Comparison of Clinical and Echocardiographic Characteristics between Cardiac Myxomas and Masses Mimicking Myxoma

Sun Hwa Lee,Joon Sung Park,Jae-Hyeong Park,Jung Yeon Chin,Won-Sik Yoon,Hyung Yoon Kim,Jae Yeong Cho,Kye Hun Kim,Won-Ho Kim 대한심장학회 2020 Korean Circulation Journal Vol.50 No.9

Background and Objectives: Cardiac myxoma is the most frequent benign cardiac tumor that can result in cardiac and systemic symptoms. We investigated clinical and echocardiographic characteristics of patients with cardiac masses suggesting myxoma. Methods: We investigated 265 consecutive patients with an echocardiographic diagnosis of cardiac myxomas in 4 teaching hospitals in Korea. Results: The mean age was 61±16 years and 169 patients (63.8%) were female. The most frequent referral reason for echocardiography was an evaluation of cardiac symptoms (43.4%). Tumors were incidentally detected in 82 patients (30.9%). Left atrium (LA) was the most frequently involved site (84.5%) and 19 patients (7.2%) had non-atrial tumors. The mean tumor size was 38.7×26.0 mm (range, 4–96 mm). Of 186 patients (70.2%) who had pathological diagnosis, 174 (93.5%) were confirmed with myxoma, 8 (4.3%) with other tumors and 4 (2.2%) with thrombi. Compared to myxoma, smaller size (20.4×12.6 mm vs. 41.4×27.6 mm, p<0.01) and non-LA location (87.5% vs. 10.5%, p<0.001) were associated with non-myxoma tumors, and more frequent atrial fibrillation (AF, 75.0% vs. 7.0%, p<0.001) and larger LA diameter (55.0±14.6 mm vs. 41.3±7.7 mm, p=0.001) were related to thrombi. Conclusions: Of 265 patients with an echocardiographic diagnosis with cardiac myxomas, 174 (65.7%) were surgically confirmed with myxomas. Compared with cardiac myxoma, other tumors were smaller and more frequently found in non-atrial sites. Thrombi were associated with AF and larger LA diameter.

Twenty Years of Clinical Experience with Cardiac Myxomas: Diagnosis, Treatment, and Follow Up

Tomás Francisco Cianciulli,Alberto Cozzarin,Juan Bautista Soumoulou,María Cristina Saccheri,Ricardo José Méndez,Martín Alberto Beck,Juan Alberto Gagliardi,Jorge Alberto Lax 한국심초음파학회 2019 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.27 No.1

BACKGROUND Cardiac myxomas are the most frequent cardiac tumors. Although histologically benign, in some cases myxomas may be lethal, due to impairment of cardiac dynamics and their thromboembolic potential. The study aimed to assess the clinical presentation of cardiac myxomas and their correlation with echocardiographic features and to describe the perioperative results and long-term outcome of surgically treated patients. METHODS A prospective study of 53 patients with cardiac myxomas who were operated the Hospital Argerich, followed clinically and with echocardiography from 1993 until 2013. All patients underwent echocardiographic studies. RESULTS The patient's mean age was 53 ± 16 years (62.3% were women). The most common findings were dyspnea followed by embolic events. Most tumors were localized in the left atrium (77.4%), mainly in the fossa ovalis (63%). Mean size of the tumors was 4.76 x 3.50 cm. Tumors were generally mobile (88%) and went beyond the valve plane, causing mild mitral or tricuspid valve obstruction (58%) and dilation of the respective atrial chamber. Patients whose tumors were obstructive had higher pulmonary artery systolic pressures (50 vs 33 mmHg p < 0.01). According to the echocardiographic appearance 67% of tumors had a smooth surface and the remaining 32% had a villous surface. All patients with embolic manifestations had tumors with a villous surface. CONCLUSIONS Clinical presentation relates to the ultrasound characteristics of myxomas. Smooth tumors are larger, occur with obstructive symptoms, and benefit from an elective surgery, whereas villous myxomas entailed a high embolic risk and require prompt surgical treatment.

승모판 환상륜에서 발생한 점액종 1 예

홍영선(Young Sun Hong),이지수(Ji Soo Lee),손희정(Hee Jung Son),신길자(Gil Ja Shin),이우형(Woo Hyung Lee),김광호(Kwang Ho Kim) 대한내과학회 1994 대한내과학회지 Vol.46 No.6

Myxomas of the heart are the most common intracavitary cardiac tumor and about three fourth of myxoma occurs in the left atrium. Myxomas may rarely be found on the mitral valve. Their clinical features are indistinguishable from the left atrial myxomas. Recently, the development of echocardiographic techinique has made it possible to screen cardiac myxomas with ease and safe, We recently experienced a case of mitral valve myxoma in a 53 years old woman, who complained of dyspnea and chest pain. The myxoma of the mitral valve was diagnosed by echocardiography and cardiac angiography. Surgical excision of the myxoma with replacement of the mitral valve was performed successfully.

Intracoronary Catheter Aspiration Can Be an Adequate Option in Patients with Acute Myocardial Infarction Caused by Left Atrial Myxoma

박형서,박재형,정진옥 한국심초음파학회 2009 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.17 No.4

Cardiac myxomas are the most common benign cardiac tumors and can be associated with systemic embolization including acute myocardial infarction (AMI). The probability of an arterial embolization is closely related to a tumor’s villous morphology. In cases of AMI caused by cardiac myxoma, open heart surgery including excision of the coronary artery has been the one of the treatment options for removing the myxoma and embolus from the coronary artery to maintain distal coronary flow. However, preparing for emergent open heart surgery takes a considerable amount of time. Moreover, this time delay can deteriorate the coronary perfusion to the infarcted area and is associated with poor clinical prognosis. So intracoronary catheter aspiration can be an additional option to maintain the distal coronary flow. In this report we present a case with acute anterior ST elevation myocardial infarction caused by a left atrial myxoma. The embolus in the left anterior descending coronary artery was successfully removed with intracoronary catheter aspiration, and distal coronary flow was restored after the procedure. Cardiac myxomas are the most common benign cardiac tumors and can be associated with systemic embolization including acute myocardial infarction (AMI). The probability of an arterial embolization is closely related to a tumor’s villous morphology. In cases of AMI caused by cardiac myxoma, open heart surgery including excision of the coronary artery has been the one of the treatment options for removing the myxoma and embolus from the coronary artery to maintain distal coronary flow. However, preparing for emergent open heart surgery takes a considerable amount of time. Moreover, this time delay can deteriorate the coronary perfusion to the infarcted area and is associated with poor clinical prognosis. So intracoronary catheter aspiration can be an additional option to maintain the distal coronary flow. In this report we present a case with acute anterior ST elevation myocardial infarction caused by a left atrial myxoma. The embolus in the left anterior descending coronary artery was successfully removed with intracoronary catheter aspiration, and distal coronary flow was restored after the procedure.

유전자 검사에서 양성 반응을 보인 가족성 점액종 −1예 보고−

이향림,박국양,김경희,이승태,기창석,전양빈,최창휴 대한흉부외과학회 2010 Journal of Chest Surgery (J Chest Surg) Vol.43 No.1

Ten percent of all myxomas are the familial form. Familial myxomas appear to have autosomal dominant transmission. We experienced two siblings with familial myxomas. A left atrial myxoma was surgically removed in a 21-year-old woman. Six years later, other myxomas were found in the right atrium and the left atrium and these were also surgically removed. Right ventricular and right atrial myxomas were surgically excised in her brother. The two siblings were found to have frame-shift mutations in the PRKAR1A gene (c.537delA; p.Gly180GlufsX26), which is the causative gene for Carney complex. Obtaining the genetic diagnosis makes it possible to prepare more effective therapeutic strategies for these patients and the gene carriers. Complete excision, ruling out multicentricity and proper postoperative follow up are all necessary to avoid recurrence of myxoma. 전체 심장 점액종의 10% 정도가 가족성이며 상염색체 우성 유전을 보인다. 저자들은 21세에 좌심방 점액종 제거술을 받고 6년 후에 우심방과 좌심방에 점액종이 재발한 여자 환자와 26세에 우심실과 우심방에 점액종이 발생하여 제거술을 받은 남동생에서 가족성 점액종의 원인이 되는 PRKAR1A 유전자의 돌연변이(c.537delA; p.Gly180GlufsX26)를 확인하였다. 유전자 검사를 통한 가족성 점액종의 진단은 효과적인 치료계획을 세우는데 도움이 된다. 가족성 점액종의 경우 처음부터 다발성으로 존재할 가능성과 잦은 재발을 고려하여 수술 시 종양의 완전 절제와 수술 후 재발에 대한 추적검사가 필수적이다.

심장 점액종에서 인터루킨-4, 인터루킨-6 및 종양괴사인자의 발현에 관한 면역조직화학적 연구

조민선,조수연,김미정,김성숙,한운섭,서정욱 대한병리학회 1995 Journal of Pathology and Translational Medicine Vol.29 No.5

A Soft Tissue Myxoma on the Palate: A Case Report

Ha, Ji-Woo,Jung, Won,Lee, Kyung-Eun,Suh, Bong-Jik Korean Academy of Orofacial Pain and Oral Medicine 2020 Journal of Oral Medicine and Pain Vol.45 No.3

Myxomas in the orofacial regions are relatively uncommon tumors that occur in two different types: odontogenic myxomas and soft tissue myxomas. Odontogenic myxomas, derived from the mesenchymal cells such as papillae, dental follicles, or periodontal ligament, occur commonly in the maxilla and mandible. However, soft tissue myxomas in the oral cavity are rare and have been previously reported in only about 30 cases of unknown pathogenesis. The aim of this case report is to present a new case of oral soft tissue myxoma in a 37-year-old male patient who presented with a soft, exophytic round mass on the palate.

A Soft Tissue Myxoma on the Palate: A Case Report

하지우,정원,이경은,서봉직 대한안면통증∙구강내과학회 2020 Journal of Oral Medicine and Pain Vol.45 No.3

Myxomas in the orofacial regions are relatively uncommon tumors that occur in two different types: odontogenic myxomas and soft tissue myxomas. Odontogenic myxomas, derived from the mesenchymal cells such as papillae, dental follicles, or periodontal ligament, occur commonly in the maxilla and mandible. However, soft tissue myxomas in the oral cavity are rare and have been previously reported in only about 30 cases of unknown pathogenesis. The aim of this case report is to present a new case of oral soft tissue myxoma in a 37-year-old male patient who presented with a soft, exophytic round mass on the palate

Infected Left Atrial Myxoma Presenting Without Bacterial Growth on Blood Cultures: A Case Report

Kim Shi A,Pyo WonKyung,Jung Sung-Ho 대한흉부외과학회 2023 Journal of Chest Surgery (J Chest Surg) Vol.56 No.2

Although cardiac myxoma is one of the most common types of benign cardiac tumors, infected cardiac myxoma is very infrequent. The diagnosis of infected cardiac myxoma may be challenging because the presenting symptoms are non-specific and established management guidelines are lacking. This report describes a 39-year-old woman with a 5-month history of uncontrolled fever, chills, and myalgia who was diagnosed with myxoma and underwent mass excision. Although blood and urine cultures were negative for growing bacteria, a pathologic examination showed that the excised mass was a left atrial myxoma, with pan-bacterial polymerase chain reaction (PCR) of the surgical specimen revealing Haemophilus parainfluenzae at 99.87%, resulting in a diagnosis of infected cardiac myxoma. Laboratory tests, such as PCR, may supplement culture results in the diagnosis of infected cardiac myxoma.

심장 점액종의 임상적 고찰

이근동,이재원,정재승,정성호,제형곤,주석중,정철현,송현 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.6

Background: Diagnosis and treatment are often successful in the setting of cardiac myxomas. However, cardiac myxomas can lead to catastrophic complications, due to intracardiac obstruction and embolism preoperatively, and can recur postoperatively. Material and Method: We retrospectively reviewed the clinical characteristics, surgical treatment, and recurrence data of 85 patients who underwent cardiac myxoma surgery at Asan Medical Center between November 1994 and June 2007. We analyzed the morphologic characteristics of 58 patients with left atrial myxomas and determined the development of functional mitral valve stenosis and systemic embolism through reviewing the results of preoperative echocardiograms to find potential preoperative risk factors. Result: Twenty-seven (31.8%) patients were men, and 58 (68.2%) were women. The mean patient age was 54.5±14.3 years. Preoperative symptoms included obstructive symptoms in 41 (48.2%) patients, signs of embolism in 19 (22.4%), constitutional symptoms in 8 (9.4%), and no symptoms in 19 (20.0%). Among the 58 patients with left atrial myxomas, the mean maximal tumor diameter was 4.3±1.8 (range 1.1∼8 cm) cm. Twenty-six (44.8%) patients had a prolapsing type, defined as a tumor mobile enough to move down to the mitral annular plane during diastole, and 32 (55.2%) had villous type, defined as a tumor consisting of multiple fine villous extensions on the surface. Twelve (20.7%) patients had severe functional mitral valve stenosis, and 15 (25.9%) had systemic embolism preoperatively. The incidence of severe functional mitral valve stenosis was significantly higher in patients with the prolapsing type than in those with the non-prolapsing type (p=0.001). The mean maximal tumor diameter in patients with severe functional mitral valve stenosis was 5.1±1.0 cm, significantly larger than that seen in patients without severe functional mitral valve stenosis (p=0.041). The incidence of systemic embolism was significantly higher in patients with the villous type than in those with the smooth type (p=0.006). Postoperative complications were noted in 6 (7.1%) patients, and early mortality was noted in 1 (1.2%). The mean postoperative follow-up duration was 36.2±37.5 months, with recurrence reported in 2 (2.4%) patients during the follow-up period. The disease free interval were 48, 12 months, respectively. Conclusion: Surgical treatment for cardiac myxomas was performed safely, and long-term prognosis was good. In patients with left atrial myxoma, close attention should be maintained and surgery should be performed promptly in those of prolapsing type, those with large maximal diameter in order to prevent severe functional mitral valve stenosis, and those of villous type in order to prevent systemic embolism. Echocardiography should be followed serially in order to detect recurrence.