BREATHTAKING DIAGNOSIS: ATRIAL MYXOMA

Abstract

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Primary cardiac tumors are one of the least investigated subjects in oncological medicine. Among these primary cardiac tumors, atrial myxoma is one of the most common primary cardiac tumors mostly arising in the left atrium.We present a unique case of atrial myxoma that will highlight the broad importance of differential diagnosis in inpatient and outpatient setting. CASE PRESENTATION: A 57-year-old female presented for outpatient CT scan of the chest to rule out pulmonary embolism due to continued dyspnea at rest and orthopnea following upper respiratory tract infection. A CT scan of the chest was negative for pulmonary embolism; however, it revealed a 4.9 x 4.8 cm low-density mass in the left atrium (Panel A, arrow). A transesophageal echocardiogram showed a large heterogeneous left atrial mass attached to the interatrial septum with characteristic "plop” across the mitral valve causing functional mitral stenosis (Panel B, arrow). Cardiac catheterization revealed non-obstructive left anterior descending and right coronary arteries; however, left circumflex coronary artery was not visualized despite aortic root angiography indicating congenital absence (Panel C, arrows [LAD and RCA denote left anterior descending and right coronary arteries, respectively]). The patient underwent surgical resection of the mass (Panel D). Biopsy of the mass revealed tumor cells with elongated and fusiform stellate with bland nuclei and eosinophilic cytoplasm with dense lymphocytic aggregation consistent with myxoma (Panel E and F). The postoperative course was unremarkable. DISCUSSION: Myxomas are the most common benign primary cardiac tumors and occur predominantly in the left atrium and in women. Patients typically present with symptoms of heart failure secondary to mitral inflow obstruction; however, one-third of the patients, especially men present with the embolic phenomenon. Cardiac myxoma disproportionately affects the female population with 65% of myxomas occurring in them. Secondary of myxomas being familial in 4.5 to 10% of the cases it is recommended to screen first degree relatives [2]. Multiple theories have been proposed regards to the origin of these tumors. The initial thought process was to classify them as organized thrombotic structure but histological and molecular investigations reported the expression of different cardiac myocytes and transcription factors lead to propose that these lesions might have mesenchymal cardiomyocyte progenitor cells [3]. Cardiac myxomas even though classified as benign tumors have a tendency to seed in other locations causing inflammation, embolism, or intra-cardiac obstruction leading to mortality and significant morbidity. CONCLUSIONS: Prompt diagnosis is crucial since the results of surgical resection are excellent with dramatic symptoms improvement and rapid postoperative recovery. Reference #1: Lam, K. Y., Dickens, P., & Chan, A. C. (1993). Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Archives of pathology & laboratory medicine, 117(10), 1027-1031 Reference #2: Ekmektzoglou, K. A., Samelis, G. F., & Xanthos, T. (2008). Heart and tumors: location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations. Journal of Cardiovascular Medicine, 9(8), 769-777. Reference #3: Amano J, Kono T, Wada Y, Zhang T, Koide N, Fujimori M, Ito K. Cardiac myxoma: its origin and tumor characteristics. Ann Thorac Cardiovasc Surg. 2003;9(4):215–221 DISCLOSURES: No relevant relationships by Pranjal Boruah, source=Web Response No relevant relationships by Gaurav Patel, source=Web Response No relevant relationships by Muhammad Siddique Pir, source=Web Response No relevant relationships by najam saqib, source=Web Response