Left atrial myxoma presenting as rheumatic fever

Virilizing ovarian stromal tumor in a young woman with Carney complex

A woman with Carney complex presented at the age of 22 years with abdominal pain and hirsutism. As a baby, she had undergone excision of a right eyelid lesion, and at age 14 years she had undergone removal of a left lower eyelid nodule that subsequently recurred. Investigation revealed an elevated level of serum testosterone and a 2-cm left ovarian tumor. A left salpingo-oophorectomy was performed. Postoperatively, she experienced relief from abdominal pain, the serum level of testosterone normalized, and the hirsutism ameliorated. The tumor featured sheets of eosinophilic cells with lipochrome pigment, myeloid metaplasia, stromal metaplasia, and markedly abnormal blood vessels. Immunocytochemically, the tumor cells were positive for vimentin, synaptophysin, inhibin-A, and calrenin. Because of the clinical setting in which the neoplasm occurred, it is likely that is occurrence was related to Carney complex.

The diagnostic challenge of left atrial myxoma. Importance of echocardiographic screening

Left atrial myxomas are extremely difficult to diagnose since their variable manifestations mimic a host of clinical entities more commonly seen, e.g. mitral stenosis, endocarditis, rheumatic fever, cardiomyopathy or mesenchymosis. At the same time, early diagnosis followed by prompt surgical removal are mandatory to prevent mutilating or lethal complications of the tumor. Six cases of left atrial myxoma were diagnosed in our hospital during 2 1/2 years. We present the case histories, diagnostic procedures and surgical findings, consolidating the unique role of echocardiography in detecting left atrial myxomas. We propose the use of echocardiography as a screening examination for atrial myxomas in the following settings: suspected mitral obstructive disease, suspected endocarditis with negative blood cultures, peripheral embolism or thrombosis in young patients, unexplained cardiac failure and mesenchymosis with uncharacteristic presentation.

Ocular pigmented spots and eyelid myxomas

Ophthalmic abnormalities are part of a recently recognized syndrome that includes myxomas, spotty pigmentation, and endocrine overactivity. The complex is familial with mendelian dominant mode of inheritance. The 63 patients (27 males and 36 females) we have identified with this complex had the following ophthalmic abnormalities: facial and eyelid lentigines in 44 patients (70%); pigmented lesions on the caruncle or conjunctival semilunar fold in 17 patients (27%); and eyelid myxomas in ten patients (16%). Because these findings usually preceded the most serious component of the syndrome, cardiac myxoma, early recognition of their significance is important.

"Syndrome myxoma": a subset of patients with cardiac myxoma associated with pigmented skin lesions and peripheral and endocrine neoplasms

From January 1954 to December 1985 cardiac myxoma was diagnosed in 75 patients at the Mayo Clinic. The clinical presentation was typical in 70 cases and was referred to as "sporadic myxoma". Forty four other cases of cardiac myxomas (five from the Mayo Clinic) presented with a combination of distinctive clinical features and these cases are described as "syndrome myxoma". The patients with syndrome myxoma were younger (mean age, 25 vs 56 years) and had unusual skin freckling (68%), associated benign non-cardiac myxomatous tumours (57%), endocrine neoplasms (30%), and a high frequency of familial cardiac myxoma (25%) and familial endocrine tumours (14%). The two types of cardiac tumour were different (syndrome vs sporadic): atrial location, 87% vs 100%; ventricular location, 13% vs 0%; single tumour, 50% vs 99%; multiple tumours, 50% vs 1%; and recurrent tumour, 18% vs 0%. It is concluded that patients with syndrome myxoma represent a distinctive subgroup in which there are important clinical, surgical, and genetic implications. More importantly, syndrome myxoma appears to be only one expression of a much larger disease entity.

Mucocutaneous pigmented spots and oral myxomas: the oral manifestations of the complex of myxomas, spotty pigmentation, and endocrine overactivity

The complex of myxomas, spotty pigmentation, and endocrine overactivity is a recently recognized syndrome, transmitted as an autosomal dominant trait. The most serious component of the disorder is cardiac myxoma, which has caused the death of one fourth of the affected patients and serious disability in an equal number. It is, therefore, important to recognize patients at risk from the syndrome and, in particular, to test them for cardiac myxoma. Fortunately, in many patients the myxoma complex has a clearly visible marker: mucocutaneous pigmentation. Among 58 patients with the syndrome, spotty facial pigmentation was present in 36 (62%), and 29 (50%) of these also had pigmented spots on their lips. This type and distribution of pigmentation should be a clue to the possible presence of the complex of myxomas, spotty pigmentation, and endocrine overactivity, and patients thus affected should be referred for further investigation. Oral cavity myxoma(s) occurred in four patients with the syndrome.

Clinical appraisal of current nuclear and other noninvasive cardiac diagnostic techniques

At a time of rapid increases in the cost of medical care and the application of complex invasive procedures to cardiovascular diagnosis, the use of noninvasive methods has aroused interest. This report discusses the usefulness and limitations of various noninvasive diagnostic methods including nuclear medicine techniques, echocardiography, exercise electrocardiography and determination of systolic time intervals. Emphasis is placed on the applicability of these methods to specific disease processes (such as ischemic heart disease, cardiac valve disease, pulmonary embolic disease), their relative merits, future potential and present shortcomings.