Histopathologic and Clinical Characterization of Atrial Myxoma: A Review of 19 Cases

Abstract

Background Atrial myxomas are the most common cardiac neoplasms. They consist of 2 macroscopic features of solid, papillary, and myxoma cells in abundant mucopolysaccharide stroma in microscopic examination. The majority of patients may experience central or peripheral embolization, intracardiac obstruction, or constitutional symptoms. We sought to investigate the clinical presentation and pathological features of atrial myxomas in the population that underwent cardiac surgery at our institution. Methods Nineteen patients undergoing atrial myxoma excision were collected prospectively from the 18,300 patients who underwent cardiac surgery between January 2001 and June 2008 at Tehran Heart Center. Results Our study population consisted of 8 men and 11 women with a mean age of 54.05 ± 7.33 years. All of the cases had left atrial tumors. The solid myxoma group (79%) was comprised of 8 females and 7 males, while papillary myxoma (21%) was detected in 3 females and 1 male. In our study, 6 patients (32%) had hypertension (HTN), 4 (21%) had diabetes mellitus, and 5 (26.3%) had hyperlipidemia. Smoking and opium addiction were detected in 6 (32%) and 3 (16%) patients, respectively. Dyspnea was the most prevalent presenting symptom occurring in 12 patients (63%), followed by chest pain in 7 (37%), and neurological symptoms in 5 (26%). Hypertension was more prevalent in the patients with neurological symptoms than in those without them ( P =0.046). Five patients were anemic, and 5 cases had leukocytosis. Anemia was detected in 75% of the patients with papillary tumors compared to 13.3% of the patients with solid tumors ( P =0.037). Thrombocytosis was detected in 1 patient. Plasma cells infiltration were found in 1 papillary and 14 solid tumors. Neutrophils were detected in 9 solid and 1 papillary tumor. Three solid tumors revealed mineralized circumscribed nodules (Gamna-Gandy bodies). In patients with chest pain, the neutrophil count in the tumor tissue, not in the blood, was not significantly different from that observed in patients without chest pain (85.7% vs. 33.3%, respectively, P =0.057). Discussion Our data demonstrated the histological features of atrial myxomas correlated to some of the patients’ clinical findings. This study identifies for the first time the correlation between HTN and CNS symptoms in atrial myxoma. The presence of these findings could be due to the production of different mediators such as interleukins. However, further studies are needed to confirm these findings.