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Durieux R, Tchana-Sato V, Lavigne JP, Radermecker MA, Moonen M, Scagnol I, Gennigens C, Defraigne JO. Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma? J Card Surg 2020; 36:357-362. [PMID: 33225534 DOI: 10.1111/jocs.15200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/08/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
Cardiac intimal sarcoma is extremely rare and aggressive primary malignant cardiac tumors. Here, we reported the case of a young man initially operated for a tumor of the left atrium, causing a dynamic obstruction of the mitral valve and (mis-)diagnosed as a myxoma at the histopathological analysis. Patient presented a local recurrence at 3 months and was reoperated. Pathology revealed this time the presence of an intimal sarcoma. Patient received adjuvant chemotherapy. Despite a good local control, the 1-year follow-up positron emission tomography scan revealed the presence of a metastasis in the left adrenal gland that was surgically resected. This article aims to highlight the risk of misdiagnosis in case of cardiac tumors, the hypothetical concept of malignant transformation of a cardiac myxoma, the aggressive course of the extremely rare cardiac intimal sarcoma, and the therapeutic modalities available to treat this pathology.
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Affiliation(s)
- Rodolphe Durieux
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Vincent Tchana-Sato
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Paul Lavigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marc A Radermecker
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marie Moonen
- Department of Cardiology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Irène Scagnol
- Department of Pathology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Christine Gennigens
- Department of Medical Oncology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
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Cardiac Myxoma: Review and Update of Contemporary Immunohistochemical Markers and Molecular Pathology. Adv Anat Pathol 2020; 27:380-384. [PMID: 32732585 DOI: 10.1097/pap.0000000000000275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiac myxoma is an uncommon benign mesenchymal neoplasm of the heart. It usually arises in the left atrium, near the valve of the fossa ovalis, and most frequently affects adults in the third through the sixth decades of life. It is hypothesized to arise from subendothelial vasoformative reserve cells or primitive cells that differentiate along the lines of the endothelium, but this remains speculative. Microscopically, the neoplastic cells are arranged individually, and nests, and are oriented in single or multiple layers around vascular channels. The neoplastic cells are immunoreactive for vimentin, calretinin, S100, nonspecific enolase, factor VIII, CD31, and CD34. The tumor can have diverse clinical presentations depending on its location and extent of disease and is predisposed to embolization. The current treatment is prompt surgical excision.
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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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Bois MC, Eckhardt MD, Cracolici VM, Loe MJ, Ocel JJ, Edwards WD, McBane RD, Bower TC, Maleszewski JJ. Neoplastic embolization to systemic and pulmonary arteries. J Vasc Surg 2018; 68:204-212.e7. [PMID: 29502997 DOI: 10.1016/j.jvs.2017.09.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/23/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens. METHODS Pathology archives from a single tertiary care institution were queried to identify cases of surgically resected arterial emboli containing neoplasm (1998-2014). Histopathology was reviewed for confirmation of diagnosis. Patient demographics and oncologic history were abstracted from the medical record. Comprehensive literature review documented 332 patients in 275 reports (1930-2016). RESULTS Eleven patients (six men) with a median age of 63 years (interquartile range, 42-71 years) were identified through institutional archives. Embolism was the primary form of diagnosis in seven (64%) cases. Cardiac involvement (primary or metastasis) was present in more than half of the cohort. Comprehensive literature review revealed that pulmonary primaries were the most common anatomic origin of arterial neoplastic emboli, followed by gastrointestinal neoplasia. Cardiac involvement was present in 18% of patients, and sentinel identification of neoplasia occurred in 30% of cases. Postmortem evaluation was the primary means of diagnosis in 27%. CONCLUSIONS This study highlights the importance of routine histopathologic evaluation of embolectomy specimens in patients with and without documented neoplasia.
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Affiliation(s)
- Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Michael D Eckhardt
- Department of Pathology and Laboratory Medicine, University of Chicago, NorthShore University HealthSystem, Evanston, Ill
| | | | - Matthew J Loe
- Interventional Radiology, St. Paul Radiology, St. Paul, Minn
| | - Joseph J Ocel
- Diagnostic Radiology, Mercy Health Services-Iowa Corporation, Mason City, Iowa
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Robert D McBane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn.
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Tarelo-Saucedo JM, Peñaloza-Guadarrama M, Villela-Caleti J, García-Cruz A, Arizmendi-Monroy DK, Reynada-Torres JL, Martinez-Ramirez L. [Surgical results and monitoring of postoperative atrial myxomas]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 86:35-40. [PMID: 26525520 DOI: 10.1016/j.acmx.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyze the casuistics of left atrial myxoma with emphasis on results and follow-up. METHOD We reviewed the clinical records of patients operated in the Hospital Cardiac Myxomas South Central High Specialty (HCSAE) of PEMEX in the last 7 years, with an emphasis on results and follow-up. RESULTS The analysis showed 10 patients, of whom 60% were female and 40% male, with ages from 12 to 76 years, with a mean age of 50 years. In the clinical characteristics of patients predominated dyspnea in 90%, followed by fatigue (80%) and chest pain (60%). The incidence was 90% for the left atrium and 10% for the right atrium, had tumors less than 3cm to up to over 10cm (average of 6 to 7cm). The pathology report was myxoma in the 100% of cases, the morbidity and early mortality was 0%, with a mean hospital stay of 6 days, and a patient of 12 years of age recurred and underwent surgery five months later. The 5-year survival was 100%. CONCLUSIONS The incidence of myxomas is well known for rare presentation, the experience in this national medical center is one patient for every 350 operations, one case per year with no mortality and excellent survival.
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Affiliation(s)
- Juan M Tarelo-Saucedo
- Servicio de Cirugía Cardiovascular, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México.
| | - Mario Peñaloza-Guadarrama
- Servicio de Cirugía Cardiovascular, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Jorge Villela-Caleti
- Servicio de Cirugía Cardiovascular, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Adriana García-Cruz
- Servicio de Anestesia, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Dulce K Arizmendi-Monroy
- Servicio de Anestesia, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Jose L Reynada-Torres
- Servicio de Anestesia, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Leonel Martinez-Ramirez
- Servicio de Cardiología, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
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Malik SB, Kwan D, Shah AB, Hsu JY. The Right Atrium: Gateway to the Heart—Anatomic and Pathologic Imaging Findings. Radiographics 2015; 35:14-31. [DOI: 10.1148/rg.351130010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Endobronchial myxoma--case report. REVISTA PORTUGUESA DE PNEUMOLOGIA 2012; 18:145-8. [PMID: 22261261 DOI: 10.1016/j.rppneu.2011.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 07/28/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Pulmonary myxoma is an extremely rare benign neoplasm. It is mostly parenchymal but may occasionally occur within the tracheobronchial tree. There are very few reports of endobronchial myxoma. CASE REPORT We describe a case of endobronchial myxoma in a 40-year-old female patient with a history of asthma and repeated right-sided pneumonia. Thoracic computed tomography (CT) showed medium lobe atelectasis. Fiber optic bronchoscopy revealed a polypoid, well-circumscribed tumor, causing total obstruction of the medium lobe bronchus. Biopsy of the mass was non-diagnostic. Further study included a positron emission tomography (PET) which demonstrated low metabolic activity of the tumor and no evidence of neoplasia in other location. The patient was submitted to a medium lobectomy and microscopic examination of the tumor revealed myxoid stroma with lobulated pattern, elongated and stellate cells, compatible with myxoma. CONCLUSION Pulmonary myxoma is extraordinary rare and endobronchial location is very few reported in medical literature.
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Lee HL, Park KY, Kim KH, Lee ST, Ki CS, Jeon YB, Choi CH. Familiar Myxoma with a Positive Genetic Test A case report-. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hyang-Lim Lee
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Hospital
| | - Kook-Yang Park
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Hospital
| | - Kyung-Hee Kim
- Department of Laboratory Medicine, Gachon University Gil Hospital
| | - Seung-Tae Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center
| | | | - Chang-Hyu Choi
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Hospital
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Irani AD, Estrera AL, Buja LM, Safi HJ. Biatrial myxoma: a case report and review of the literature. J Card Surg 2008; 23:385-90. [PMID: 18384573 DOI: 10.1111/j.1540-8191.2007.00545.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In surgical series, a majority of benign cardiac tumors are myxomas. Of these, only about 2.5% are biatrial. Only 10 cases have been reported in the last 10 years. We present here a successful case in a 51-year-old man. A brief review of the literature is presented to place this case in context. METHODS The tumor was removed surgically via a midline sternotomy using cardiopulmonary bypass. Both left and right atrial extensions of the tumor mass were removed. The resection involved the entire septum, with a bovine patch used to reconstruct the atrial septum. RESULTS Patient recovered uneventfully. We advised follow-up evaluation using transthoracic echocardiography annually. CONCLUSIONS Biatrial myxoma is a very rare condition, with diagnostic challenges, but is amenable to modern surgical approaches.
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Affiliation(s)
- Adel D Irani
- Department of Cardiothoracic and Vascular Surgery, the University of Texas at Houston Medical School, Houston , TX, USA.
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Denguir R, Dhiab M, Meddeb I, Hermi N, Khanfir I, Ben Romdhane R, Khayati A, Gharsallah N, Abid A. [Cardiac myxoma. Surgical treatment. About 20 cases]. Ann Cardiol Angeiol (Paris) 2006; 55:49-54. [PMID: 16457036 DOI: 10.1016/j.ancard.2005.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Cardiac myxoma is the commune cardiac tumors. Their clinical status depends in the anatomic type. The aim of this study is to evaluate our results and to compare them for literature. PATIENTS AND METHODS From January 1990 to June 2004, 20 patients (8 males and 12 females) with mean age of 49 years underwent surgical treatment of cardiac myxoma. The tumors were in left atrium in 14 cases, in right atrium in 4 cases and biatrial in 2 cases. Surgical treatment consisted in complete resection of the tumor in all cases associated with partial atrial septal resection in 9 cases. RESULTS There is not death in the postoperative outcome. The mean follow up is 50 months. The late mortality rate was 10%. All patients are asymptomatic and the echocardiography control showed no tumor recurrence. CONCLUSION Cardiac myxoma is the communist primary tumor of the heart. Diagnosis is based upon echocardiography. Surgical management has well out come with low morbidity and mortality. Late results are satisfactory but regular screening is recommended although risk of recurrence is low.
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Affiliation(s)
- R Denguir
- Service de chirurgie cardiovasculaire, hôpital La-Rabta, 1007 Jabbari-Bab-Saadoun, Tunis, Tunisie.
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Naseri E, Eralp B, Oztek I. Emergency management of severe right ventricular inflow obstruction secondary to a metastatic cardiac tumor. Ann Thorac Surg 2005; 79:709-11. [PMID: 15680874 DOI: 10.1016/j.athoracsur.2003.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2003] [Indexed: 10/25/2022]
Abstract
We report the case of a 21-year-old female with previous history of primitive neuroectodermal tumor of the anterior abdominal wall who developed severe manifestations of right heart failure due to a mass obliterating the right ventricular cavity. She underwent emergent resection of the mass with histopathologic confirmation of metastatic neuroectodermal tumor. To the best of our knowledge, this is the first case of emergent surgical excision of a metastatic cardiac tumor of primitive neuroectodermal origin.
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Affiliation(s)
- Erdinç Naseri
- Department of Cardiovascular Surgery, Tokat Medical School, Tokat, Turkey.
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Abstract
We report a case of a primary pulmonary myxoma. The patient was a 69-year-old previously healthy human. Computed tomographic scan demonstrated a well-circumscribed tumor with a diameter of approximately 13 mm in the right upper lobe. We performed a right upper lobectomy under video-assisted thoracoscopy. Microscopic examination of the tumor disclosed elongated and stellate cells in a myxoid stroma, typical of myxoma.
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Affiliation(s)
- Hidehito Matsuoka
- Department of Surgery, Hyogo Prefectural Kaibara Hospital, Kaibara, Japan.
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Sughimoto K, Shiikawa A, Ohkado A, Nanaumi M. Multiple cardiac myxomas with pulmonary arterial obstruction and acute right heart failure. ACTA ACUST UNITED AC 2004; 52:530-3. [PMID: 15609646 DOI: 10.1007/s11748-004-0005-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multiple myxomas in the ventricles, causing pulmonary obstruction, are extremely uncommon. We treated multiple myxomas, seemingly clinically malignant, which had caused acute right heart failure due to their position in the outlet of the right ventricle. The position of the myxomas obstructed the pulmonary artery. To prevent the right heart from failing, we proceeded with tumor resection with the cardiopulmonary bypass on a beating heart and added cryoablation. Following the removal of the tumor, symptoms improved drastically. The postoperative course was uneventful.
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Affiliation(s)
- Koichi Sughimoto
- Department of Cardiovascular Surgery, Cardiovascular Center of Sendai, 21-1 Honda-chou, Izumi-ku, Sendai 981-3107, Japan
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