Right atrial lipoma in patient with Cowden syndrome

Bridging the gap in cardiac mass diagnosis: Advanced imaging, genetic associations, and biomarkers

In this editorial we comment on the article by Huffaker et al published in a recent issue of the World Journal of Clinical Cases. We focus on cardiac tumors linked to genetic syndromes and the differential diagnosis of cardiac masses. As cardiomyocytes lack the ability to actively divide, primary cardiac tumors are extremely rare across all ethnicities and age groups. Once they occur, these tumors are often associated with genetic mutations and, occasionally, genetic syndromes. This underscores the importance of considering genetic mutations and syndromes when encountering these cases. The more common growths in the heart are thrombi and vegetations, which can mimic tumors, further making the differential diagnosis challenging. Among the imaging techniques, contrast-enhanced cardiac magnetic resonance imaging has the highest sensitivity for differential diagnosis. To aid in the differential diagnosis of cardiac masses, especially thrombi, appropriate utilization of biomarkers (i.e. D-dimer level) may provide pivotal clinical implications. Employing a multidisciplinary approach that integrates personal history, epidemiological insights, imaging findings, genetic markers, and biomarkers is therefore critical in the diagnostic process of cardiac masses.

Complete resection of a giant intrapericardial cardiac synovial sarcoma

Synovial sarcoma of the heart is a rare tumor. Herein we would like to report a case of giant intrapericardial cardiac synovial sarcoma that originated from the right ventricle and grew outward near the diaphragm. After making adequate preoperative preparation, we performed the surgery as quickly as possible and resected the tumor completely. Based on the identification of the translocation on chromosome 18 rearrangement, the tumor can be diagnosed as a primary cardiac synovial sarcoma. Through this study, we aim to afford more information about cardiac synovial sarcomas as well as a reference for similar cases.

Management of left atrial myxoma in pregnant women: a case series

BACKGROUND

Left atrial myxoma during pregnancy is rare. We present three cases in order to aid in the management.

CASE PRESENTATION

Three cases of left atrial myxoma during pregnancy were presented in this article. Three patients all received multidisciplinary team work and acquired good outcomes. The case 1 had no symptoms and delivered before traditional cardiac surgery. The case 2 and case 3 undergone totally endoscopic minimally invasive cardiac surgery during pregnancy. The case 3 maintained pregnancy to term and gave birth to a healthy baby via vaginal delivery. No relapse of the tumor was observed.

CONCLUSIONS

The management of left atrial myxoma during pregnancy ought to be individualized and combined with the gestational age. If the diagnosis was made in the first two trimesters of pregnancy, totally endoscopic minimally invasive cardiac surgery during pregnancy would be an optimal choice. The patients can benefit from the multidisciplinary team work.

Visual analysis based on CiteSpace software: a bibliometric study of atrial myxoma

Objective

To use CiteSpace and VOSviewer visual metrology to analyze the research status, frontier hotspots, and trends in research on atrial myxoma.

Methods

The Web of Science core collection database was used to retrieve relevant literature on atrial myxoma from 2001 to 2022. CiteSpace software was used to analyze keywords with a co-occurrence network, co-polymerization class, and burst terms, and a corresponding visual atlas was drawn for analysis.

Results

A total of 893 valid articles were included. The country with the highest number of articles was the United States (n = 186). The organization with the highest number of articles was the Mayo Clinic (n = 15). The author with the highest number of articles was Yuan SM (n = 12). The highest cited author was Reynen K (n = 312). The highest cited journal was Annals of Thoracic Surgery (n = 1,067). The most frequently cited literature was published in the New England Journal of Medicine in 1995, which was cited 233 times. The keywords co-occurrence, copolymerization analysis, and Burst analysis revealed that the main research focuses were surgical methods, case reports, and genetic and molecular level studies on the pathogenesis of myxoma.

Conclusions

This bibliometric analysis revealed that the main research topics and hotspots in atrial myxoma included surgical methods, case reports, genetic and molecular studies.

Bayés syndrome secondary to atrial lipoma

This case describes a 74-year-old male who presented with rapid atrial flutter in association with large atrial lipoma along the interatrial septum. Conversion to sinus rhythm revealed the electrocardiographic criteria for advanced interatrial block. Interatrial block results from disruption of conduction through Bachmann's bundle, most commonly due to progressive atrial fibrosis. Bayés syndrome is recognized as the association of atrial arrhythmias with underlying interatrial block. This case supports the concept that localized disruption of atrial conduction via Bachmann's bundle from an atrial lipoma can produce the electrophysiologic substrate for atrial arrhythmias and the Bayés syndrome.

Intracardiac tumor as a rare manifestation of genetic syndromes-presentation of a family with Gorlin syndrome and a literature review

Intracardiac tumors in children are relatively rare, but their clinical consequences may include severe outflow tract obstruction, embolism, cardiac insufficiency, or rhythm disturbances. In some cases, the tumor may constitute part of a genetic condition and prompt additional investigations, as well as a modification of therapeutic management. Herein, we present a molecularly confirmed familial case of Gorlin syndrome with an early cardiac tumor as a presenting sign. We provide detailed clinical characteristics of the affected individuals and a useful review of syndromic causes of pediatric cardiac tumors in clinical practice.

Voluminous Intrapericardial Lipoma Mimicking Pericardial Effusion

Lipomas are rare primary heart tumors and may involve the endocardium, myocardium, or pericardium. Signs and symptoms depend on the tumor location and size. The intrapericardial lipoma we report has massive dimensions and mimics a pericardial effusion. A 38-year-old male complained of dyspnea and precordial pain. On physical examination, heart sounds were diminished. The patient had received extensive medication for a clinically suspected pericardial effusion due to heart failure. A voluminous mass resembling fat within the pericardial sac was revealed by transesophageal echocardiography and a computed tomography scan. The tumor was removed successfully by a subxiphoid surgical approach. The diagnosis of a 635 gram intrapericardial lipoma was confirmed by pathological examination. After surgery, the patient recovered well and was completely asymptomatic at a follow-up at 90 days. No medications were being taken since. The diagnosis of a pericardial effusion should be secured by imaging exams to avoid unnecessary medications. Cardiac lipomas can be readily recognized by their typical features on radiologic imaging. The surgical pathology examination confirms the diagnosis and rules out malignancy criteria.

Enlarging left atrial haemangioma in a patient with Cowden syndrome

A 53-year-old female patient known to have Cowden disease (PTEN mutation positive) was found to have a mass at the left atrium on a CT coronary angiography performed as part of a preoperative workup for an unrelated surgery. Further radiological characterisation of the lesion was achieved using MRI and positron emission tomography. Interval growth prompted surgical excision; however, surgery was expedited after the patient presented with haemopericardium and cardiac tamponade. The patient was discharged home 8 days postoperatively, and no intraoperative or postoperative complications were encountered. A diagnosis of cavernous haemangioma was made on histology.

Left atrial cavernous haemangioma presenting with cardiac tamponade in a patient with Cowden syndrome

Cowden syndrome (CS) is a rare disorder characterised by multiple non-cancerous, tumour-like growths called hamartomas. The syndrome is associated with the development of cancer of the breast, endometrium, kidneys, skin and rarely the brain. We report a rare case of symptomatic cardiac haemangioma in a patient with CS. A 54-year-old woman with CS presented with dyspnoea and orthopnoea in the setting of cardiac tamponade. Echocardiography revealed a large haemopericardium and tamponade physiology, secondary to a pericardial mass. The patient underwent urgent cardiopulmonary bypass with removal of the mass. Histopathology confirmed a benign cavernous haemangioma. We postulate that tumours involving the heart/pericardium may be an additional manifestation of CS. This case further highlights the necessity to consider pericardial/cardiac manifestations in patients with hamartomatous syndromes who present with cardiorespiratory symptoms, so that opportunistic investigation and treatment may be instituted.

Intrapericardial lipoma compressing the right atrium

We report a case of intrapericardial lipoma compressing the right atrium. Cardiac lipomas are very rare benign tumors that may cause life-threatening complications by rapid growth. A 67-year-old woman presented with dyspnea and palpitations on effort due to compression of the right atrium. The tumor was surgically resected. There was no local recurrence after surgery.

A rare case of a intracardiac lipoma

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Cardiac lipomas are the third most common type of primary cardiac tumor.

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There is no defined age or sex distribution.

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Cardiac lipoma can present with a wide range of symptoms.

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Echocardiography, CCT/CMR are radiological investigations of choice for diagnosis.

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Surgical resection remains the mainstay of treatment of symptomatic cardiac lipomas.

Introduction

Primary tumors of the heart are exceedingly rare, accounting for less than 5% of all cardiac tumors; the remaining 95% of tumors are metastatic tumors to the heart. The most common primary cardiac tumors in adults are myxomas (usually occurring in the left atrium) followed by papillary fibroelastomas and lipomas with rhabdomyoma the most common in children.

Presentation of case

We are presenting a case of a 74-years-old female who initially presents with dizziness. No other associated symptoms reported and initial labs were in normal range. Echocardiogram was done as part of the dizziness/syncope work up which demonstrated a large right atrial mass. Due to the size of the mass and patient being symptomatic the mass was surgically resected with complete resolution of her symptoms and pathology consistent with a lipoma.

Discussion

Cardiac lipomas are benign and may be associated with a spectrum of symptoms which depends upon the size and location of the lipoma; although most cardiac lipomas are found incidentally and are asymptomatic. The best radiologic study to identify and help differentiate cardiac lipoma is echocardiogram. Cardiac computerized tomography (CCT) and cardiac magnetic resonance imaging (CMR) also place a role in differentiating cardiac lipomas from other cardiac tumors/lesions.

Conclusion

Cardiac lipomas are benign primary tumors which have no defined age or sex distribution and present with a wide range of symptoms. Echocardiography is first line diagnosis method with CCT/CMR for better imaging before surgical intervention. Surgical resection of the symptomatic cardiac lipomas remains the mainstream treatment.

An asymptomatic right atrial intramyocardial lipoma: a management dilemma

Background

The atrial intramyocardial lipomas are rare benign unusual tumors of the heart. The indication and best form of treatment for cardiac lipomas remain controversial.

Case presentation

The atrial intramyocardial lipomas are rare benign unusual tumors of the heart. We report a 55-year-old Chinese female with a history of hypertension. Echocardiography and 64-slice computed tomography showed a fatty mass in the right atrium. Although she was asymptomatic, a surgical resection was indicated since the lipoma could cause an embolism and arrhythmias and its potential to enlarge. Surgery revealed an intramyocardial lipoma on the atrial free wall which was confirmed by histopathology. The patient remained asymptomatic after surgery, and no recurrence was seen after 1 year.

Conclusions

Although cardiac lipomas are usually benign, tumor embolism, potential to enlarge, or intracardiac obstruction can cause a critical situation. Therefore, a surgical resection was indicated even in asymptomatic patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12957-015-0441-9) contains supplementary material, which is available to authorized users.