Carney Complex syndrome

Cardiac myxoma: a comprehensive review

Heart tumours are a diverse group of tumours that may present with symptoms or be discovered incidentally when a patient is being evaluated for a physical or seemingly unrelated ailment. Cardiac myxoma, although rare, is the second most common benign primary cardiac tumours after papillary fibroelastoma. It occurs in sporadic form and familial form, as seen in Carney complex disorder. Cardiac myxoma can affect all age groups, but the majority manifests in their third to sixth decade of life, with a mean age of 50 years at diagnosis. There is a slight preponderance in females in a ratio of 2:1. Conversely, they are incredibly uncommon in fetuses and newborns but commonly diagnosed in children around a mean age of 9-10 years. About 90% originate in the atrium as a solitary or pedunculated mass. Within the atrial chamber, 75% occur on the left atrium close to the fossa ovalis, while others occur in the right atrium, ventricles, and valves. Serious complications often arise even in the absence of symptoms, and such complications include intracardiac obstruction, systemic and pulmonary emboli, as well as constitutional symptoms that mimic connective tissue and inflammatory diseases. There is no pathognomonic clinical presentation. Complete surgical excision of the tumour, including the use of robotic surgery, is the key component of a successful course of treatment. To monitor for tumour recurrence, long-term follow-up is frequently carried out with interval echocardiography. This review will focus on providing information on the various forms of cardiac myxoma, aetiology, molecular genetics, clinical presentation, histopathologic findings, differential diagnosis, treatment, and complications.

Carney complex: A clinicopathologic study on a single family from several Canadian provinces

Carney syndrome is an autosomal dominant complex involving endocrinopathy, mucocutaneous hyperpigmentation, and different tumors, including cardiac myxomas. We report on a single family with several members affected with Carney syndrome. Family and individual medical histories were investigated in several Canadian provinces. The histology slides were also reviewed. Four family members (two young women, both sisters, their mother, and maternal grandmother) were found to harbor Carney syndrome. Everyone was presented with multiple and recurrent atrial myxomas of the heart, requiring multiple open cardiac surgeries. Breast myxomas and cutaneous hyperpigmentation were also revealed in one of the sisters and their mother. Interestingly, genetic testing was positive for the female family members and negative for the father and brother. We cannot rule out that the brother may have had a new mutation or harboring a mosaic. The young woman's brother did not have cardiac myxoma but developed a unilateral Sertoli cell tumor of testis. Carney syndrome is a rare complex multisystemic genetic disorder, including multiple and recurrent cardiac myxomas. We strongly suggest that reporting familial Carney syndrome is still critical in the 21st century to augment the awareness of this situation among clinicians and pathologists.

Association between subclinical hyperthyroidism and a PRKAR1A gene variant in Carney complex patients: A case report and systematic review

BACKGROUND AND OBJECTIVES

It is currently controversial whether subclinical hyperthyroidism is associated with PRKAR1A gene variants. We describe a man with subclinical hyperthyroidism and a PRKAR1A gene variant who was diagnosed with Carney complex (CNC), and we performed a systematic review of published studies to assess the association between PRKAR1A gene variants and the risk of subclinical hyperthyroidism.

DESIGN AND METHODS

The PubMed, EMBASE, OVID, Science Direct, and gray literature electronic databases were searched for articles published from January 2002 to May 2021 using predefined keywords and inclusion and exclusion criteria. Data on thyroid function from selected studies were extracted and analyzed.

RESULTS

We identified a CNC patient with a subclinical hyperthyroidism phenotype combined with multiple components and genetic sequenced data. In a subsequent systematic review, twenty selected studies (14 case studies and 6 series studies) enrolling 23 individuals were included in the final analysis. The patient's thyroid function data were qualitative in 11 cases and quantitative in 12 cases. The prevalence of subclinical hyperthyroidism in the CNC patients with a PRKAR1A gene variant, including our patient, was markedly higher than that in the normal population (12.5% vs. 2%).

CONCLUSIONS

The findings of this systematic review provide helpful evidence that PRKAR1A gene variants and subclinical hyperthyroidism are related and suggest that subclinical hyperthyroidism may be a neglected phenotype of PRKAR1A gene variants and a novel component of CNC patients.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42021197655.