Hematologic manifestations and etiology of atrial myxoma

Giant cardiac myxoma in a patient with thrombocytopenia: is there a physiopathologic link? (a case report)

Atrial myxoma is the most common primary cardiac tumor. We report the case of left atrium myxoma accompanied by severe thrombocytopenia in a 72-years-old woman. The thrombocytopenia has been discovered 5 years ago, it was explored, no obvious cause was found, the diagnosis of idiopathic thrombocytopenia was retained based on clinical and paraclinical arguments, corticosteroid treatment was ineffective and platelet count remains low. Complete surgical excision of the mass was performed. Platelet count was gradually increased to reach 95 103/µl after 6 months postoperatively. In this report, we highlight that thrombocytopenia might be one rare hematological manifestation of myxoma but need more cases for support. By illustrating this association, we hope to facilitate an earlier diagnosis of cardiac myxoma to treat and avoid complications of both thrombocytopenia and myxoma.

Intracardiac metastasis from unknown uterine cervical cancer with severe thrombocytopenia

INTRODUCTION

Cardiac metastasis is relatively common in malignant neoplasms, such as lung cancers, breast cancers, melanomas, lymphomas, and leukemias. In contrast, cardiac metastasis of uterine cervical cancer, solitary metastasis to the heart, and tumors inducing severe thrombocytopenia are rare.

CASE REPORT

The present patient was a 52-year-old female who was diagnosed with a solitary cardiac tumor prior to uterine cervical cancer and presented with severe thrombocytopenia. Our case had two remarkable aspects: 1) successful treatment under the condition of severe thrombocytopenia in association with the presence of a cardiac tumor, and survival without recurrence of the carcinoma one year after surgery; and 2) a solitary cardiac metastatic tumor larger than the primary uterine cervix carcinoma.

COMMENT

we report an extremely rare case of solitary cardiac metastasis of uterine cervical cancer, which wassuccessfully treated. One year after cardiac surgery, the patient is alive without recurrence of the carcinoma.

A classic mimicker of systemic vasculitis

BACKGROUND AND OBJECTIVE

Embolic and constitutional manifestations of intracavitary cardiac tumors are included within the classic mimickers of systemic vasculitis, especially in those in which there are no cardiac manifestations. We present a case report of atrial myxoma in which the patient only presented systemic symptoms and in whom an initial diagnostic approach of systemic vasculitis was made. We also performed a literature search of the cases described.

PATIENT AND METHOD

A case report of atrial myxoma with atypical presentation manifested as a systemic disease with no concomitant cardiac symptoms is described. The case report is discussed and 11 cases of atrial myxoma pseudovasculitis described in the literature are reviewed, emphasizing their similarities and differences.

DISCUSSION

Constitutional symptoms and cutaneous manifestations were the most common. Most of the cases showed partial response to glucococorticosteroid treatment, reinforcing the theory of the inflammatory role in its pathogenesis. Mean delayed time to diagnosis was 12.27 months.

CONCLUSION

Atrial myxoma is a systemic vasculitis mimicker, this being difficult to diagnose in the absence of cardiac manifestations. This delay in diagnosis entails serious complications.

Fatal thrombocytopenia: A rare case with possible explanation

A 22 year old male presented with breathlessness on exertion, ecchymosis, jaundice and features of worsening right heart failure for the last fifteen days. On physical examination, he had a mid diastolic murmur in the tricuspid area and an ejection systolic murmur in the pulmonary area. Bone marrow histopathology report showed an increased in megakaryocytes count. Routine investigations reports were normal. Echocardiography and computerized tomography (CT) revealed a single mobile large intra cardiac mass originating from the right atrium and causing dynamic obstruction of the right ventricular inflow and outflow tract. Associated fatal thrombocytopenia did not respond to intravenous steroids or platelet transfusion. Patient could not be operated because of very low platelet count, and died during hospital stay before excision biopsy could be done. Pathological autopsy was not done. This is a rare case, as the fatal thrombocytopenia observed here was the result of mechanical effects like frictional and shear force, which can be attributed to the physical presence of a large intra cardiac mass resulting in obstruction to flow.

Severe thrombocytopenia complicating giant left atrial rhabdomyosarcoma

We report an adult patient with a large left atrial rhabdomyosarcoma causing intracardiac blood flow obstruction and thrombocytopenia, in whom platelet count normalized after surgical excision of the tumor. The patient presented a fatal intracranial hemorrhage 2 weeks after surgery.

Atrial myxoma: case report and a review of the literature

Atrial myxomas are the most common benign primary tumor of the heart and occur in as many as 3 in 1000 patients. These tumors are a major cause of patient morbidity and mortality. Although the majority of atrial myxomas occur in the left atrium, 3 separate familial myxoma syndromes can result in multiple myxomas in atypical locations. Approximately 50% of patients with myxomas may experience symptoms due to central or peripheral embolism or intracardiac obstruction, but 10% of patients may be completely asymptomatic. Screening for myxomas should involve a thorough history and physical examination and a transthoracic and/or transesophageal echocardiogram. Transthoracic echocardiography is approximately 95% sensitive for the detection of cardiac myxomas, and transesophageal echocardiography approaches 100% sensitivity. Though the majority of atrial myxomas are sporadic, it is imperative that first-degree relatives of patients with documented myxomas undergo screening for occult myxomas. Surgical removal of the myxoma is the treatment of choice and usually curative; however, myxoma recurrence does occur and is most frequently associated with a familial syndrome.

Right atrial myxoma with extracardiac manifestations

Right atrial myxoma is a rare intracardiac tumor that is often difficult to diagnose. Pulmonary embolism from tumor fragments originating from the tumor mass is a potentially fatal complication. Early diagnosis of cardiac myxoma is important since surgical treatment leads to resolution with low rates of recurrence and good long-term survival. The presence of a cardiac myxoma can be heralded by nonspecific constitutional symptoms as well as by disturbances in the clotting mechanism.

Cardiac myxomas

Although cardiac myxomas are histologically benign, they may be lethal because of their strategic position. They can mimic not only every cardiac disease but also infective, immunologic, and malignant processes. Myxomas must therefore be included in the differential diagnosis of valvular heart disease, cardiac insufficiency, cardiomegaly, bacterial endocarditis, disturbances of ventricular and supraventricular rhythm, syncope, and systemic or pulmonary embolism. The symptoms depend on the size, mobility, and location of the tumor. Echocardiography, including the transesophageal approach, is the most important means of diagnosis; CT and MRI may also be helpful. Coronary arteriography in patients over 40 years of age is generally required to rule out concomitant coronary artery disease. Surgical removal of the tumor should be performed as soon as possible; the long-term prognosis is excellent, and recurrences are rare. In follow-up examinations as well, echocardiography is essential.

Right atrial myxoma with a nonembolic intestinal manifestation

A 5-year-old male with right atrial myxoma without interatrial communication who presented with abdominal pain, vomiting, fever, and guaiac positive stool is reported. He was later found to have ischemia of a jejunal segment necessitating segmental resection. Although his symptoms persisted postoperatively, surgical removal of a right atrial myxoma was followed by complete resolution of his intestinal symptoms. We demonstrated that the mesenteric vasculitis was of nonembolic origin, and we speculate autoimmune arteritis as a possible mechanism.

Primary liposarcoma of the right atrium

Primary intracardiac liposarcomas are among the rarest tumors of the heart, with a total of six reported cases. The previous reports have focused on clinical features with minimal histologic documentation. We report a primary right atrial liposarcoma showing extracardiac spread and three types of histologic differentiation. This case demonstrated that certain clinical and pathologic features are common to all intracavitary cardiac neoplasms, emphasizing the need for careful histologic examination.

Primary tumors of the heart: a review with emphasis on diagnosis and potential treatment modalities

Primary cardiac tumors, while uncommon, are not rare neoplasms. They occur in individuals of all ages. A variety of benign and malignant tumors has been described. Presenting signs and symptoms mimic numerous systemic and cardiac disease states. Echocardiography, catheterization, and nuclear magnetic resonance techniques are diagnostic tools available to the physician. Early diagnosis and surgical intervention are curative measures for many benign cardiac tumors. Malignant variants are uniformly unresponsive to treatment.