Cardiac Myxoma: Typical Presentation but Unusual Histology.

Hassan H Alahmadi,Mohamed A Shawarby,Fayez Ahmed,Noor Said Alsafwani,Gerald S Supinski

doi:10.1155/2021/6611579

Hassan H Alahmadi, Mohamed A Shawarby + Show 3 more

Open Access

https://doi.org/10.1155/2021/6611579

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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.

Highlights

Cardiac myxoma, a benign heart tumor, is the most common primary tumor of the heart [1]
We report a case of left atrial myxoma with glandular differentiation, emphasizing its distinction from metastatic adenocarcinoma
A primary heart tumor, is the most common benign cardiac tumor [1]. It usually occurs in the atria and presents with variable signs and symptoms ranging from an asymptomatic incidentally found lesion to shortness of breath, systemic embolization, syncope, or even death [1, 4,5,6,7]. ese different presentations can be explained by the tumor hemodynamic impact dictated by its location and proximity to heart valves and its propensity to embolize as determined by the texture of the tumor

Summary

Introduction

A benign heart tumor, is the most common primary tumor of the heart [1]. A common entity among cardiac neoplasms, different histological presentations may hinder the diagnostic process. Among these is the presence of glandular differentiation in rare cardiac myxomas. Ever since 1946, when Anderson and Dmytryk first described this change [2], only a few cases of “glandular cardiac myxomas” had been reported in the English literature (fewer than fifty) [3]. We report a case of left atrial myxoma with glandular differentiation, emphasizing its distinction from metastatic adenocarcinoma

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