). The follow-up period was 0.2 to 12.6 years (mean:7.2 years). Two patients could not be traced, and the follow-up completion rate was 91.30%. One patient (4.35%) died of myocardial infarction early after surgery with low continuous cardiac output. There were no cerebral embolism, acute heart failure, atrioventricular block and other related complications in 19 cases. A patient with cerebral infarction complicated with right hemiplegia recovered well after rehabilitation treatment. There was no recurrence of CM in 19 cases and all patients recovered after surgery. One patient relapsed 5 years after surgery, and no tumor recurrence was observed after the second surgery. Among the 20 long-term survivors, 13 (65.00%) were NYHA Class I patients and 7(35.00%) were NYHA Class II patients. CONCLUSIONS Although CM in children is rare, it may cause cerebral infarction and other multi-organ embolism. Once CM is found and removed as soon as possible, it can reduce serious complications. If the complete resection is possible, surgery provides better palliation. Follow-up echocardiographic should be paid attention to after surgery.
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Affiliation(s)
- Shengliang Zhao
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, No. 20, Jinyu Avenue, Liangjiang New District, Chongqing, P. R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P. R. China
- Department of Thoracic Surgery, Second Affiliated Hospital of Army Medical University, Chongqing, P. R. China
| | - Hua Li
- Department of Thoracic Surgery, Second Affiliated Hospital of Army Medical University, Chongqing, P. R. China
| | - Chun Wu
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, No. 20, Jinyu Avenue, Liangjiang New District, Chongqing, P. R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P. R. China
| | - Zhengxia Pan
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, No. 20, Jinyu Avenue, Liangjiang New District, Chongqing, P. R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P. R. China
| | - Gang Wang
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, No. 20, Jinyu Avenue, Liangjiang New District, Chongqing, P. R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P. R. China
| | - Jiangtao Dai
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, No. 20, Jinyu Avenue, Liangjiang New District, Chongqing, P. R. China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P. R. China.
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Amemiya K, Yonemoto Y, Ishibashi-Ueda H, Matsumoto M, Ohta-Ogo K, Ikeda Y, Kobayashi J, Fukushima S, Fujita T, Hatakeyama K. Morphological characteristics of cardiac myxoma causing embolism: a series of 40 years of experience at a single institute. Virchows Arch 2023; 482:377-384. [PMID: 36441241 DOI: 10.1007/s00428-022-03461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
Systemic and cerebral embolisms are serious complications of associated with cardiac myxoma. Embolism risk reportedly depends on the gross and histological morphology. This study is aimed at analyzing the morphologic pattern of excised cardiac myxoma as a high-risk embolic cause. Between 1978 and April 2022, 116 surgical specimens of cardiac myxomas were recorded at the pathology department of our hospital. The tumors were classified into three types based on their macroscopic shapes and external morphology-round-smooth, irregular, and villous-to investigate the embolic complications. Of the 116 specimens, 106 macroscopic images of cardiac myxoma (89% were located in the left atrium) were prepared. Round-smooth types were found in 36 (34.0%) patients, irregular types in 32 (30.2%) patients, and the villous types in 38 (35.8%) patients. Multivariable analysis revealed that a villous external appearance was an independent predictor of embolic events (odds ratio: 8.7; 95% confidence interval: 2.4-42.1; p < 0.001). Villous external appearance of cardiac myxoma was associated with the highest risk of distal embolism.
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Affiliation(s)
- Kisaki Amemiya
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Yumiko Yonemoto
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.,Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.,Division of Diagnostic Pathology, Hokusetsu General Hospital, Takatsuki, Japan
| | - Manabu Matsumoto
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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11
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Qiao ML, Ma L, Wang CB, Fang LB, Fan ZX, Niu TT, Wang ZY, Lu JF, Yuan BY, Liu GZ. Clinical features, risk factors and survival in cardiac myxoma-related ischemic stroke: A multicenter case-control study. J Neurol Sci 2023; 444:120517. [PMID: 36528975 DOI: 10.1016/j.jns.2022.120517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac myxoma (CM) is an important etiology of stroke in young adults, but studies on CM-related ischemic stroke (CM-IS) are limited and conflicting. Hence, we investigated clinical characterizations, risk factors of CM-IS, and short-term survival after surgical resection. METHODS We performed a retrospective analysis of data from all CM patients at three referral management centers and conducted follow-up examination. RESULTS Among 414 CM patients, 402 were recruited for further analysis, including 54 patients with CM-IS and 348 patients with CM without stroke (Non-stroke). In the acute phase, patients presented with NIHSS 3 (interquartile range: 0-10) and clinical presentation comprising neurological, cardiac and constitutional symptoms. Multivariate analysis showed that the factors associated with an increased risk of CM-IS were tumor width < 30 mm [OR = 2.652, 95% CI: 1.061-6.627, P = 0.037], tumors with high-mobility (OR = 2.700, 95% CI: 1.357-5.371, P = 0.005), thrombus on the tumor surface (OR = 1.856, 95% CI: 1.003-3.434, P = 0.049), and lower B-type natriuretic peptide (BNP) levels (OR = 0.995, 95% CI: 0.989-0.999, P = 0.047). The overall three-year survival rate was 95.7% (95% CI: 94.9-96.5) in CM-IS patients who underwent surgery. CONCLUSIONS CM-IS patients had mild or moderate neurologic deficits with various presentations at disease onset. Narrower tumor width, tumors with high-mobility, thrombus on the tumor surface, and lower BNP levels are potential predictors of CM-IS development. Surgical removal of CM is safe and efficacious in patients with CM-IS.
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Affiliation(s)
- Man-Li Qiao
- Department of General Practice Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Lin Ma
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Chao-Bin Wang
- Department of Neurology, Beijing Fangshan district Liangxiang Hospital, Beijing 102400, China
| | - Li-Bo Fang
- Department of Neurology, Beijing Fuxing Hospital, Capital Medical University, Beijing 100029, China
| | - Ze-Xin Fan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Tian-Tong Niu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Ze-Yi Wang
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jian-Feng Lu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Bo-Yi Yuan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Guang-Zhi Liu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
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12
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Muacevic A, Adler JR, Cappello JP. Cerebrovascular Accident: An Initial Presentation of Atrial Myxoma in a Young Female. Cureus 2023; 15:e33529. [PMID: 36779142 PMCID: PMC9906568 DOI: 10.7759/cureus.33529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/11/2023] Open
Abstract
Myxomas make up roughly half of all primary cardiac tumors, with three-quarters originating in the left atrial cavity and one-quarter in the right. These tumors can occur sporadically or in families. Atrial myxomas are classified as severe based on factors such as their size, the patient's age and gender, and the tumor's proclivity to embolize or occlude coronary vessels. The case of a young female with an unusual presentation of left atrial myxoma and a new neurovascular deficit is discussed.
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13
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Ma L, Cai B, Qiao ML, Fan ZX, Fang LB, Wang CB, Liu GZ. Risk factors assessment and a Bayesian network model for predicting ischemic stroke in patients with cardiac myxoma. Front Cardiovasc Med 2023; 10:1128022. [PMID: 37034338 PMCID: PMC10079949 DOI: 10.3389/fcvm.2023.1128022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective This study aims to identify relevant risk factors, assess the interactions between variables, and establish a predictive model for ischemic stroke (IS) in patients with cardiac myxoma (CM) using the Bayesian network (BN) approach. Methods Data of patients with CM were collected from three tertiary comprehensive hospitals in Beijing from January 2002 to January 2022. Age, sex, medical history, and information related to CM were extracted from the electronic medical record system. The BN model was constructed using the tabu search algorithm, and the conditional probability of each node was calculated using the maximum likelihood estimation method. The probability of each node of the network and the interrelationship between IS and its related factors were qualitatively and quantitatively analyzed. A receiver operating characteristic (ROC) curve was also plotted. Sensitivity, specificity, and area under the curve (AUC) values were calculated and compared between the BN and logistic regression models to evaluate the efficiency of the predictive model. Results A total of 416 patients with CM were enrolled in this study, including 61 with and 355 without IS. The BN model found that cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility were directly associated with the occurrence of IS in patients with CM. The BN model for predicting CM-IS achieved higher scores on AUC {0.706 [95% confidence interval (CI), 0.639-0.773]} vs. [0.697 (95% CI, 0.629-0.766)] and sensitivity (99.44% vs. 98.87%), but lower scores on accuracies (85.82% vs. 86.06%) and specificity (6.56% vs. 11.48%) than the logistic regression model. Conclusion Cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility are candidate predictors of IS in patients with CM. The BN model was superior or at least non-inferior to the traditional logistic regression model, and hence is potentially useful for early IS detection, diagnosis, and prevention in clinical practice.
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Affiliation(s)
- Lin Ma
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bin Cai
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Man-Li Qiao
- Department of General Practice Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ze-Xin Fan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Li-Bo Fang
- Department of Neurology, Beijing Fangshan District Liangxiang Hospital, Beijing, China
| | - Chao-Bin Wang
- Department of Neurology, Beijing Fuxing Hospital, Capital Medical University, Beijing, China
| | - Guang-Zhi Liu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Correspondence: Guang-Zhi Liu
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14
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Hung LW, Lee CY, Hii HP, Wu NC, Cheng BC. Robot-assisted endoscopic removal of a huge tricuspid valve myxoma: case report. J Cardiothorac Surg 2022; 17:258. [PMID: 36203203 PMCID: PMC9540697 DOI: 10.1186/s13019-022-01978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cardiac myxoma is the most common benign cardiac tumor. Its tremendous size and fragile character severely bother the surgeons. Several minimal invasive approaches had been applied for radical tumor excision. The wound was forcibly enlarged for en-bloc specimen removal and prevention of debris sputtering. Case presentation We reported a case of huge tricuspid valve (TV) myxoma managed by robot-assisted endoscopic tumor resection and TV repair, with initial presentation of worsening shortness of breath for two months. The tumor was downsized with a morcellator and removed through a keyhole wound (1.1 cm in diameter). The patient recovered uneventfully and was discharged after four days. Conclusions With the first morcellator application, this might be the smallest surgical wound reported after the removal of a huge cardiac myxoma. The ICU and hospital stays were shortened. This might be effectively applied to further minimally invasive surgeries for cardiac tumor excision. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01978-5.
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Affiliation(s)
- Lun-Wu Hung
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Cheng-Ya Lee
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Hiong-Ping Hii
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Nan-Chun Wu
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Bor-Chih Cheng
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan. .,Division of Cardiovascular Surgery, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No.699, Section 8, Taiwan Boulevard, Wuqi District, Taichung City, 43503, Taiwan.
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15
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Rao J, Tao Z, Bao Q, Jiang M, Zhou E, Cai X, Fu F. Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis. Front Neurol 2022; 13:893807. [PMID: 35645949 PMCID: PMC9133336 DOI: 10.3389/fneur.2022.893807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) is a major life-threatening consequence of cardiac myxoma (CM) and leads to a poor prognosis. Although intravenous thrombolysis (IVT) is the first-line treatment for AIS, its efficacy and safety in CM-AIS have not been established. Currently, there are only limited data from case reports. Our study aimed to investigate the clinical characteristics of CM-AIS and evaluate the safety and efficacy of IVT for CM-AIS patients. Methods Fourteen CM-AIS patients who received IVT between January 2016 and December 2021 were identified from our multicenter stroke registry databases. Clinical, neuroimaging and outcome data were analyzed. We then performed a pooled analysis of the published literature from inception to December 2021. Results Of the 14 CM-AIS patients, nine were treated with IVT alone, and five were treated with bridging therapy (BT). The median age was 51.5 years, and 57.1% were female. The median onset-to-needle time was 160 min. The median National Institute of Health Stroke Score (NIHSS) decreased from 15.5 at presentation to 13 24 h after IVT. Very early neurological improvement (VENI) was observed in one patient. Hemorrhagic transformation (HT) was observed in five (35.7%) patients, and only one patient was symptomatic (7.1%). Three-month favorable outcomes were achieved in six patients (66.7%) who underwent IVT alone and three patients (60%) who received BT, which resulted in a total proportion of favorable outcomes of 64.3%. None of the patients died at 3 months follow-up. Forty-seven cases (15 BT patients) were included for the pooled analysis. The median NIHSS score was 16.5, and VENI was observed in 10 (21.3%) patients. HT was detected in 11 patients (23.4%), and four (8.5%) patients were symptomatic. Favorable outcomes at 3 months were achieved in 61.7% of patients, 56.3% of patients who underwent IVT alone, and 73.3% of patients who received BT. The 3-month mortality rate was 4.3%. Conclusions IVT is a potentially safe and efficient treatment for CM-AIS patients. Further studies with larger sample sizes are required to provide more evidence on the safety and efficacy of IVT and BT in CM-AIS patients.
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Affiliation(s)
- Jie Rao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Zi Tao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongqiong Bao
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mingxia Jiang
- Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Enyang Zhou
- Department of Neurology, Qingtian People's Hospital, Lishui, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- *Correspondence: Xueli Cai
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Fangwang Fu
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16
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Islam AKMM. Cardiac myxomas: A narrative review. World J Cardiol 2022; 14:206-219. [PMID: 35582466 PMCID: PMC9048271 DOI: 10.4330/wjc.v14.i4.206] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/28/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.
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Affiliation(s)
- A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka 1207, Bangladesh
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17
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Rao J, Tao Z, Bao Q, Xu M, Jiang M, Weng X, Yin B, Li D, Li Y, Cai X, Fu F. Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis. Front Neurol 2022; 13:877056. [PMID: 35509996 PMCID: PMC9058073 DOI: 10.3389/fneur.2022.877056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) is a common and life-threatening complication of patients with cardiac myxoma (CM). The role of the mechanical thrombectomy (MT) technique in CM-AIS patients remains unclear, and no guidelines exist for this population. Therefore, we conducted a case series study of MT in CM-AIS patients to investigate its safety and efficacy via a pooled analysis of published literature. Methods Eleven CM-AIS patients who underwent MT between 2016 and 2021 were screened from multicenter stroke databases. Clinical, procedural, and outcome data were obtained from medical records. A systematic review was conducted to identify additional cases from published studies by searching PubMed and China National Knowledge Infrastructure databases. We then performed a pooled analysis of the published cases. Results In the case series study, most patients were male (81.8%), with a median age of 51 years. All patients had CM located in the left atrium. The rate of successful reperfusion using the first-line thrombectomy technique was 100% with stent retriever (SR) and 66.7% with direct aspiration (DA), which resulted in overall successful reperfusion in 94.1% of all occlusions. The retrieved emboli of the five patients who underwent histopathology examination were identified as myxoma components. Hemorrhagic transformation was observed in five (45.5%) patients, of whom one was symptomatic (9.1%). Three-month favorable functional outcomes were achieved in five (45.5%) patients with a 3-month mortality rate of 18.2%. For the literature review, 35 cases with 51 target vessel occlusions were identified and included in the pooled analysis. The rate of successful reperfusion following first-line thrombectomy did not differ between SR (30 patients, 90.9%) and DA (10 patients, 83.3%). The overall successful reperfusion rate was 91.8% of all occlusions. Three-month favorable functional outcomes were achieved in 21 (60.0%) patients, and the mortality rate was 8.6%. Conclusions Our findings suggest that MT is not only an effective technique but also a safe option for CM-AIS patients with large vessel occlusion. MT has several advantages for this population, which include a high recanalization rate, low bleeding risk, and the ability to evaluate the source of emboli and the etiology of stroke.
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Affiliation(s)
- Jie Rao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Zi Tao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongqiong Bao
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mengbei Xu
- Department of Neurology, Ningbo Second Hospital, Ningbo, China
| | - Mingxia Jiang
- Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiongpeng Weng
- Department of Neurology, Huangyan Hospital, Wenzhou Medical University, Taizhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dandong Li
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Li
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- Xueli Cai
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Fangwang Fu
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18
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Nomura S, Ishii W, Hara R, Nanasawa S, Nishiwaki K, Kagoshima M, Takano T, Satomi H, Usui T. IgG4-related Disease with a Cardiac Mass Causing Cerebral Infarction. Intern Med 2022; 61:1259-1264. [PMID: 34615822 PMCID: PMC9107975 DOI: 10.2169/internalmedicine.8049-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by infiltration of extensive IgG4-positive plasma cells and lymphocytes. Although IgG4-RD has been observed in almost all organs, it rarely affects the myocardium. Cardiovascular lesions of IgG4-RD appear as aortic (aortic aneurysm and aortitis) and pericardial (constrictive pericarditis) lesions as well as pseudotumors around the coronary arteries. We herein report a case of IgG4-RD with a cardiac mass in the right atrium involving a sinus node. This condition caused arrhythmia and repeated strokes. We successfully treated the patient through resection of the cardiac mass, catheter ablation and immunosuppressive therapy.
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Affiliation(s)
- Shun Nomura
- Division of Rheumatology, Department of Internal Medicine, Nagano Red Cross Hospital, Japan
| | - Wataru Ishii
- Division of Rheumatology, Department of Internal Medicine, Nagano Red Cross Hospital, Japan
| | - Ryosuke Hara
- Division of Rheumatology, Department of Internal Medicine, Nagano Red Cross Hospital, Japan
| | | | - Kei Nishiwaki
- Division of Cardiology, Joetsu General Hospital, Japan
| | | | - Tamaki Takano
- Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Japan
| | | | - Tatsuya Usui
- Department of Cardiology, Nagano Red Cross Hospital, Japan
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19
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Tumors of the cardiovascular system: heart and blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Cardiac myxomas as great imitators: A rare case series and review of the literature. Heart Lung 2022; 52:182-189. [DOI: 10.1016/j.hrtlng.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 11/19/2022]
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21
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Tulin R, Geana RC, Robu M, Iliescu VA, Stiru O, Nayyerani R, Chibulcutean AS, Bacalbasa N, Balescu I, Tulin A, Tomescu L. Predictors of Late Mortality in Patients With Surgically Resected Cardiac Myxomas: A Single-Center Experience. Cureus 2022; 14:e20866. [PMID: 35145773 PMCID: PMC8803384 DOI: 10.7759/cureus.20866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Myxomas are the most common cardiac tumors. This study aimed to analyze the possible risk factors associated with late mortality in this group of patients and assess long-term survival. Methods A retrospective study was conducted among patients who underwent myxomas resection between January 2008 and July 2019 in our service. The patients' preoperative, intraoperative, and postoperative data were analyzed. Multivariate logistic regression was performed to identify predictors of mortality at five years. The Kaplan-Meier curve and Cox proportion-adjusted survival curves were used to assess mortality at five and 10 years. Results A total of 108 patients with cardiac myxomas were identified. All cardiac tumors resected were confirmed as myxomas on histopathological examination. Ninety-six patients presented with left-side myxomas (94 left-atria and two left-ventricle) and 12 with right-side myxomas (11 right-atria, one right-ventricle); 78 of the tumors were capsulated, and 30 were sessile-papillary. The mean dimensions were 37 ±6.1 mm on the left side and 41 ±6.7 mm on the right side. Surgical excision was successful in all cases, with 25% requiring interatrial septum patch repair. Recurrence occurred in 2.77% of the patients. Multivariate logistic regression showed chronic kidney disease (CKD) (OR: 7.96, 95% CI: 1.469-43.125, p=0,016) to be an independent predictor for five-year mortality. The mean follow-up period was 7.13 ±2.965 years, and the Kaplan-Meier curve cumulative proportion survival of patients at five years and 10 years were 100% and 88.8%, respectively. There was no statistically significant difference in late-term survival between patients with and without CKD in the Cox proportion-adjusted survival curve (p=0.275). Conclusions Patients with myxomas have a good long-term prognosis following surgical resection. The multivariate logistic regression showed CKD to be an independent predictor of five-year mortality.
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22
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Mallapasi MN, Kusumanegara J, Kabo P, Usman U, Mulyono MT, Faruk M. Cardiac metastasis of triple-negative breast cancer mimicking myxoma: A case report. Int J Surg Case Rep 2021; 88:106552. [PMID: 34763167 PMCID: PMC8591356 DOI: 10.1016/j.ijscr.2021.106552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Metastatic heart tumors are rare, occurring in 1.5-20% of cancer patient autopsies. Lymphoma, melanoma, leukemia, and carcinomas of the lung, esophagus, and breast are the most prevalent causes of these metastases, although they can originate from any malignant tumor. Here we report a case of triple-negative breast cancer with cardiac metastasis mimicking myxoma. PRESENTATION OF CASE A 39-year-old woman presented at the emergency department with shortness of breath. Vital signs were hypotension and tachypnea. There were coarse crackles at the bases of both lungs. Electrocardiography results showed a normal sinus rhythm. Chest X-ray revealed cardiomegaly with signs of pulmonary edema. Echocardiography revealed a large left atrial (LA) mass protruding to the mitral valve and attached to the interatrial septum during diastole. The patient was diagnosed with cardiogenic shock, acute kidney injury, elevated liver enzymes, and an LA mass. Surgical excision through median sternotomy was planned. Intraoperatively, an LA mass was found. The histopathology evaluation showed an LA mass with invasive ductal carcinoma of metastatic breast tumors. Immunohistochemistry (IHC) confirmed the diagnosis of triple-negative breast cancer that had metastasized to the heart. Postoperative echocardiography confirmed complete excision of the tumor. DISCUSSION Breast cancer that has metastasized to the heart is uncommon. This patient was referred to the surgical oncology section for the treatment of triple-negative breast cancer with cardiac metastasis. CONCLUSION A heart mass should be suspected of having metastasized if the patient has a history of malignancy, even if it occurred several years earlier.
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Affiliation(s)
- Muhammad Nuralim Mallapasi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Wahidin Sudirohusodo Hospital, Makassar, Indonesia.
| | - Jayarasti Kusumanegara
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Wahidin Sudirohusodo Hospital, Makassar, Indonesia.
| | - Peter Kabo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Umar Usman
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Mario Tri Mulyono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
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23
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Griborio-Guzman AG, Aseyev OI, Shah H, Sadreddini M. Cardiac myxomas: clinical presentation, diagnosis and management. Heart 2021; 108:827-833. [PMID: 34493547 DOI: 10.1136/heartjnl-2021-319479] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/24/2021] [Indexed: 11/04/2022] Open
Abstract
Cardiac myxomas (CM) are the most common type of primary cardiac tumours in adults, which have an approximate incidence of up to 0.2% in some autopsy series. The purpose of this review is to summarise the literature on CM, including clinical presentation, differential diagnosis, work-up including imaging modalities and histopathology, management, and prognosis. CM are benign neoplasms developed from multipotent mesenchyme and usually present as an undifferentiated atrial mass. They are typically pedunculated and attached at the fossa ovalis, on the left side of the atrial septum. Potentially life-threatening, the presence of CM calls for prompt diagnosis and surgical resection. Infrequently asymptomatic, patients with CM exhibit various manifestations, ranging from influenza-like symptoms, heart failure and stroke, to sudden death. Although non-specific, a classic triad for CM involves constitutional, embolic, and obstructive or cardiac symptoms. CM may be purposefully characterised or incidentally diagnosed on an echocardiogram, CT scan or cardiac MRI, all of which can help to differentiate CM from other differentials. Echocardiogram is the first-line imaging technique; however, it is fallible, potentially resulting in uncommonly situated CM being overlooked. The diagnosis of CM can often be established based on clinical, imaging and histopathology features. Definitive diagnosis requires macroscopic and histopathological assessment, including positivity for endothelial cell markers such as CD31 and CD34. Their prognosis is excellent when treated with prompt surgical resection, with postsurgical survival rates analogous to overall survival in the age-matched general population.
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Affiliation(s)
- Andres G Griborio-Guzman
- Division of Cardiology, Department of Internal Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada .,Department of Internal Medicine, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Olexiy I Aseyev
- Department of Medical Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.,Department of Oncology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hyder Shah
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Masoud Sadreddini
- Division of Cardiology, Department of Internal Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.,Department of Internal Medicine, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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24
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Fan C, Zhang H, Zhuang H, Jiang Z, Tan H, Iroegbu CD, Song L, Liu L. Case Report: Giant Biatrial Myxoma Mimicking Malignant Cardiac Tumor in a Patient With a Hepatic Angiomatous Mass. Front Cardiovasc Med 2021; 8:676807. [PMID: 34124204 PMCID: PMC8192690 DOI: 10.3389/fcvm.2021.676807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 12/02/2022] Open
Abstract
Cardiac myxomas, primarily originating from the left atrium, are the most prevalent types of benign cardiac tumors; however, biatrial myxomas are extremely rare. Herein, we present a rare case of a 55-year old male with exertional dyspnea and intermittent chest discomfort due to a giant biatrial mass with concomitant atrial fibrillation and hepatic hemangioma. The giant tumor with its peduncle at the interatrial septum involved both atria; however, bulging through the tricuspid valve to the right ventricle during systole. Hence, excision of the giant cardiac tumor (which grossly composed of three parts: stiff, fleshy, and soft) and Cox-Maze IV procedure was performed with the resected specimen measuring 100 × 80 × 40 mm. The patient who was in a stable condition was discharged home on the 12th post-operative day. Thus, given the excellent post-operative results achieved, surgical treatment in large multi-cavitary benign cardiac tumors is feasible and should be considered a potentially curative therapy.
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Affiliation(s)
- Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zhang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Huanwei Zhuang
- Department of Cardiothoracic Surgery, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Zenan Jiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haoyu Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Long Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liming Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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25
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Cardiac Myxoma: Typical Presentation but Unusual Histology. Case Rep Med 2021; 2021:6611579. [PMID: 34035819 PMCID: PMC8116158 DOI: 10.1155/2021/6611579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
Cardiac myxoma, a benign heart tumor, is the most common primary tumor of the heart. Glandular differentiation within these tumors is rare, occurring in approximately 3% of all cardiac myxomas. Its presence can complicate the diagnostic process. A 43-year-old Saudi male was referred with a two-month history of progressively increasing shortness of breath. Cardiovascular examination demonstrated a soft first heart sound with a plopping sound in the mitral area and a mid-diastolic murmur. A transthoracic echocardiogram revealed a large mass attached to the interatrial septum. A diagnosis of cardiac myxoma was made, and the patient underwent en bloc resection of the mass. Microscopic evaluation of the resected mass showed a neoplastic lesion with two components: first, a typical myxoma consisting of stellate and spindle cells in a myxomatous/hemorrhagic background; second, a glandular component consisting of separate, fused, and cribriform acini embedded within the myxomatous component. The acini were lined by a single row of columnar epithelial cells with basal nuclei and apical mucin. Occasional goblet cells were also identified. The postoperative period was uneventful, and on his recent follow-up in the clinic (nine months after the surgery), the patient is doing well with no complications. Herein, we emphasize the importance of accurately diagnosing such an entity, as it can be easily confused for a metastatic adenocarcinoma, especially in patients with a history of malignancy.
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26
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Stiru O, Dragulescu R, Geana RC, Chibulcutean A, Raducu L, Tulin A, Stroescu AB, Diaconu C, Savu C, Bacalbasa N, Balescu I, Iliescu VA. Catheter-related giant right atrial thrombosis mimicking a myxoma: A case report. Exp Ther Med 2021; 21:603. [PMID: 33936260 DOI: 10.3892/etm.2021.10035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/02/2021] [Indexed: 11/05/2022] Open
Abstract
Despite the development of imagistic methods, the differential diagnosis of a right atrial mass may be difficult to be established, the most common pathologies which should be taken in consideration being represented by thrombus, tumors, prominent crista terminalis, or vegetation of infectious endocarditis. In this study, we present the case of a 63-year-old man with chronic kidney disease, in hemodialysis (HD) with a silicone central venous catheter (CVC) with the incidental transthoracic echocardiography (transthoracic echocardiogram, TTE) finding of a tumoral mass of 35x26 mm in the right atrium (RA), not related with the catheter, which was diagnosed as right atrial myxoma and underwent surgical excision. After reviewing the histopathology probe, the diagnosis of right atrial thrombus was confirmed. In conclusion, differentiating intracardiac right atrial masses (RAMs) could may prove challenging. In our patient, clinical presentation and the preoperative investigations could not differentiate the right atrial thrombus from a myxoma, and only the postoperative histopathology diagnosis was able to guide correct diagnosis.
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Affiliation(s)
- Ovidiu Stiru
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Razvan Dragulescu
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Roxana Carmen Geana
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Andreea Chibulcutean
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Laura Raducu
- Department of Plastic and Reconstructive Microsurgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of General Surgery, 'Prof. Dr. Agripa Ionescu', Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, 'Prof. Dr. Agripa Ionescu', Clinical Emergency Hospital, 011356 Bucharest, Romania.,Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andra Balcangiu Stroescu
- Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Vlad Anton Iliescu
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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27
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Qian WL, Jiang Y, Liu X, Guo YK, Li Y, Tang X, Yang ZG. Distinguishing cardiac myxomas from cardiac thrombi by a radiomics signature based on cardiovascular contrast-enhanced computed tomography images. BMC Cardiovasc Disord 2021; 21:152. [PMID: 33765929 PMCID: PMC7993472 DOI: 10.1186/s12872-021-01961-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 02/08/2023] Open
Abstract
Background Cardiac myxomas (CMs) and thrombi are associated with high morbidity and mortality. These two conditions need totally different treatments. However, they are difficult to distinguish using naked eye. In clinical, misdiagnoses occur now and then. This study aimed to compare the characteristics of CMs and cardiac thrombi and investigate the value of a radiomics signature in distinguishing CMs from cardiac thrombi, based on cardiovascular contrast-enhanced computed tomography (CECT) images. Methods A total of 109 patients who had CMs (n = 59) and cardiac thrombi (n = 50) were enrolled in this retrospective study from 2009 to 2019. First, the lesion characteristics of cardiovascular CECT images were documented and compared by two radiologists. Then all patients were randomly allotted to either a primary group or a validation group according to a 7:3 ratio. Univariate analysis and the least absolute shrinkage and selection operator were used to select robust features. The best radiomics signature was constructed and validated using multivariate logistic regression. An independent clinical model was created for comparison. Results The best radiomics signature was developed using eight selected radiomics. The classification accuracies of the radiomics signature were 90.8% and 90.9%, and the area under the receiver operating characteristic curves were 0.969 and 0.926 in the training and testing cohorts, respectively. Cardiovascular CECT images showed that the two diseases had significant differences in location, surface, Hydrothorax, pericardial effusion and heart enlargement. The naked eye findings were used to create the clinical model. All metrics of the radiomics signature were higher than those of clinical model. Conclusions Compared with clinical model, the radiomics signature based on cardiovascular CECT performed better in differentiating CMs and thrombi, suggesting that it could help improving the diagnostic efficiency. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01961-3.
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Affiliation(s)
- Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xi Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road Hai Dian District, Beijing, 100142, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xin Tang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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28
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Gregory RJ, Lazicki TJ, Pagel PS. Filling a Gap: A Rare Cause of Progressive Dyspnea and Intermittent Atypical Chest Pain. J Cardiothorac Vasc Anesth 2021; 35:3829-3833. [PMID: 33663979 DOI: 10.1053/j.jvca.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Robert J Gregory
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Lazicki
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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29
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Tang Y, Li J, Zhao F, Chen T. Total thoracoscopic surgery for biatrial cardiac myxoma: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1608. [PMID: 33437807 PMCID: PMC7791203 DOI: 10.21037/atm-20-6993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myxoma is the most common type of benign cardiac tumor in adults. Myxoma can occur anywhere in the heart. The left atrium is the most frequent site of origin, specifically located on the left atrium side of the fossa oval in the atrial septum, followed by the right atrium, the right ventricle and left ventricle. But biatrial myxoma is extremely rare. Thoracoscopic resection of myxoma has become more common, but there are few reports on thoracoscopic surgery for biatrial myxoma. We present a case of a 72-year-old woman with biatrial myxoma, who presented with intermittent dyspnea for one week. Echocardiography revealed a medium echo in both the left and right atrium and was connected via the atrial septum. Computed tomography revealed a hypointense mass in both atria. Thoracoscopic resection successfully removed the tumors, and histological examination confirmed the diagnosis. Also, the patient was discharged six days after surgery. There was no evidence of tumor recurrence during the one-year follow-up period. Biatrial myxoma is rare. Surgical resection is the primary method for myxoma. Compared with the traditional medium thoracotomy, thoracoscopic surgery for myxoma has the following advantages: less trauma, keeping the integrity of the sternum, less bleeding, faster postoperative recovery, etc. Total thoracoscopic surgery for biatrial myxomas is effective and safe.
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Affiliation(s)
- Yipeng Tang
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Jinghui Li
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Feng Zhao
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Tongyun Chen
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
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30
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Shafi AMA, Akhtar MA, Smith A, Yates M, Oo AY. An unusual cause of heart failure in a young female: a case of massive left atrial mxyoma. J Card Surg 2020; 35:3227-3230. [PMID: 32840897 DOI: 10.1111/jocs.14978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ahmed Mohamed Abdel Shafi
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital (Barts NHS Trust) Barts Heart Centre, West Smithfield London UK
| | | | - Alexander Smith
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital (Barts NHS Trust) Barts Heart Centre, West Smithfield London UK
| | - Martin Yates
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital (Barts NHS Trust) Barts Heart Centre, West Smithfield London UK
| | - Aung Y. Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital (Barts NHS Trust) Barts Heart Centre, West Smithfield London UK
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31
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Dell'Aquila M, Carbone A, Pennacchia I, Stigliano E, Oliva A, Arena V. Sudden death by massive systemic embolism from cardiac myxoma. Role of the clinical autopsy and review of literature. Cardiovasc Pathol 2020; 49:107244. [PMID: 32652483 DOI: 10.1016/j.carpath.2020.107244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022] Open
Abstract
Cardiac myxoma is a rare benign neoplasm of the heart. Historically myxomas were incidental findings during autopsies, however improved imaging techniques made these diagnosis possible in living patients, making the surgical treatment of these neoplasms achievable. Cardiac myxomas may occur both sporadically and in a familial context, often in the clinico-pathological picture of the Carney complex. While familial myxomas occur in the context of well-known genetic mutations, the molecular etiology of sporadically occurring myxomas is still not completely clear. We must note however that many of the patients affected by myxomas are asymptomatic; when symptoms are present they are often nonspecific and hard to decipher, especially when referring to sporadically occurring heart myxomas. In this paper we describe a case of sudden death from the massive embolization of a left atrial cardiac myxoma. We also reviewed all the cases in the literature of sudden death from heart myxoma embolism. An accurate epidemiology of heart myxomas would be the key to outline the best treatment practices and the etiology of sporadic myxomas, nevertheless this target could only be pursued with a deep revaluation of the clinical autopsy as a fundamental diagnostic tool.
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Affiliation(s)
- Marco Dell'Aquila
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica Del Sacro Cuore, Rome, Italy.
| | - Arnaldo Carbone
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Ilaria Pennacchia
- Department of Pathology, San Camillo Forlanini Hospital, Rome, Italy
| | - Egidio Stigliano
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica Del Sacro Cuore, Rome, Italy
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32
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Ma S, Xu Q, Shi R, Zhang X, Chen X. The omitted symptoms challenge the diagnosis of right atrial myxoma: a case report. BMC Cardiovasc Disord 2020; 20:149. [PMID: 32213175 PMCID: PMC7093949 DOI: 10.1186/s12872-020-01413-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac myxoma (CM) is the most common type of primary cardiac tumors. The prevalence of primary cardiac tumors is 0.0017-0.28% in various autopsy studies. The clinical symptoms of CM which includes embolism, intracardiac obstruction, general or constitutional manifestations and infected myxoma are largely depended on the size, growing speed, location and pedicle length of the tumor. The following case reported a missed diagnostic case of a right atrial myxoma firstly presented digestive, systemic symptoms and immunologic disorder, leading to emergent tricuspid valves obstruction situation. CASE PRESENTATION We reported a critical case of a 51-year-old female with CM was firstly admitted to the gastroenterology clinical department because of poor appetite, marked fatigability and weight loss for 2 months. The physician diagnosed her as chronic gastritis and treated her with some symptomatic treatment such as ilaprazole and magnesium aluminum carbonate. After months without definitive diagnosis, this right atrial myxoma grew into right ventricle and obstructed the tricuspid valves, causing her dyspnea, sweating, dizziness, feeling of impending death when she was sleeping. Transthoracic echocardiogram revealed a 6.1 × 4.2 × 3.7 cm2 mass adjacent to tricuspid valves. The patient underwent surgical excision and pathology revealed a primary cardiac myxoma. CONCLUSION This case reported a critical result of missed diagnosis of right atrial myxoma and showed its systematic symptoms and immunologic disorder, highlighting the importance of systematic examinations on patients. Furthermore, it appeals early diagnosis of CM and consideration of drug targets to suppress CM development.
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Affiliation(s)
- Shulun Ma
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, 410008, China.,Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, 410008, China
| | - Ruizheng Shi
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, 410008, China
| | - Xuliang Chen
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Xiangya Rd 87, Changsha, 410008, China.
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33
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Li Z, Xu X, Hu L, Sun H, Yue Y. Intracranial Aneurysms After Intravenous Thrombolysis in Patient with Atrial Myxoma: A Case Study. J Stroke Cerebrovasc Dis 2020; 29:104796. [PMID: 32220555 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/28/2020] [Accepted: 02/26/2020] [Indexed: 11/17/2022] Open
Abstract
We administered intravenous thrombolytic therapy to a 51-year-old female patient with a 101-min stroke onset. The patient was unconscious during the manifestation of symptoms. Computed tomography angiography examination of the intracranial artery at the time of admission suggested that the left middle cerebral artery was occluded. The patient regained consciousness after the intravenous thrombolytic treatment was administered. On an urgent cerebral angiography, it was revealed that the recanalization of the left middle cerebral artery was successful. Although blood perfusion was restored, occlusion of the distal blood flow remained. The symptoms of the patient gradually improved after the treatment. However, 6 months after the onset of the condition, intracranial aneurysms formed distal to the recanalized arteries that were previously embolized. The full process underlying the development of cerebral embolism caused by atrial myxomas and subsequent formation of aneurysms is illustrated in this patient. Although the underlying mechanism remains unclear, intravenous thrombolysis can successfully restore cerebral blood flow in and may improve the prognosis of patients with cerebral embolism caused by cardiac myxoma. Despite the positive revascularization therapy, the occurrence of the complication of intracranial aneurysms is possible. Long-term follow-up to evaluate the progression of myxomatous aneurysms after cerebral embolism with conservative treatment may be a suitable strategy for managing such patients.
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Affiliation(s)
- Zhizhang Li
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Xushen Xu
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Liang Hu
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Hongxian Sun
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
| | - Yunhua Yue
- Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China.
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Coffee E, Sankhla N, Bass R, Dure L, Rashid S. Child Neurology: Arterial ischemic stroke in a 12-year-old patient with cardiac myxomas. Neurology 2020; 94:e1103-e1106. [DOI: 10.1212/wnl.0000000000009060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wedin JO, Kristófi R, Ölander CH, Grinnemo KH. Cardiac Arrest after a Transatlantic Flight in a Patient with a Large Left Atrial Myxoma. ACTA ACUST UNITED AC 2020; 4:28-32. [PMID: 32099941 PMCID: PMC7026534 DOI: 10.1016/j.case.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac myxoma is the most common benign primary cardiac tumor. Cardiac myxomas can cause a variety of symptoms from dyspnea to cardiac arrest. Echocardiography plays an essential role in the diagnosis of cardiac myxomas. Prompt surgical excision is the gold standard treatment of cardiac myxomas. Air-travel predispose for cardiac decompensation in several heart conditions. We describe a case of cardiac decompensation in a patient with a cardiac myxoma.
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Affiliation(s)
- Johan O Wedin
- Department of Surgical Sciences, Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden
| | - Robin Kristófi
- Department of Medical Sciences, Emergency Care, Uppsala University Hospital, Uppsala, Sweden
| | - Carl-Henrik Ölander
- Department of Surgical Sciences, Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden
| | - Karl-Henrik Grinnemo
- Department of Surgical Sciences, Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden
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Jagtap SV, Salunkhe P, Mane A, Kumbhar S, Mayekar P, Boral S. Cardiac myxoma with cartilaginous differentiation-An uncommon variant presented as mitral stenosis. INDIAN J PATHOL MICR 2020; 62:599-601. [PMID: 31611449 DOI: 10.4103/ijpm.ijpm_281_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The estimated incidence of primary cardiac tumors is extremely rare. Among it, cardiac myxoma represents the most common benign cardiac tumor constituting about 80% of cases. We are presenting a 30-year-old female with large left atrial myxoma. She was presented with severe dyspnea, palpitations, and systolic murmurs. On 2D echocardiography, left atrial mass obstructing mitral flow was noted. On cardiac magnetic resonance imaging, a single, large, mobile pedunculated mass lesion in left atrium attached to inferior interatrial septum with heterogeneous enhancement was noted, which was likely represented to be myxoma. The mass was surgically excised and valve repairing was done. We received large, solid, lobulated, gray white, soft-to-firm mass measuring 4.5 × 4.1 × 2.5 cm, and on microscopy showed cardiac myxoma with cartilaginous differentiation. We are presenting this case for its clinical, imaging, and uncommon histological features.
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Affiliation(s)
- Sunil V Jagtap
- Department of Pathology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India
| | - Pravin Salunkhe
- Department of Cardio Vascular and Thoracic Surgery, Krishna Hospital and Medical Research Centre, Karad, Maharashtra, India
| | - Avinash Mane
- Department of Pathology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India
| | - Sujata Kumbhar
- Department of Pathology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India
| | - Purva Mayekar
- Department of Pathology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India
| | - Saswati Boral
- Department of Pathology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India
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Hasan M, Abdelmaseih R, Faluk M, Chacko J, Nasser H. Atrial Myxoma, a Rare Cause of Sudden Cardiac Death: A Case Report and Review of Literature. Cureus 2020; 12:e6704. [PMID: 32117655 PMCID: PMC7029832 DOI: 10.7759/cureus.6704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 12/02/2022] Open
Abstract
Despite the huge improvement in cardiovascular care over the past several decades and the decline in cardiovascular deaths, sudden cardiac death (SCD) continues to present a nationwide health problem accounting to more than half of all deaths from cardiovascular disease. Majority of these cases are related to coronary artery disease and arrhythmias, however, a very small number of these cases are secondary to cardiac neoplasms. These neoplasms commonly present with conduction abnormalities or symptoms secondary to valvular disease such as dyspnea, orthopnea, cough and/or edema. This is a rare case of a 63-year-old gentleman who suffered sudden cardiac death secondary to a cardiac myxoma.
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Affiliation(s)
- Mustajab Hasan
- Internal Medicine, Ocala Regional Medical Center/University of Central Florida College of Medicine, Ocala, USA
| | - Ramy Abdelmaseih
- Internal Medicine, Ocala Regional Medical Center/ University of Central Florida College of Medicine , Ocala, USA
| | - Mohammed Faluk
- Internal Medicine, Ocala Regional Medical Center/ University of Central Florida College of Medicine, Ocala, USA
| | - Jay Chacko
- Internal Medicine, Ocala Regional Medical Center/ University of Central Florida College of Medicine, Ocala, USA
| | - Hesham Nasser
- Internal Medicine, University of Central Florida College of Medicine, Ocala, USA
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Tan YH, Chien CY. Papillary fibroelastoma of the aortic valve. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Central Nervous System Involvement by Small Lymphocytic Lymphoma after a Myxoma-Related Embolic Event. Case Rep Hematol 2019; 2019:1825491. [PMID: 31827948 PMCID: PMC6881765 DOI: 10.1155/2019/1825491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/05/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
Involvement of the central nervous system by chronic lymphocytic leukemia/small lymphocytic lymphoma is exceedingly rare, and currently no risk factors have been described. We report the case of a patient with concomitant chronic lymphocytic leukemia/small lymphocytic lymphoma and an embolic cerebrovascular accident related to a cardiac myxoma, who developed parenchymal central nervous system involvement of lymphoma on the ischemic bed. The patient was successfully treated with a high-dose fludarabine-based chemotherapy regimen, achieving a sustained remission. We propose that embolic breakage of the blood-brain barrier may be a major risk factor in producing central nervous system involvement. We also propose that a high-dose fludarabine-based chemotherapy regimen may be adequate to achieve a better CNS penetration and improved outcomes.
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Milman T, Salomao DR, Ida CM, Capiz Correa DR, Grossniklaus HE, Zhang Q, Hamershock RA, Shields C, Shields JA, Raber I, Rapuano CJ, Patel R, Eagle RC. Conjunctival Myxoid Lesions: Clinical-Pathologic Multiparametric Analysis, Including Molecular Genetics (An American Ophthalmological Society Thesis). Am J Ophthalmol 2019; 205:115-131. [PMID: 31078543 DOI: 10.1016/j.ajo.2019.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the clinical and pathologic characteristics of conjunctival myxoid lesions, with specific focus on PRKAR1A studies, in order to distinguish neoplastic conjunctival myxoma from other myxoid conjunctival lesions. METHODS A retrospective, interventional, multicenter study of all patients with conjunctival myxoma, conjunctival stromal tumor, or reactive fibromyxoid proliferation diagnosed during 1988-2018. Patient and family medical histories and clinical and pathologic characteristics of excised lesions were assessed. RESULTS There were 28 patients with conjunctival myxoid lesions diagnosed as myxoma (16/28), conjunctival stromal tumor (10/28), or reactive fibromyxoid proliferation (2/28). The patients with abundant myxoid matrix lesions (14/28, 50%) were younger (mean 49 [range 23-68] years) than those with scant-to-moderate myxoid matrix lesions (14/28, mean 61 [range 18-82] years; P = .04). Abundant myxoid matrix lesions more likely contained predominantly stellate cells (6/14 [43%] vs 0/14 [0%]; P = .05) and fibrillar collagen (13/14 [93%] vs 2/14 [14%]; P < .0001), conforming to the standard morphologic definition of myxoma. Absence of PRKAR1A protein expression was found in 2 lesions with morphologic features of myxoma (2/14, 14%), 1 of which demonstrated a pathogenic mutation in the PRKAR1A gene. There was no difference between the lesions with respect to other clinical and pathologic parameters. CONCLUSIONS PRKAR1A plays a role in the development of a subset of conjunctival myxomas, particularly in tumors fulfilling stringent morphologic criteria for myxoma. With the exception of PRKAR1A studies, current immunohistochemical panels cannot reliably distinguish between neoplastic conjunctival myxomas and other myxoid lesions, underscoring the importance of morphology in establishing accurate diagnosis.
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Affiliation(s)
- Tatyana Milman
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Department of Pathology, Wills Eye Hospital, Philadelphia, PA, USA.
| | - Diva R Salomao
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Hans E Grossniklaus
- Department of Ophthalmology, Ocular Oncology and Pathology Section, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Qiang Zhang
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Rose A Hamershock
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Carol Shields
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Jerry A Shields
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Irving Raber
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Christopher J Rapuano
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ravi Patel
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ralph C Eagle
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Department of Pathology, Wills Eye Hospital, Philadelphia, PA, USA
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Duman U, Furat C, Keskin G, Kahraman D, Hafiz E. Outcomes of Patients with Cardiac Myxoma: A Retrospective Multicentre Study. Open Cardiovasc Med J 2019. [DOI: 10.2174/1874192401913010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:We present a 15-year follow-up of patients with Cardiac Myxoma (CM) who underwent tumour resection.Patients and Methods:Between 2001 and 2016, 38 patients with CM were operated on. We retrospectively reviewed, their clinical presentations. We also analysed the echocardiographic, electrocardiographic and pathology reports.Results:No mortality was seen after surgery. The mean age of the patients was 41.7±7.8 years and the female/male ratio was 22/16. Two patients with CM were children. The main symptoms of left atrial CM were dyspnoea on exertion, chest pain and congestive heart failure. Tricuspid valve pathology, and leg oedema were the main symptoms in patients with right atrial CM combined with right heart failure. CM as a cause of nephrotic syndrome was detected in 2 patients. In 5 asymptomatic patients (13.1%), CM was detected incidentally. We detected a pericardial invasion by the tumour in 1 patient. We performed secondary surgery because of tumour recurrence in 2 patients. Overall, survival for patients after surgical excision was 96.4±1.6% at 1 year, 91.7±2.4% at 5 years, 87.6±2.6% at 10 years and 85±1.9% at 15 years.Conclusion:The symptoms of CM may include congestive heart failure or nephrotic syndrome. Because CM may be associated with serious cardiac symptoms, tumour excision should be performed immediately after diagnosis. The use of right anterior thoracotomy for CM resection is a safe surgical approach.
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42
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Heart myxoma develops oncogenic and metastatic phenotype. J Cancer Res Clin Oncol 2019; 145:1283-1295. [PMID: 30900156 DOI: 10.1007/s00432-019-02897-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/13/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Heart myxomas have been frequently considered as benign lesions associated with Carney's complex. However, after surgical removal, myxomas re-emerge causing dysfunctional heart. METHODS To identify whether cardiac myxomas may develop a metastatic phenotype as occurs in malignant cancers, a profile of several proteins involved in malignancy such as oncogenes (c-MYC, K-RAS and H-RAS), cancer-associated metabolic transcriptional factors (HIF-1α, p53 and PPAR-γ) and epithelial-mesenchymal transition proteins (fibronectin, vimentin, β-catenin, SNAIL and MMP-9) were evaluated in seven samples from a cohort of patients with atrial and ventricular myxomas. The analysis was also performed in: (1) cardiac tissue surrounding the area where myxoma was removed; (2) non-cancer heart tissue (NCHT); and (3) malignant triple negative breast cancer biopsies for comparative purposes. RESULTS Statistical analysis applying univariate (Kruskal-Wallis and Dunn's tests) and multivariate analyses (PCA, principal component analysis) revealed that heart myxomas (7-15 times) and myxoma surrounding tissue (22-99 times) vs. NCHT showed high content of c-MYC, p53, vimentin, and HIF-1α, indicating that both myxoma and its surrounding area express oncogenes and malignancy-related proteins as occurs in triple negative breast cancer. CONCLUSIONS Based on ROC (receiver operating characteristics) statistical analysis, c-MYC, HIF-1α, p53, and vimentin may be considered potential biomarkers for malignancy detection in myxoma.
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Cianciulli TF, Cozzarin A, Soumoulou JB, Saccheri MC, Méndez RJ, Beck MA, Gagliardi JA, Lax JA. Twenty Years of Clinical Experience with Cardiac Myxomas: Diagnosis, Treatment, and Follow Up. J Cardiovasc Imaging 2019; 27:37-47. [PMID: 30701715 PMCID: PMC6358422 DOI: 10.4250/jcvi.2019.27.e7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/16/2018] [Accepted: 12/26/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiac myxomas are the most frequent cardiac tumors. Although histologically benign, in some cases myxomas may be lethal, due to impairment of cardiac dynamics and their thromboembolic potential. The study aimed to assess the clinical presentation of cardiac myxomas and their correlation with echocardiographic features and to describe the perioperative results and long-term outcome of surgically treated patients. METHODS A prospective study of 53 patients with cardiac myxomas who were operated at Hospital Argerich, followed clinically and with echocardiography from 1993 until 2013. All patients underwent echocardiographic studies. RESULTS The patient's mean age was 53 ± 16 years (62.3% were women). The most common findings were dyspnea followed by embolic events. Most tumors were localized in the left atrium (77.4%), mainly in the fossa ovalis (63%). Mean size of the tumors was 4.76 x 3.50 cm. Tumors were generally mobile (88%) and went beyond the valve plane, causing mild mitral or tricuspid valve obstruction (58%) and dilation of the respective atrial chamber. Patients whose tumors were obstructive had higher pulmonary artery systolic pressures (50 vs 33 mmHg p < 0.01). According to the echocardiographic appearance 67% of tumors had a smooth surface and the remaining 32% had a villous surface. All patients with embolic manifestations had tumors with a villous surface. CONCLUSIONS Clinical presentation relates to the ultrasound characteristics of myxomas. Smooth tumors are larger, occur with obstructive symptoms, and benefit from an elective surgery, whereas villous myxomas entailed a high embolic risk and require prompt surgical treatment.
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Affiliation(s)
- Tomás Francisco Cianciulli
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina.,Researchers of the Ministry of Health of the Government of the City of Buenos Aires, Buenos Aires, Argentina.
| | - Alberto Cozzarin
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Juan Bautista Soumoulou
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina
| | - María Cristina Saccheri
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Ricardo José Méndez
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Martín Alejandro Beck
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Juan Alberto Gagliardi
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina.,Researchers of the Ministry of Health of the Government of the City of Buenos Aires, Buenos Aires, Argentina
| | - Jorge Alberto Lax
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina.,Researchers of the Ministry of Health of the Government of the City of Buenos Aires, Buenos Aires, Argentina
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Jawaid A, Naqvi SY, Wiener R. Atrial myxoma presenting as acute ischaemic stroke and chronic right lower leg claudication. BMJ Case Rep 2018; 11:11/1/e227427. [PMID: 30567250 DOI: 10.1136/bcr-2018-227427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 48-year-old man presented with acute onset of left facial numbness, ataxic gait and double vision. He also complained of chronic right lower leg pain with acute onset a year prior to presentation. His vital signs were within normal limits. Physical exam was notable for right-sided intranuclear opthalmoplegia, decreased sensation to light touch on the left side of his body, left-sided dysmetria and ataxic gait. Neuroimaging showed evidence of acute stroke in the cerebellum and brainstem, for which he was treated with thrombolytics. An echocardiogram revealed a 5×3 cm left atrial myxoma, which was surgically resected. Subsequent imaging of his lower extremity revealed a chronic common iliac artery occlusion for which he underwent angioplasty. His claudication symptoms resolved, and he was without any neurological deficits at a 2-year follow-up visit.
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Affiliation(s)
- Anas Jawaid
- Internal Medicine Department, Strong Memorial Hospital, Rochester, New York, USA
| | - Syed Yaseen Naqvi
- Cardiology Division, Strong Memorial Hospital, Rochester, New York, USA
| | - Roy Wiener
- Cardiology Division, Strong Memorial Hospital, Rochester, New York, USA
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Stefanou MI, Rath D, Stadler V, Richter H, Hennersdorf F, Lausberg HF, Lescan M, Greulich S, Poli S, Gawaz MP, Ziemann U, Mengel AM. Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study. Front Neurol 2018; 9:823. [PMID: 30337904 PMCID: PMC6178925 DOI: 10.3389/fneur.2018.00823] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Cardiac myxoma (CM) is the most frequent, cardiac benign tumor and is associated with enhanced risk for cerebrovascular events (CVE). Although surgical CM excision is the only curative treatment to prevent CVE recurrence, in recent reports conservative treatment with antiplatelet or anticoagulant agents in high-risk patients with CM-related CVE has been discussed. Methods: Case records at the University Hospital of Tübingen between 2005 and 2017 were screened to identify patients with CM-related CVE. Clinical features, brain and cardiac imaging findings, histological reports, applied treatments and long-term neurological outcomes were assessed. Results: 52 patients with CM were identified and among them, 13 patients with transient ischemic attack, ischemic stroke or retinal ischemia were included to the (to our knowledge) largest reported retrospective study of CM-related CVE. In all identified patients, CVE was the first manifestation of CM; 61% suffered ischemic stroke, 23% transient ischemic attack and 15% retinal ischemia. In 46% of the patients, CVE occurred under antiplatelet or anticoagulation treatment, while 23% of the patients developed recurrent CVE under bridging-antithrombotic-therapy prior to CM surgical excision. Prolonged time interval between CVE and CM-surgery was significantly associated with CVE recurrence (p = 0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation. Discussion: Our results suggest that antiplatelet or anticoagulation treatment is no alternative to cardiac surgery in patients presenting with CM-related CVE. We found significantly prolonged time-intervals between CVE and CM surgery in patients with recurrent CVE. Therefore, we suggest that the waiting- or bridging-interval with antithrombotic therapy until curative CM excision should be kept as short as possible. Based on our data and review of the literature, we suggest that in patients with CM-related CVE, i.v. thrombolysis and/or endovascular interventions may present safe and efficacious acute treatments.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Vera Stadler
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Hardy Richter
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Henning F Lausberg
- Department of Thoracic and Cardiovascular Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Simon Greulich
- Department of Cardiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Meinrad P Gawaz
- Department of Cardiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Annerose M Mengel
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
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46
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Wen XY, Chen YM, Yu LL, Wang SR, Zheng HB, Chen ZB, Ma L, Liao XP, Li QF. Neurological manifestations of atrial myxoma: A retrospective analysis. Oncol Lett 2018; 16:4635-4639. [PMID: 30214598 DOI: 10.3892/ol.2018.9218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 07/04/2018] [Indexed: 02/05/2023] Open
Abstract
Atrial myxoma is the most common type of primary cardiac tumor and it is closely associated with stroke in adults. Early diagnosis and treatment of atrial myxomas is essential for the prevention of embolic events. The aim of the present study was to assess neurological complications associated with atrial myxoma. The neurological signs of atrial myxoma were retrospectively assessed in individuals who underwent treatment at West China Hospital (Chengdu, China) and The Affiliated Hospital of Hainan Medical University (Haikou, China), between March 2003 and February 2015. A total of 130 patients with atrial myxoma were included and 22 (17%) exhibited neurologic signs. These patients were aged 39.9±12.6 years (range, 13-78 years) and there were 13 female and 9 male patients. Ischemic cerebral infarct constituted the dominant clinical symptom (68.2%) and 3 patients exhibited concomitant cardiac manifestations. Atrial myxoma was diagnosed by echocardiography in all patients. Irregular surface of atrial myxomas was associated with a high risk of embolic events. The patients with myxoma successfully underwent surgery with no mortality recorded. In conclusion, atrial myxomas frequently manifest as cerebral infarction in individuals without cardiovascular risk factors. These tumors more commonly affect the middle cerebral artery. Irregular surface of myxomas appears to be associated with embolic events. Echocardiography may improve the diagnosis and early treatment of atrial myxomas.
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Affiliation(s)
- Xue-Yan Wen
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Yong-Min Chen
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Li-Li Yu
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Shu-Rong Wang
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Hong-Bo Zheng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhi-Bin Chen
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Lin Ma
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Xiao-Ping Liao
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
| | - Qi-Fu Li
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 571199, P.R. China
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Pucci A, Mattioli C, Matteucci M, Lorenzini D, Panvini F, Pacini S, Ippolito C, Celiento M, De Martino A, Dolfi A, Belgio B, Bortolotti U, Basolo F, Bartoloni G. Cell differentiation in cardiac myxomas: confocal microscopy and gene expression analysis after laser capture microdissection. Heart Vessels 2018; 33:1403-1410. [PMID: 29789901 DOI: 10.1007/s00380-018-1189-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/18/2018] [Indexed: 12/27/2022]
Abstract
Cardiac myxomas are rare tumors with a heterogeneous cell population including properly neoplastic (lepidic), endothelial and smooth muscle cells. The assessment of neoplastic (lepidic) cell differentiation pattern is rather difficult using conventional light microscopy immunohistochemistry and/or whole tissue extracts for mRNA analyses. In a preliminary study, we investigated 20 formalin-fixed and paraffin-embedded cardiac myxomas by means of conventional immunohistochemistry; in 10/20 cases, cell differentiation was also analyzed by real-time RT-PCR after laser capture microdissection of the neoplastic cells, whereas calretinin and endothelial antigen CD31 immunoreactivity was localized in 4/10 cases by double immunofluorescence confocal microscopy. Gene expression analyses of α-smooth muscle actin, endothelial CD31 antigen, alpha-cardiac actin, matrix metalloprotease-2 (MMP2) and tissue inhibitor of matrix metalloprotease-1 (TIMP1) was performed on cDNA obtained from either microdissected neoplastic cells or whole tumor sections. We found very little or absent CD31 and α-Smooth Muscle Actin expression in the microdissected cells as compared to the whole tumors, whereas TIMP1 and MMP2 genes were highly expressed in both ones, greater levels being found in patients with embolic phenomena. α-Cardiac Actin was not detected. Confocal microscopy disclosed two different signals corresponding to calretinin-positive myxoma cells and to endothelial CD31-positive cells, respectively. In conclusion, the neoplastic (lepidic) cells showed a distinct gene expression pattern and no consistent overlapping with endothelial and smooth muscle cells or cardiac myocytes; the expression of TIMP1 and MMP2 might be related to clinical presentation; larger series studies using also systematic transcriptome analysis might be useful to confirm the present results.
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Affiliation(s)
- Angela Pucci
- Histopathology Department, Pisa University Hospital, Pisa, Italy. .,Pisa University, Pisa, Italy.
| | - Claudia Mattioli
- Histopathology Department, Pisa University Hospital, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore "Sant'Anna", Pisa, Italy
| | - Marco Matteucci
- Institute of Life Sciences, Scuola Superiore "Sant'Anna", Pisa, Italy
| | | | | | | | - Chiara Ippolito
- Unit of Medical Histology and Embryology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Amelio Dolfi
- Unit of Medical Histology and Embryology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Beatrice Belgio
- Histopathology Department, Pisa University Hospital, Pisa, Italy
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48
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[Combination of left atrial myxoma and retrocardiac liposarcoma with right atrial infiltration]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:60-61. [PMID: 29223346 DOI: 10.1016/j.acmx.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/23/2022] Open
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49
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Mo R, Mi L, Zhou Q, Wang D. Outcomes of surgical treatment in 115 patients with primary cardiac tumours: a 15-year experience at a single institution. J Thorac Dis 2017; 9:2935-2941. [PMID: 29221265 DOI: 10.21037/jtd.2017.08.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Primary cardiac tumours are rare, and few studies have examined large samples. The aim of this study was to review a single institution's 15 years of experience with primary cardiac tumours. Methods We conducted a retrospective analysis of 119 consecutive patients admitted to the Nanjing Drum Tower Hospital from April 2002 to January 2017. Five patients declined surgery due to illness or for financial reasons, and one patient underwent a second operation due to tumour recurrence 10 years after the first operation. In total, 115 patients underwent surgery. The surgeons used median sternotomy and a right atrial approach to complete the gross total resection. The patients were separated into three groups according to their tumour pathology (myxomas, other benign tumours, or malignant tumours). A total of 84 patients were followed up for an average of 34.8±31.2 months (range 2-141 months). Results The sites of the cardiac tumours included the left atrium (n=93, 80.1%), right atrium (n=14, 14.0%), left ventricle (n=2, 1.7%), valves (n=7, 6.0%), and other sites (n=1, 0.8%). According to the postoperative pathology, 99 (86.0%) tumours were classified as myxomas, 8 (7.0%) were other types of benign tumours, and 8 (7.0%) were malignant tumours. Patients with malignant tumours had a longer surgical time (P=0.035) and postoperative hospitalization time (P=0.009). Patients with myxoma tumours exhibited better 5-year survival than patients with malignant tumours (95.7% vs. 57.1%, P<0.001). Conclusions In the Chinese population, the incidence of primary cardiac tumours is mainly attributable to myxomas. Gross total resection is a safe and effective treatment for both benign and malignant tumours. Long-term survival is satisfactory for benign tumours but low for malignant tumours, and a risk of recurrence exists. Postoperative chemotherapy or radiotherapy may be needed to achieve better outcomes.
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Affiliation(s)
- Ran Mo
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Lin Mi
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Qing Zhou
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Dongjin Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
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50
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Anvari MS, Sabagh M, Goodarzynejad H, Ziaei S, Boroumand MA, Pourgholi L, Jenab Y, Abbasi K. Association between herpes simplex virus Types 1 and 2 with cardiac myxoma. Cardiovasc Pathol 2017; 27:31-34. [PMID: 28081512 DOI: 10.1016/j.carpath.2016.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/23/2016] [Accepted: 12/29/2016] [Indexed: 11/15/2022] Open
Abstract
Most cases of atrial myxoma are sporadic, and the exact etiology is unknown. We examined if herpes simplex virus (HSV)-1 and HSV-2 antigens and/or DNA could be detected in a cohort of Iranian patients with cardiac myxomas. From July 2004 to June 2014, among a total of 36,703 patients undergoing open heart surgeries, consecutive patients with cardiac myxoma who were treated by surgical excision at our center included in this study. Of 73 patients studied, 56% were female with a mean age of 54 years (ranging from 23 to 77 years). Seventy-four myxomas were surgically removed from 73 patients, since one patient had two myxomas which were located on both the right atrium and right ventricle. The materials for this analysis were retrospectively gathered from extracted tumors that stored in a pathology bank of tissue paraffin blocks. The formalin fixed paraffin embedded tissue samples were investigated for HSV genomic DNA by both immunohistochemistry (IHC) and polymerase chain reaction (PCR) analysis. In all 74 cases there was no presence of HSV 1 and HSV 2 infection. This suggests that HSV may not play a role in sporadic cardiac myxomas; however, evidence for such association is currently lacking, and further studies are required to determine such a role.
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Affiliation(s)
- Maryam Sotoudeh Anvari
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran..
| | - Moud Sabagh
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Goodarzynejad
- Department of Clinical and Experimental Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Ziaei
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Boroumand
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leyla Pourgholi
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kyomars Abbasi
- Department of cardiac surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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