Diagnosis Of Myxoma Research Articles

Atrial myxoma: case presentation and review

Kristina Daujotienė1 1Lithuania University of Health Sciences, Kaunas Hospital Abstract Introduction. Myxomas are the most common cavity primary tumor of the heart. Cardiac myxoma is 50% benign heart tumors [1,2]. In most cases, 75-80% cases, myxoma grows in the left atrium at the mitral ring or in the area of ​​the atrium at the foramen ovale, 20% in the right atrium and in 5-8% in the ventricules. [3,4]. Myxoma usually grows on a so-called stem (a narrowed part of the tumor at the base) or attached to a wide base. This article presents a clinical case of a patient who was diagnosed with left atrial myxoma on echocardiography. Echocardiography is the most commonly used method in diagnostics. Accuracy 95% in the diagnosis of myxoma [9]. Transesophageal echocardiography (TEE) is 100% accurate study in the diagnosis of myxoma [1]. After a diagnosis of myxoma by imaging, surgical removal of the tumor should be performed as soon as possible. The results of surgical treatment are usually very good. Aim: to present the clinical case in the Kaunas hospital of the Lithuanian University of Health Sciences. To select and analyze the causes, diagnostic and treatment recommendations of left atrial myxoma provided by experts. Methods: the review of literature was conducted using medical databases selecting publications investigating left atrial myxoma. Results: after the analysis of the literature, the main causes, diagnostics and treatment methods of left atrial myxoma are presented. Conclusions: Myxomas are the most common cavernous benign heart tumor. Usually in 75-80% of cases myxoma grows in the left atrium. The clinical diagnosis of myxoma should be considered in all patients during clinical monitoring for symptoms of dyspnea, especially onset of sleep, nocturnal dyspnea, pulmonary edema, cough, hemoptysis and general fatigue. Keywords: atrial myxoma, clinical case, tumor. Full article

A case report of left atrial myxoma presenting with amnesia

BackgroundPrimary cardiac tumors are rare, and approximately 90% of them are benign. Myxoma is the most common type of these tumors occurring in the left atrium in 75–85% of cases. The tumor can cause the left atrio-ventricular valve obstruction and embolization phenomenon.Case presentationWe reported a case of 54-year-old man with complaints of dyspenea and amnesia. In our patient, transthoracic echocardiography revealed a mass of 28*63 mm attached to the upper intra-atrial septum, which was prolapsing through the mitral valve into the left ventricle during diastole, being indicative of the left atrial myxoma. On examination, he was alert and conversant, and no pathological abnormality was observed in the examination of cardiovascular, gastrointestinal, respiratory, hepatic, renal and nervous systems. After myxoma diagnosis, the tumor was removed under cardiac surgery and discharged under good conditions. In the telephone follow-up after discharge, the patient recovered and did not report the disease and surgery complications.ConclusionsPatients with cardiac myxoma are usually asymptomatic, but they may have manifestations related to the embolism phenomenon or intracardiac obstruction. Therefore, myxoma may represent an emergency. Surgery should be performed as soon as possible. If surgery is delayed, the patient may suffer from serious and irreversible complications, such as stroke and cardiac arrest.

Сardiac myxoma: challenge in diagnostics. Case report

Cardiac myxoma is the most common primary benign cardiac tumor (up to 50% of all primary cardiac neoplasms). The implementation of the modern imaging techniques into the clinical practice, particularly, 2D echocardiography, computed tomography and magnetic resonance tomography (MRI) results to the prompt diagnosis of the myxoma. However, the absence of specific clinical features, insufficient awareness of this condition among the physicians along with a rare prevalence, may lead to a misdiagnosis. This case report is notable for the relatively late diagnosis of a giant left atrial myxoma due to a number of circumstances but with successful surgical treatment.

Left Atrium Emboligenic Myxoma: Case Report and Review of the Literature

Introduction: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. Observation: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. Conclusion: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.

A rare Localization of Mixoma: Originating in the Right Atrial Septum

Myxoma is the most common bening cardiac tumourt. Approximately 75-80 % of cardiac myxomas are located in the left atrium. The most common non-specific symptoms are such as shortness of breath, syncope. A 74-year-old female patient was admitted to our outpatient clinic with shortness of breath and chest pain, in the echocardiography showed a mobile mass in the right atrium. The patient, whose diagnosis of myxoma was confirmed by trans esophageal echocardiography, underwent intracardiac mass excision. Because the right atrial myxomas are rare, we wanted to present our patient. An underlying cardiac pathology should be kept in mind in patients presenting with symptoms such as non-specific breathlessness

Cardiac Magnetic Resonance Evaluation of Cardiac Masses in Patients with Suspicion of Cardiac Masses on Echo or Computed Tomography

Objectives:In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT).Material and Methods:We reviewed all the patients referred for CMR at Aga Khan University Hospital, Karachi, from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Only those with the confirmed diagnosis of cardiac mass on CMR were included in the study.Results:A total of 27 patients were referred for CMR from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Four patients were excluded as no cardiac mass was found on CMR. Out of 23 cases, majority (n = 15, 65%) were female, age ranging from 3 months to 70 years, with a mean age of 40 ± 22 years. Shortness of breath was the main presenting symptom (n = 19, 83%). Echocardiogram was the initial imaging modality done in all the patients while CT was also performed in 6 patients (26%). Out of 23 patients, 4 (17%) were diagnosed to have thrombus on CMR. In two cases, it was in the left ventricle with evidence of myocardial infarction on late gadolinium images. Myxoma was the most common tumor diagnosed on CMR in 6 patients (26%) followed by rhabdomyoma (n = 3, 13%) and fibroma (n = 2, 8.7%). There were three malignant primary tumors of the heart based on CMR appearances and one with tumor thrombus extension of hepatocellular carcinoma in the right atrium from inferior vena cava. Two patients were diagnosed to have non-neoplastic lesions – one with large intracardiac hydatid cyst and one with possible large fungal vegetation. Among 23 patients, 9 patients (39%) underwent surgery, 5 with myxoma, 2 with rhabdomyoma, 1 with fibroma, and 1 with fibroelastoma. Findings on surgery and histopathology matched the CMR diagnosis in all the patients except the one with the CMR diagnosis of myxoma in which histopathology was consistent with thrombus.Conclusion:CMR can play an important role in confirming the presence or absence of a mass in the heart. It can also provide differentiation of non-neoplastic and neoplastic lesions and among different types of neoplastic lesions with reasonable accuracy. However, the limitations of CMR must be recognized.

Left Atrial Myxoma: A Rare Tumor in a Child

Atrial myxomas are uncommon in the pediatric population but are very important due to pursuant atrioventricular valve obstruction and systemic embolic events. Concerning multiple symptoms ranging from congestive heart failure to neurological deficits, the diagnosis of this disease is complicated. This paper reports a case of left atrium myxoma in a child treated with a surgical excision of the tumor. Surgical excision appears to be curative, as shown in postoperative echocardiogram of this patient. To be precise, an immediate and timely diagnosis of myxoma by echocardiography, allowed the immediate surgical treatment of this rare, benign but potentially lethal cardiac tumor.

Masas cardíacas, utilidad de la ecocardiografía transesofágica durante el intraperioperatorio

We present our experience in cardiac tumor resection surgery in adult patients: 30 subjects with sternotomy approach with later diagnosis of myxomas (12), fibroelastomas (7), sarcomas (4), cardiac methastasis of a breast cancer and cardiac invasion of renal tumor (6), and 3 with videothroacoscopic approach with diagnosis of atrial myxoma (2) and intraventricular sarcoma (1). We highlight the usefulness of TEE as an essential monitor in this subtype of cardiac surgery in allowing location confirmation and completion of resection. Likewise as anesthesiologists and active participants of the surgical team, we were able to document absence of residual heart defects, lesions or perforations or dysfunction of heart valves. Evaluation of preexisting anatomy and function and post Cardiopulmonary Bypass ventricular function and circulation were important in early diagnosis of complications.

P1460 Atrial myxoma with atypical location in an asymptomatic patient

Abstract Introduction Primary cardiac tumours are rare. Most of them are benign, among which myxomas are the most common. Usually they occur in the left atrium (75%) but there are cases of right atrial myxomas. The majority of patients with atrial myxoma present with one or more symptoms of clinical triad of embolic events, intracardiac obstruction, or nonspecific manifestations. We report a rare case of cardiac myxoma arising from the right atrium as an accidental finding during routine medical checkup. Case report A 52 years-old woman was admitted to ambulatory care for a general checkup. At presentation, her heart rate was 82 bpm, regular and blood pressure was 150/90 mmHg. Other investigative results were normal. Her ECG showed normal sinus rhythm. She was sent for a routine echocardiography to judge for further treatment of the arterial hypertension. Transthoracic echocardiogram showed normal left ventricular ejection fraction. There was a mobile echogenic mass of nearly 6 cm2 in the right atrium, prolapsing through the tricuspid valve with mild tricuspid regurgitation without causing obstruction and protruding into the inferior vena cava (IVC). The transesophageal echocardiographic examination confirmed the presence of a mobile multilobular mass in the right atrial free wall close to the IVC origin. A total body angio-CT scan showed an intraatrial mass measuring approximately 5 × 4 cm, without infiltration of the adjacent structures, suggesting the diagnosis of myxoma. Coronary angiography revealed normal coronary arteries. The patient underwent median sternotomy under general anesthesia. The tumor was completely excised through a right atriotomy. The resected mass was sent for histological assessment which confirmed the diagnosis of myxoma. Discussion RA myxomas usually originate in the fossa ovalis or base of the interatrial septum, but in this case, the myxoma was implanted in the atrial inferior vena cava junction. Myxomas are usually polypoid and pedunculated tumors (approximately 83% of cases). In this report, our patient had a solitary, pedunculated mass with polypoid areas and a lobulated surface. Echocardiography remains the best diagnostic method for locating and assessing the extent of myxomas and for detecting their recurrence, with a sensitivity of up to 100%. However, transthoracic echocardiogram may not identify tumors smaller than 5 mm in diameter, and a transesophageal echocardiogram is required when there is suspicion of a very small tumor. In this case, an echocardiogram suggested the hypothesis of RA myxoma, which was confirmed by a histopathological exam. Myxomas are friable with high chance of systemic or pulmonary embolization depending on tumour location. Early diagnosis and timely surgical resection is the treatment of choice to prevent possible fatal consequences such as sudden death. Abstract P1460 Figure. Right Atrial Myxoma

P853 Bilateral lower limb ischemia in a healthy young man what if the heart was hiding the etiology

Abstract Cardiac myxoma is the most common benign cardiac tumor with diverse nonspecific clinical manifestations; moreover, atrial myxoma embolization to the peripheral vessels is rare. A 24-year-old man presented tothe emergency departement complaining ofpain and coldness of his two lower extremities. The right femoral pulse was normally felt while the pulses of the left lower limb from the femoral down to the posterior and anterior tibial arteries were not felt. Bilateral thrombectomy was performed on emergency basisand a fatty-like mass from the left femoral artery was removed. The histological examination of this mass was suggestive of myxoma.So, transthoracic echocardiography was done and confirmed the diagnosis of myxoma that was seen in the left atrium and measuring about 10X6 cm in its maximal dimensions. Surgical removal of the myxoma was done later and the patient recovered uneventfully. Conclusion Although myxomas are rare, they should be considered in the differential diagnosis of peripheral embolic disease, especially when an embolic event occurs in a young adult without evidence of endocarditis or arrhythmia. Echocardiography is the modality of choice for diagnosis and follow-up of this type of tumors. FIGURE 1: CTA (computed tomography angiography) showing Occlusion of the left popliteal artery and occlusion of the distal part of the right popliteal artery FIGURE 2: macroscopic view of gelatinous left atrial myxoma

P1407 Three dimensional echocardiography in cardiac myxomas

Abstract The majority of cardiac myxomas (75–80%) are located within the left atrium, characteristically originating from the mid-portion of the atrial septum by a narrow stalk; The detection of such a feature has paramount importance for the diagnosis of myxoma ; in fact other anatomical findings as sessile implantation or other locations may be common to other cadiac tumors. Two dimensional (2D) transthoracic (TT) and transesophageal(TE) echocardiography E and cardiac magnetic resonance imaging (MRI) are mainstay in the diagnosis; It has been reported that Three dimensional(3D) E and in particular the 2D orthogonal cross sectional planes generated by electronically sectioning the 3D volume, could correctly identify the attachment and the peduncle sometimes missed by other imaging modality and therefore lead to a correct diagnosis. Purpose of our study was to assess the usefulness of 3DE in the detection of the mainstay anatomical features of the cardiac myxomas; We retrospectively reviewed all the case of the myxomas with pathology confirmation that underwent 2D TEE, 3D TEE and MRI in the past 5 years in order to assess the ability of the techniques in identifying the following anatomical features: site of attachment (mid atrial septum, other locations ) , modality of attachment (pedunculated or sessile); Every study was reviewed by an expert reader. Our study group is comprised by 7 patients, 6 female, mean age 48.8 ±9.7 with 12 myxomas ; 8 located in the left atrium 3 in the right atrium ; In 6 case was the first diagnosis , in one patient was a recurrence. 9 mixomas were in the left atrium , 3 in the right atrium. & were pedunculated, 5 sessile. There was an agreement in detecting the anatomical features except in two patients in a one patients the attachment by a peduncle in the atrial septum close to the opening of the left upper pulmonary vein was seen only by 3DE ; in a second patient a small myxoma close to the left atrial appendage was detected only by TEE ; Until now few reports have described the uselfuness of three dimensional echocardiography in detecting the anatomical features of cardiac myxomas. Even though MRI is the only technique able to detect perfusion of a mass otherwise it is not able to distinguish among different tumors; therefore the visualization of the anatomical features may lead a more correct diagnosis that can help in a better therapeutical and surgical plan. In our study 3DE was the only technique able to correctly depict the mainstay anatomical features of cardiac myxomas. It was possible in particular by using the 2D cross sectional planes generated by electronically sectioning the 3D volume in a case of a small peduncle attached in an uncommon location of the interatrial septum. All the techniques are reliable in assessing the anatomical features of myxomas however 3DE could have an additional value in particular in not common location and will compliment 2D imaging in cardiac myxoma diagnosis

P4657Cardiac myxomas: are we dealing with distinct clinical entities?

Abstract Background Cardiac myxomas are rare, despite being the most common primary cardiac tumours. A significant number of myxomas are discovered accidentally in asymptomatic patients (pts), as there is increased use of non-invasive cardiac imaging. Our aim was to describe the experience of a cardiac surgery centre managing cardiac myxomas during the last 28 years. Methods Single-center retrospective study of consecutive pts admitted with the diagnosis of a cardiac myxomas between 1990 and 2018. Registry data concerning clinical presentation, non-invasive imaging assessment and definitive histopathology were collected. Results From 154 pts with the diagnosis of cardiac tumours, we identified 106 (68.8%) myxomas (67% females; mean age at diagnosis 61,5±13,1 years). Myxoma diagnosis increased throughout the 3 decades (27 cases until 2000; 26 cases in the second decade; 52 cases from 2010 until present). 30% of the pts were asymptomatic at diagnosis. Obstructive symptoms (heart failure and syncope) and embolic events were the most common complaints among symptomatic pts. Transthoracic echocardiography firstly identified the tumours in 88% of the cases. Cardiac magnetic resonance and computed tomography were performed for further investigation in 7% of the cases. Presumptive pre-operative diagnosis was correct in 83.8% pts. Surgical excision was successfully achieved in all cases. 89% of the tumours were located in the left atrium with inter-atrial septum implantation (13 in right chambers; 1 valvular tumour). There were 10 multifocal tumours. At histopathology myxomas were grossly described as mucous jelly appearance (80%), solid (15%) and mixed type lesions (5%). Rare histologic findings were described in 30% of the cases (8 tumours with bone tissue; 1 with forming bone marrow; 4 with endocrine type glandular epithelium; 16 with lympho-plasmocytic infiltrates; 3 with high mitotic grade; 5 with concomitant thrombus). For a median follow up of 86 [31–214] months there were 15 deaths (2 of them with tumour related deaths). There were 3 recurrences (2 with high mitotic grade histology), mostly occurring 3 years after the first intervention. Conclusion In this case series cardiac myxomas are the most common cardiac tumours, with a significant proportion of asymptomatic lesions. Clinical heterogeneity followed polymorphic histology, with recognized differences when compared to classical descriptions of this kind of tumour.

Renal Myxoma in a Feline

Background: Renal neoplasms are a rare condition in felines, with metastatic lymphoma presenting the highest incidence rate. Secondary renal neoplasms are more frequent (88%) than primary renal tumors, with primary mesenquimal renal neoplasms accounting for 22% of the cases and the incidence of benign tumors not exceeding 5%. Myxomas are neoplasms in undifferentiated mesenchymal cells with abundant reproduction of the myxoid matrix, with few few case reports about this type of neoplasm in the veterinary literature. This study reports the first case of renal myxoma in a young feline afflicted by granulomatous nephritis and diagnosed with FIP (Feline Infectious Peritonitis).Case: A 9-month-old, male, mixed breed feline, was admitted into the Veterinary Hospital maintained by the School of Veterinary Medicine and Animal Science, Botucatu, Brazil, presenting symptoms such progressive weight loss and occasional episodes of emesis for one week, progressing to anorexia, hematochezia, vocalization, lack of coordination, spasms, anuria and inability to defecate. A physical examination revealed moderate dehydration, low temperatures (< 33ºC), dyspnea (36 mpm), slight hyperglycemia (187 mg/dL) and distension of the abdomen and of the urinary bladder. The hematological assay and the serum biochemistry assay revealed neutrophilic leukocytosis, thrombocytopenia, anemia and slight uremia. In view of the severity of the neurologic signs and lack of response to the clinical treatment, the owner opted to euthanize the animal. The necropsy revealed diffused jaundice, with kidney injuries observed through the pale coloration of the tissue and irregular surface with multiple off-white small nodules distributed in a marked and diffuse way. The same injury pattern was observed markedly in the lungs and discretely in the spleen and liver. The material collected was fixed in a 10% formalin solution, and processed according to the routine technique (Hematoxylin & Eosin). The remaining samples were submitted to a histochemical analysis with the Alcian Blue and Masson’s Trichrome stains, in addition to an immunohistochemical expression test. The histopathological examination with H&E staining revealed multiple focuses of pyogranulomatous injuries in the kidneys, lungs, spleen, uvea and leptomeninges, corroborating the diagnosis of feline infectious peritonitis (FIP). In addition, there was a neoplastic proliferation of fusiform cells among an abundant myxoid matrix, evident in Alcian Blue staining. Normal renal tissue, such as glomeruli or tubules, were occasionally observed inside the neoplastic proliferation. Masson’s Trichrome technique was used to exclude the possibility of a fibroblastic origin. In addition, immunohistochemistry (IHC) was performed to confirm the diagnosis of myxoma using the Vimentin, pan-cytokeratin and p63 antibodies. Discussion: Kidney tumors are rare in veterinary medicine, but have an incidence rate four to five times greater in cats than in dogs. The veterinary literature describes myxomas located in joints, cardiac valves and ureter, but reports of myxomas afflicting the kidneys are more commons in human medicine. This tumor should be included in the differential diagnosis process for young cats with suspicions of renal neoplasms, however, to differentiate between neoplasms with a myxoid component in benign tumors. This is the first reported case of renal myxoma afflicting a young feline with feline infectious peritonitis (FIP) in the veterinary literature.

Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases.

ObjectiveTo assess long-term survival and late cardiovascular events in patients with atrial myxoma after surgical intervention.MethodsRetrospective analysis of 403 patients undergoing resection of atrial myxoma from January 2002 to December 2016 was conducted with a median follow-up period of 4.5 (range: 0.5–15) years.ResultsThe cross-clamp time and cardiopulmonary bypass times were 41.1 ± 21.4 and 65.2 ± 27.3 min, respectively. A diagnosis of myxoma was histopathologically confirmed in all cases. The early in-hospital mortality rate was 0.7% (n = 3). During the follow-up period, tumor recurrence occurred in six patients and cerebral infarction in nine. There were 48 (11.9%) patients with late onset atrial fibrillation (AF). By multivariate analysis, age (HR = 1.05, 95% CI: 1.02–1.09, P < 0.001), left atrial diameter (HR = 1.23, 95% CI: 1.08–1.36, P = 0.012), and mitral valve surgery (HR = 1.17, 95% CI: 1.05–1.29, P = 0.027) were independent predictors of late onset AF. Twenty-one (5.2%) patients died during the follow-up period. Advanced age (HR = 1.07, 95% CI: 1.04–1.10, P = 0.003) and multiple surgical procedures (HR = 1.18, 95% CI: 1.06–1.29, P = 0.012) were significantly associated with overall mortality.ConclusionsAtrial myxoma can be resected with good long-term survival. Late onset AF is common after surgery in patients with atrial myxoma. Advanced age, left atrial diameter, and mitral valve surgery were independent predictors of outcomes.

Oral Myxoma in a Steer

Background: Myxoma is a benign neoplasm of mesenchymal cells producing a myxomatous matrix rich in mucopolysaccharides. This tumor occasionally has been described in older dogs and cats, and rarely occurs in other species. In ruminants myxomas can be found in the rumen and omasum, but there are no reports of these neoplasms involving the oral cavity of cattle. Only one case of myxoma was diagnosed in a 40-year study of 606 neoplasms in cattle in South Africa. Similar retrospective studies done in cattle from southern and northeastern Brazil also detected a single case of cutaneous myxoma. The current study reports the clinical and pathological findings of a rare occurrence of bovine oral myxoma.Case: A 22-month-old male crossbreed steer (Bosindicus) from the municipality of Rio Verde, GO (17°44′42″S 50°55′00″W), Brazil, presented a history of sialorrhea. There is no another affected animal in the herd. Clinical evaluation revealed mild swelling in the lower incisive gum. Treatment with flumetasone IM for three consecutive days was performed. Two months after this procedure, there was a considerable increase in the size to a flat, firm mass of 16x13x9 cm. Other clinical signs included emaciation and severe difficulty in feeding and drinking water. After surgical excision, fragments of the tumor were collected for histopathology. There is no local recurrence within approximately one year of the surgery. Microscopically, the lamina propria was found to be expanded and replaced by a nonencapsulated, moderately cellular, poorly demarcated, neoplastic proliferation. The lesion was composed of numerous loosely arranged bundles of cells in an abundant myxoid matrix. The bulk of the tumor parenchyma was formed by spindle or stellate cells with poorly demarcated borders and scant, eosinophilic cytoplasm. The nuclei were oval and hyperchromatic. Mild anisocytosis and anisokaryosis were present, along with rare mitotic figures. The myxoid matrix presented strong positive labeling to mucin by the Alcian blue staining. Based on the anatomopathological and histochemical findings, a diagnosis of myxoma was established.Discussion: Neoplasms of connective tissue originate from poorly differentiated fibroblasts and can produce collagenous (fibroma/fibrosarcoma) or mucinous (myxoma/myxosarcoma) stroma. In some cases, it is difficult to establish a histopathological classification and to distinguish between benign and malignant neoplasms, for which assessment of cell morphology, mitotic index, and biologic behavior are required. Very few cases of myxoma have been previously reported in cattle, this neoplasm and it was never diagnosed in the oral cavity of this species. Thre majority of neoplasms diagnosed in the oral cavity of cattle are squamous cell carcinomas and papillomas, although sporadic cases of lingual fibroma, lingual mastocytoma, odontoma and ameloblastic fibroma have been described. In the current case, the steer presented weight loss and difficulty in feeding and drinking water, probably due to the large volume of the neoplasm. Similar clinical signs can occur in cattle affected by other types of large neoplasms in the oral cavity. After surgical excision, the animal of the current report presented general improvement and considerable weight gain. The myxoma-related pathologic findings observed in the present case are similar to those described in other studies. Because myxoma is considered an infiltrative neoplasm, postoperative recurrence can occur; however, this was not noted in the current case and reports of myxoma in other species. The main differential diagnosis for myxoma is fibroma; the presence of mucin (Alcian blue positive) in the intercellular matrix as seen in the current case confirms the diagnosis of myxoma.

Cardiac myxoma: clinical characteristics, surgical intervention, intra-operative challenges and outcome

The objectives of this retrospective study were to characterize the clinical presentation, diagnostic findings, surgical approaches, intra-operative challenges and complications following the surgical treatment of cardiac myxoma in two of the largest referral hospitals in Jordan. Medical records of all patients presented to the cardiology department during the period between 1984 and 2016 were reviewed. Criteria for inclusion in the study were: (1) patients who were presented for cardiac evaluation due to symptoms suggestive of a primary cardiac problem, (2) completed medical records, including results of echocardiography suggestive of intra-cardiac occupying mass, (3) the surgical operation was undertaken and intra-operative data was available, (4) a histological diagnosis of myxoma was available and (5) the discharge status and follow-up data were available for at least 2 years after initial surgery. A total of 27 patients fulfilled the criteria for inclusion in the study. The average age was 42 years. Thirteen of the patients were females and 14 patients were males. The most common clinical presentations were dyspnea (29.6%) and murmurs (22.2%). Non-specific signs, such as weight loss, fever, fatigue, arthralgia and anemia, were reported in 10 (37%) patients. Signs related to systemic embolization were reported in 9 (33.3%) of the patients, involving the upper and lower extremities (55.6%), brain ischemia and vision loss (54.4%). Tumors in all patients were successfully resected under cardiopulmonary bypass support. The tumor was pedunculated in 17 (62.9%) of the patients and the size of the tumors varied from 1 to 7 centimeters in diameter. The tumor was located in the left atrium in 21 patients (77.7%), in the right atrium in 4 patients (14.8%), in the right ventricular side of the septum in 1 patient (3.7%) and involving the tricuspid valve in 1 patient (3.7%). The left atrial approach was used in 3 patients, a right atrial approach in 4 patients and a bi-atrial approach in 20 patients. The most common concomitant cardiac pathology was coronary artery disease in 3 patients and an atrial septal defect in one patient. The most common intra-operative challenges were inter-atrial communication (2 patients), large defect in the tricuspid valve leaflet (1 patient) and involvement of the inter-ventricular septum (1 patient). In the post-operative period, 1 patient suffered a stroke. In the post-operative period, the most common complications were stroke (1 patient) and recurrence of the tumor (2 patients). The success rate after surgical removal of cardiac myxoma in this study was substantial and complications were rare.

Extranodal Rosai–Dorfman disease arising in the heart: clinical course and review of literature

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a nonmalignant disease of unknown etiology. It may present as bilateral, massive, painless cervical lymphadenopathy; however, one third of the cases have extranodal involvement. Extranodal sites include soft tissue, skin, upper respiratory and gastrointestinal tracts, and central nervous system, with head and neck being the most common. Here we report a rare case of intracardiac RDD in a 46-year-old, African-American female who presented with worsening shortness of breath and fatigue for 7 weeks. Comprehensive physical examination was within normal limits; the patient had no lymphadenopathy. Echocardiogram revealed a large mass in the left atrium extending into the mitral valve. The mass was resected under the pretext of clinical diagnosis of myxoma, and the patient underwent a radical extended interatrial septectomy with bovine pericardial patch reconstruction. The 8-cm resected mass consisted of areas of fibrosis alternating with sheets of histiocytes enmeshed in a mixed inflammatory infiltrate. Histiocytes contained intact lymphocytes, plasma cells, neutrophils, and erythrocytes suggesting emperipolesis. The diagnosis of RDD was confirmed by immunohistochemistry. This case highlights the extranodal manifestation of RDD in the heart which could be easily mistaken for a myxoma on clinical and radiologic evaluation. RDD must be considered in the differential diagnosis of any patient who presents with a cardiac mass.

The Deceptive Myxoid Appearance of a Low-Grade Cardiac Sarcoma and Its Accompanying Diagnostic Challenges: A Case Report

: We present a 40-year-old man with a recurrent left atrial mass, previously diagnosed as cardiac myxoma elsewhere. His new admission was due to a regrowth of the mass. Progressive exertional dyspnea was his major complaint. A large lobulated tumor was seen in echocardiography in the posterior wall of left atrium involving the posterior leaflet of mitral valve, and resulting in severe stenosis and diastolic protrusion of the mass into the left ventricle. Surgery showed a non-homogenous myxomatous mass which infiltrated the posterior wall of the left atrium and parts of the inter-atrial septum. As a result, the surgeon excised parts of the septum and the posterior wall and did a reconstruction with pericardial patches. The pathologic examination revealed soft creamy-brown tumoral fragments, m: 10 × 4 cm altogether. Contrary to his previous diagnosis, we observed a malignant neoplasm with cells that had plump, round to oval nuclei, set in a myxoid and vascular background, but mitotic figures and necrosis were not conspicuous. Therefore, we made a diagnosis of recurrent myxoid round cell sarcoma and recommended immunohistochemical (IHC) studies. Multiple IHC and histopathological studies elsewhere favored a diagnosis of myxoma which was not compatible with our diagnosis. A second recurrent mass was soon found in the left atrium making further surgical attempts impossible. At last, a diagnosis of myxoid leiomyosarcoma confirmed our diagnosis, but the patient was not fortunate enough to survive and passed away before heart transplantation could be done as a remedy.

Atrial mass: a myxoma?

Key Clinical MessageA middle‐aged woman with a history of resected colorectal cancer and receiving chemotherapy presented with a right atrial mass and the provisional diagnosis of myxoma supported by echocardiography, computed tomography, and magnetic resonance imaging. Successful surgical removal revealed organized thrombus instead. Atrial thrombus may be mistaken for myxoma and long‐term intracardiac indwelling catheters can be thrombogenic.

A rare case of right ventricular myxoma causing recurrent stroke

We present a 62-year-old lady admitted in our hospital with two episodes of acute ischemic stroke about 2 weeks apart. She was evaluated for acute ischemic stroke and was thrombolysed for recent stroke in right MCA territory first time. On further evaluation, she was found to have a RVOT mass. A transthoracic and transesophageal echocardiogram revealed a PFO and a large, 5.1cm×2.3cm, ovoid, well circumscribed, echogenic mass in the right ventricle outflow tract attached by small pedicle to the ventricular side of anterior tricuspid leaflet, partly obstructing the right ventricular outflow tract and protruding through the pulmonic valve during systole. She was scheduled for surgery (right ventricular mass excision and PFO closure) after 3 weeks due to the risk of secondary hemorrhage in the infarcted area following thrombolysis and anticoagulation and so was discharged with medications after full neurologic recovery after about a week of hospital stay.She was readmitted 7 days after discharge, before the scheduled date of surgery with history of weakness of right upper limb, slurred speech and mild breathing difficulty lasting for about 20min following which she improved slowly (transient ischemic attack). The tumor was completely removed with the stalk using cardiopulmonary bypass support. The histopathological findings confirmed the diagnosis of myxoma.