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Zhang L, Qiu ZH, Wei X, Yao M, Chen SK, He J, Ye JQ, Li YM, Chen LW. 10× single-cell sequencing revealed cellular composition heterogeneity in cardiac myxoma with malignant glandular properties. Microvasc Res 2024:104697. [PMID: 38801942 DOI: 10.1016/j.mvr.2024.104697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/06/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Cardiac myxoma is the most common primary cardiac tumor in adults. The histogenesis and cellular composition of myxoma are still unclear. This study aims to reveal the role of myxoma cell components and their gene expression in tumor development. We obtained single living cells by enzymatic digestion of tissues from 4 cases of surgically resected cardiac myxoma. Of course, there was 1 case of glandular myxoma and 3 cases of nonglandular myxoma. Then, 10× single-cell sequencing was performed. We identified 12 types and 11 types of cell populations in glandular myxoma and nonglandular myxoma, respectively. Heterogeneous epithelial cells are the main components of glandular myxoma. The similarities and differences in T cells in both glandular and nonglandular myxoma were analyzed by KEGG and GO. The most important finding was that there was active communication between T cells and epithelial cells. These results clarify the possible tissue occurrence and heterogeneity of cardiac myxoma and provide a theoretical basis and guidance for clinical diagnosis and treatment.
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Affiliation(s)
- Li Zhang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, 350001, China; The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, The School of Basic Medical Sciences, 350102, China
| | - Zhi-Huang Qiu
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, 350001, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, 350102, China; Fujian Provincial Special Reserve Talents Laboratory, 350102, China; Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, 350102 Fuzhou, China
| | - Xiaozhen Wei
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, 350001, China; The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, The School of Basic Medical Sciences, 350102, China
| | - Mengge Yao
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, 350001, China; The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, The School of Basic Medical Sciences, 350102, China
| | - Shao-Kun Chen
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, The School of Basic Medical Sciences, 350102, China
| | - Jian He
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, 350001, China
| | - Jian-Qiang Ye
- Fujian Center for Safety Evaluation of New Drug, Fujian Medical University, 350102 Fuzhou, China
| | - Yu-Mei Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, 350001, China; Fujian Center for Safety Evaluation of New Drug, Fujian Medical University, 350102 Fuzhou, China.
| | - Liang-Wan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, 350001, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, 350102, China; Fujian Provincial Special Reserve Talents Laboratory, 350102, China; Engineering Research Center of Tissue and Organ Regeneration, Fujian Province University, 350102 Fuzhou, China.
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2
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Liu X, Shen H, Yu J, Luo F, Li T, Li Q, Yuan X, Sun Y, Zhou Z. Resolving the heterogeneous tumour microenvironment in cardiac myxoma through single-cell and spatial transcriptomics. Clin Transl Med 2024; 14:e1581. [PMID: 38318640 PMCID: PMC10844892 DOI: 10.1002/ctm2.1581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Cardiac myxoma (CM) is the most common (58%-80%) type of primary cardiac tumours. Currently, there is a need to develop medical therapies, especially for patients not physically suitable for surgeries. However, the mechanisms that shape the tumour microenvironment (TME) in CM remain largely unknown, which impedes the development of targeted therapies. Here, we aimed to dissect the TME in CM at single-cell and spatial resolution. METHODS We performed single-cell transcriptomic sequencing and Visium CytAssist spatial transcriptomic (ST) assays on tumour samples from patients with CM. A comprehensive analysis was performed, including unsupervised clustering, RNA velocity, clonal substructure inference of tumour cells and cell-cell communication. RESULTS Unsupervised clustering of 34 759 cells identified 12 clusters, which were assigned to endothelial cells (ECs), mesenchymal stroma cells (MSCs), and tumour-infiltrating immune cells. Myxoma tumour cells were found to encompass two closely related phenotypic states, namely, EC-like tumour cells (ETCs) and MSC-like tumour cells (MTCs). According to RNA velocity, our findings suggest that ETCs may be directly differentiated from MTCs. The immune microenvironment of CM was found to contain multiple factors that promote immune suppression and evasion, underscoring the potential of using immunotherapies as a treatment option. Hyperactive signals sent primarily by tumour cells were identified, such as MDK, HGF, chemerin, and GDF15 signalling. Finally, the ST assay uncovered spatial features of the subclusters, proximal cell-cell communication, and clonal evolution of myxoma tumour cells. CONCLUSIONS Our study presents the first comprehensive characterisation of the TME in CM at both single-cell and spatial resolution. Our study provides novel insight into the differentiation of myxoma tumour cells and advance our understanding of the TME in CM. Given the rarity of cardiac tumours, our study provides invaluable datasets and promotes the development of medical therapies for CM.
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Affiliation(s)
- Xuanyu Liu
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular DiseasesCenter of Laboratory MedicineFuwai HospitalBeijingChina
| | - Huayan Shen
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular DiseasesCenter of Laboratory MedicineFuwai HospitalBeijingChina
| | - Jinxing Yu
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular DiseasesCenter of Laboratory MedicineFuwai HospitalBeijingChina
| | - Fengming Luo
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular DiseasesCenter of Laboratory MedicineFuwai HospitalBeijingChina
| | - Tianjiao Li
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular DiseasesCenter of Laboratory MedicineFuwai HospitalBeijingChina
| | - Qi Li
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiovascular SurgeryFuwai HospitalBeijingChina
| | - Xin Yuan
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiovascular SurgeryFuwai HospitalBeijingChina
| | - Yang Sun
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular DiseasesCenter of Laboratory MedicineFuwai HospitalBeijingChina
- Department of Cardiovascular SurgeryFuwai HospitalBeijingChina
- Department of PathologyFuwai HospitalBeijingChina
| | - Zhou Zhou
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular DiseasesCenter of Laboratory MedicineFuwai HospitalBeijingChina
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Donato G, Mignogna C, Santise G, Presta I, Ferrazzo T, Garo V, Maselli D, Curcio A, De Rosa S, Spaccarotella C, Mollace V, Gentile F, Indolfi C, Malara N. Distinctive phenogroup to differentiate diagnosis of cardiac myxoma vs cardiovascular disease examining blood-based circulating cell biomarkers. Sci Rep 2023; 13:20357. [PMID: 37990043 PMCID: PMC10663517 DOI: 10.1038/s41598-023-47639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Cardiac myxoma (CM) is a potentially life-threatening disease because frequently asymptomatic or debuts with aspecific manifestations. Definitive diagnosis is established by histopathological assessment including tumor and endothelial cell markers. To derive a specific panel of circulating cells antigenically detectable, pre-surgery peripheral blood samples of CM patients were analyzed. Pre-surgery peripheral blood samples from patients with CM were simultaneously analyzed for Circulating tumor cells (CTCs) and circulating endothelial cells (CECs) that were matched with tumor tissue profiles and with patient-derived xenografts (PDXs) distinguishing tumor regions. Moreover, CECs values in CM patients were further matched with CEC's levels in cardiovascular disease and control subjects. The blood-derived cytological specimens detected at least 1-3 CTCs/ml in 10 tested CM samples (p = 0.0001) showing specific CM features preserved in the central zones of the tumor. The central zone of the primary tumor, supported by a vessel density rate (55 ± 7%), with a proliferative profile of 32 ± 3% and a percentage of Calretininpos cells (p = 0.03), is the principal site of CTCs (r = 00) dissemination. The subsets of endothelial cells recognized in the blood were indifferent to their topological distribution within the tumor and corresponding PDXs. With further refinement and validation in large cohorts, multiparametric liquid biopsies can optimally integrate clinically informative datasets and maximize their utility in pre-surgery evaluation of CM patients. Blood-derived culture's protocol provides a versatile method capable of viable analysis of CTCs of non-hematological rare tumors which conventional antibody-mediated analytical platform is unable to perform. Distinctive blood- based cell phenotype contributes to differentiate CM from other differentials assuring its prompt surgical resection by combining blood-based cell biomarkers integrated with clinically informative datasets.
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Affiliation(s)
- Giuseppe Donato
- Department of Health Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Chiara Mignogna
- Interdipartimentale Service Center, University Magna Graecia, Catanzaro, Italy
| | - Gianluca Santise
- Cardiothoracic Surgery Unit, Sant'Anna Hospital, Via Pio X, 111, Catanzaro, Italy
| | - Ivan Presta
- Department of Health Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Teresa Ferrazzo
- Department of Health Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Virginia Garo
- Department of Health Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Daniele Maselli
- Cardiothoracic Surgery Unit, Sant'Anna Hospital, Via Pio X, 111, Catanzaro, Italy
| | - Antonio Curcio
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Carmen Spaccarotella
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Vincenzo Mollace
- Department of Health Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Francesco Gentile
- Department of Experimental and Clinical Medicine, University Magna Graecia, Catanzaro, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Natalia Malara
- Department of Health Sciences, University "Magna Graecia", 88100, Catanzaro, Italy.
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Machida N, Sasaki T, Kimura Y. Pathological features of primary cardiac myxoid tumour in dogs: a review of 11 cases (2002-2022). J Comp Pathol 2023; 207:50-58. [PMID: 37944473 DOI: 10.1016/j.jcpa.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/30/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
This report documents the pathological features of primary cardiac myxoid tumour (MT) in 11 dogs. Macroscopically, all the tumours were located in the tricuspid valve (TV), its septal leaflet being predominantly affected. Therefore, it appears that the TV is the most common site of occurrence for cardiac MT in dogs. Two gross anatomical types of canine valvular MT were evident. Seven of the 11 tumours were round or oval with a smooth or gently lobulated and glistening surface, while the other four were gelatinous, multilobulated and polypoid, with an irregular surface. Microscopically, in nine cases the tumours had an abundant myxoid matrix within which elongated spindle-shaped cells with no remarkable cytological atypia were sparsely embedded, suggesting a benign character (ie, myxoma). In the other two cases the tumours consisted of variably dense, haphazardly arranged, interlacing streams of anaplastic spindle-shaped or polygonal cells containing many mitotic figures, indicative of a malignant form of myxoma (ie, myxosarcoma). Isolated or clustered collections of myxoma cells (eg, cords, rings, syncytia) characteristic of human atrial myxoma were only rarely evident or lacking in all 11 cases, indicating that rarity or absence of such structural features may be specific to valvular MTs. Immunohistochemical findings were indicative of smooth muscle differentiation of the neoplastic cells. Tumour embolization to the intrapulmonary arteries and/or tumour implantation on the endocardium of the right heart chambers was evident only in the four cases of irregular-surfaced MT.
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Affiliation(s)
- Noboru Machida
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan.
| | - Takafumi Sasaki
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| | - Yusuke Kimura
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
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Khan MQA, Zaheer A, Yasir SB, Fatima R, Anand A. Management of calcified right atrial myxoma extending into the inferior vena cava: a case report. J Surg Case Rep 2023; 2023:rjad568. [PMID: 37854527 PMCID: PMC10581705 DOI: 10.1093/jscr/rjad568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023] Open
Abstract
Cardiac myxomas can rarely involve the right atrium, get calcified and involve the inferior vena cava (IVC). Early surgical intervention is critical to prevent life-threatening complications. We presented the case of a 39-year-old male with fever, cough and shortness of breath for 1 week. Initial laboratory investigations revealed leucocytosis and thrombocytopenia. His electrocardiogram was normal, and his chest X-ray showed bilateral infiltrates. Based on the findings of a high-resolution chest computed tomography scan, echocardiography and cardiac magnetic resonance imaging, we made a provisional diagnosis of calcified right atrial myxoma extending up to the IVC. We managed the case with cardiopulmonary bypass via aortic cannulation followed by a right atriotomy. Post-operatively, the patient's condition improved and was doing well on monthly follow-ups.
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Affiliation(s)
| | - Amna Zaheer
- Liaquat National Hospital and Medical College, Karachi 75300, Pakistan
| | - Sarib Bin Yasir
- Liaquat National Hospital and Medical College, Karachi 75300, Pakistan
| | - Ramsha Fatima
- Liaquat National Hospital and Medical College, Karachi 75300, Pakistan
| | - Ayush Anand
- B. P. Koirala Institute of Health Sciences, Dharan 56700, Nepal
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6
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Zhang S, Wang J, Song F, Yang F, Li F, Liu S, Ma J, Zhang H, Ma X. Case report: Left atrial myxoma with morphology of cavernous hemangioma supplied by the right coronary artery. Front Cardiovasc Med 2023; 10:1207339. [PMID: 37593147 PMCID: PMC10427500 DOI: 10.3389/fcvm.2023.1207339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Here, we report an unusual case of left atrial myxoma presented with morphology of cavernous hemangioma supplied by the right coronary artery. Surgical resection of the left atrium myxoma was performed, and the patient experienced an uneventful recovery during hospitalization.
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Affiliation(s)
- Shouji Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Junlin Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fahang Song
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fan Yang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Fang Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shangxin Liu
- Imaging Department, Pingyin Chinese Medicine Hospital, Jinan, China
| | - Jiwei Ma
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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7
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Sun Y, Li Z, Sun J, Ma D, Shan X, Chen X. Somatic Mutation of PRKAR1A in Four Cases of Sporadic Cardiac Myxoma. ARCHIVES OF IRANIAN MEDICINE 2023; 26:346-354. [PMID: 38310436 PMCID: PMC10685830 DOI: 10.34172/aim.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/02/2022] [Indexed: 02/05/2024]
Abstract
BACKGROUND Inactivating mutations of the protein kinase A regulatory subunit 1 alpha (PRKAR1A) gene have been reported in familial cardiac myxoma. However, the role of PRKAR1A mutation in sporadic cardiac myxoma remains unknown. METHODS Targeted next-generation sequencing (NGS) was performed to identify mutations with the PRKAR1A gene in seven cases of sporadic cardiac myxomas. Sanger sequencing of DNA from cardiac myxoma specimens and matched peripheral blood samples was performed to verify the identified mutations. RESULTS Targeted NGS of myxoma DNA revealed 232 single nucleotide variants in 141 genes and 38 insertion-deletion mutations in 13 genes. Six PRKAR1A mutations were identified in four of the seven cardiac myxoma cases, and thus, the PRKAR1A inactivating mutation rate was 57.2% (4/7, 95% CI=0.44-0.58, P<0.05). The PRKAR1A variants identified by Sanger sequencing analysis were consistent with those from the NGS analysis for the four myxoma specimens. All of the pathogenic PRKAR1A mutations led to premature termination of PRKAR1A, except for one synonymous mutation. Moreover, none of the nonsense and missense mutations found in the myxoma specimens were found in the matched peripheral blood samples. CONCLUSION Pathogenic mutations of the PRKAR1A gene were identified in tumor specimens from four cases of sporadic cardiac myxoma, and the absence of these mutations in peripheral blood samples demonstrated that they were somatic mutations.
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Affiliation(s)
- Yunpeng Sun
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Zhiping Li
- Department of Pharmacology, Basic Medical College of Jilin University, Changchun, Jilin, 130021, China
| | - Jingnan Sun
- Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Dashi Ma
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xue Shan
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xia Chen
- Department of Pharmacology, Basic Medical College of Jilin University, Changchun, Jilin, 130021, China
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8
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Sido V, Volkwein A, Hartrumpf M, Braun C, Kühnel RU, Ostovar R, Schröter F, Chopsonidou S, Albes JM. Gender-Related Outcomes after Surgical Resection and Level of Satisfaction in Patients with Left Atrial Tumors. J Clin Med 2023; 12:jcm12052075. [PMID: 36902863 PMCID: PMC10003994 DOI: 10.3390/jcm12052075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Cardiac tumors are rare, with a low incidence of between 0.0017 and 0.19%. The majority of cardiac tumors are benign and predominantly occur in females. The aim of our study was to examine how outcomes differ between men and women. METHODS From 2015 to 2022, 80 patients diagnosed with suspected myxoma were operated on. In all patients, preoperative, perioperative, and postoperative data were recorded. Such patients were identified and included in a retrospective analysis focused on gender-related differences. RESULTS Patients were predominantly female (n = 64; 80%). The mean age was 62.76 ± 13.42 years in female patients and 59.65 ± 15.84 years in male patients (p = 0.438). The body mass index (BMI) was comparable in both groups: between 27.36 ± 6.16 in male and 27.09 ± 5.75 (p = 0.945) in female patients. Logistic EuroSCORE (LogES) (female: 5.89 ± 4.6; male: 3.95 ± 3.06; p = 0.017) and EuroSCORE II (ES II) (female: 2.07 ± 2.1; male: 0.94 ± 0.45; p = 0.043), both scores to predict the mortality in cardiac surgery, were significantly higher in female patients. Two patients died early, within 30 days after surgery: one male and one female patient. Late mortality was defined as the 5-year survival rate, which was 94.8%, and 15-year survival rate, which was 85.3% in our cohort. Causes of death were not related to the primary tumor operation. The follow up showed that satisfaction with surgery and long-term outcome was high. CONCLUSION Predominately female patients presented with left atrial tumors over a 17-year period. Relevant gender differences aside from that were not evident. Surgery could be performed with excellent early (within 30 days after surgery) and late results (follow up after discharge).
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Stejskal V, Steiner I, Vobornik M. Cardiac myxoma with atypical cell population mimicking malignancy - a diagnostic pitfall. Cardiovasc Pathol 2023; 63:107511. [PMID: 36462616 DOI: 10.1016/j.carpath.2022.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Herein, a case of a 45-year-old woman is reported with left atrial myxoma showing unique histological findings mimicking malignancy. For 3 months before surgery, the patient suffered from a long-standing fever of unknown etiology, malaise and weight loss; she had no history of malignancy. The CT scan revealed a tumorous mass in the left atrium. Grossly, the tumor had a smooth rounded surface with areas of haemorrhage on the cut surface. Microscopic examination revealed two distinct regions. One showed classical myxoma histology, the other atypical and highly cellular population with sarcoma-like or melanoma-like features mixed with inflammatory cells and posthemorrhagic changes. Immunohistochemically, the atypical cells expressed calretinin and CD31, analogous to the neighbouring bland myxoma cells. Negative markers included SOX10, S100, Melan A, HMB45, CD34, desmin, ERG, CK, LCA, CD68 and MDM2; SMARCB1/INI1 was retained. The proliferation index Ki67 was low, in about 1 % of atypical cells. The results suggest exaggerated reactive and degenerative changes of the myxoma cells rather than true malignant transformation. Similar case reports of cardiac myxomas and diagnostic challenges are discussed.
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Affiliation(s)
- Vaclav Stejskal
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic.
| | - Ivo Steiner
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Martin Vobornik
- The Department of Cardiosurgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
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Amemiya K, Yonemoto Y, Ishibashi-Ueda H, Matsumoto M, Ohta-Ogo K, Ikeda Y, Kobayashi J, Fukushima S, Fujita T, Hatakeyama K. Morphological characteristics of cardiac myxoma causing embolism: a series of 40 years of experience at a single institute. Virchows Arch 2023; 482:377-384. [PMID: 36441241 DOI: 10.1007/s00428-022-03461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
Systemic and cerebral embolisms are serious complications of associated with cardiac myxoma. Embolism risk reportedly depends on the gross and histological morphology. This study is aimed at analyzing the morphologic pattern of excised cardiac myxoma as a high-risk embolic cause. Between 1978 and April 2022, 116 surgical specimens of cardiac myxomas were recorded at the pathology department of our hospital. The tumors were classified into three types based on their macroscopic shapes and external morphology-round-smooth, irregular, and villous-to investigate the embolic complications. Of the 116 specimens, 106 macroscopic images of cardiac myxoma (89% were located in the left atrium) were prepared. Round-smooth types were found in 36 (34.0%) patients, irregular types in 32 (30.2%) patients, and the villous types in 38 (35.8%) patients. Multivariable analysis revealed that a villous external appearance was an independent predictor of embolic events (odds ratio: 8.7; 95% confidence interval: 2.4-42.1; p < 0.001). Villous external appearance of cardiac myxoma was associated with the highest risk of distal embolism.
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Affiliation(s)
- Kisaki Amemiya
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Yumiko Yonemoto
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.,Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.,Division of Diagnostic Pathology, Hokusetsu General Hospital, Takatsuki, Japan
| | - Manabu Matsumoto
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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11
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Matsuo T, Tanaka T. Resection of Orbital Myxoma With Magnetic Resonance Imaging Evidence of Ethmoid Sinus Origin: Case Report and Review of 20 Patients in the Literature. J Investig Med High Impact Case Rep 2023; 11:23247096231201013. [PMID: 37737575 PMCID: PMC10517617 DOI: 10.1177/23247096231201013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023] Open
Abstract
A 41-year-old woman showed a palpable mass at the superonasal orbital edge on the right side. Magnetic resonance imaging demonstrated a lobulated fluid-containing tubular mass which extended anteriorly to posteriorly along the medial orbital wall, nasal to the eyeball. She was followed once a year for 8 years until the age of 49 years when she decided to undergo surgical resection because of the enlarged mass. The lobulated large mass was resected and the pathology showed sparsely distributed spindle cells, positive for CD34, in alcian blue-positive mucous substances, indicative of myxoma. Postoperative magnetic resonance imaging showed residual lobulated tubular mass along the optic nerve on the medial side and superior to the eyeball. The residual orbital mass showed stable structure with more evident connection with the ethmoid sinus lesion, suggestive of the ethmoid origin, in 12 years until the age of 61 years. In the review of 20 patients with orbital myxomas in the literature, in addition to this case, roughly classified locations in the orbit were retrobulbar in 8 patients, on the lateral side of the orbit in 4, on the superior side in 6, on the medial side in 1 (this patient), and in the orbit with no specific description in 2. In pathological examinations, immunohistochemistry was not done in 8 patients, done but all negative in 2, and positive in 11 patients: nerve sheath myxoma was diagnosed in 3 patients based on positive S100 staining. Orbital myxoma is rare but considered in differential diagnosis of orbital masses.
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12
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Islam AKMM. Cardiac myxomas: A narrative review. World J Cardiol 2022; 14:206-219. [PMID: 35582466 PMCID: PMC9048271 DOI: 10.4330/wjc.v14.i4.206] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/28/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.
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Affiliation(s)
- A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka 1207, Bangladesh
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13
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Corin J, Carlsson A, Peters B. Right atrial myxoma as the first manifestation of granulomatosis with polyangiitis, and a possible association with vascular endothelial growth factor (VEGF) and interleukin 6 (IL-6): a case report and review of the literature. Eur J Med Res 2022; 27:4. [PMID: 35016713 PMCID: PMC8753902 DOI: 10.1186/s40001-022-00632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background Granulomatosis with polyangiitis and myxomas are rare conditions previously described to co-exist. Cardiac masses are often presumed to be myxomas rather than lesions of granulomatosis with polyangiitis. Case presentation We present a review of the symptoms for the two diagnoses along with the first verified case. Conclusions Two possible risk factors for developing myxomas (VEGF and IL-6) are explored and discussed.
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Affiliation(s)
- Joel Corin
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Amanda Carlsson
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden. .,Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, 41 345, Gothenburg, Sweden.
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14
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Ramms DJ, Raimondi F, Arang N, Herberg FW, Taylor SS, Gutkind JS. G αs-Protein Kinase A (PKA) Pathway Signalopathies: The Emerging Genetic Landscape and Therapeutic Potential of Human Diseases Driven by Aberrant G αs-PKA Signaling. Pharmacol Rev 2021; 73:155-197. [PMID: 34663687 PMCID: PMC11060502 DOI: 10.1124/pharmrev.120.000269] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Many of the fundamental concepts of signal transduction and kinase activity are attributed to the discovery and crystallization of cAMP-dependent protein kinase, or protein kinase A. PKA is one of the best-studied kinases in human biology, with emphasis in biochemistry and biophysics, all the way to metabolism, hormone action, and gene expression regulation. It is surprising, however, that our understanding of PKA's role in disease is largely underappreciated. Although genetic mutations in the PKA holoenzyme are known to cause diseases such as Carney complex, Cushing syndrome, and acrodysostosis, the story largely stops there. With the recent explosion of genomic medicine, we can finally appreciate the broader role of the Gαs-PKA pathway in disease, with contributions from aberrant functioning G proteins and G protein-coupled receptors, as well as multiple alterations in other pathway components and negative regulators. Together, these represent a broad family of diseases we term the Gαs-PKA pathway signalopathies. The Gαs-PKA pathway signalopathies encompass diseases caused by germline, postzygotic, and somatic mutations in the Gαs-PKA pathway, with largely endocrine and neoplastic phenotypes. Here, we present a signaling-centric review of Gαs-PKA-driven pathophysiology and integrate computational and structural analysis to identify mutational themes commonly exploited by the Gαs-PKA pathway signalopathies. Major mutational themes include hotspot activating mutations in Gαs, encoded by GNAS, and mutations that destabilize the PKA holoenzyme. With this review, we hope to incite further study and ultimately the development of new therapeutic strategies in the treatment of a wide range of human diseases. SIGNIFICANCE STATEMENT: Little recognition is given to the causative role of Gαs-PKA pathway dysregulation in disease, with effects ranging from infectious disease, endocrine syndromes, and many cancers, yet these disparate diseases can all be understood by common genetic themes and biochemical signaling connections. By highlighting these common pathogenic mechanisms and bridging multiple disciplines, important progress can be made toward therapeutic advances in treating Gαs-PKA pathway-driven disease.
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Affiliation(s)
- Dana J Ramms
- Department of Pharmacology (D.J.R., N.A., J.S.G.), Department of Chemistry and Biochemistry (S.S.T.), and Moores Cancer Center (D.J.R., N.A., J.S.G.), University of California, San Diego, La Jolla, California; Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy (F.R.); and Department of Biochemistry, University of Kassel, Kassel, Germany (F.W.H.)
| | - Francesco Raimondi
- Department of Pharmacology (D.J.R., N.A., J.S.G.), Department of Chemistry and Biochemistry (S.S.T.), and Moores Cancer Center (D.J.R., N.A., J.S.G.), University of California, San Diego, La Jolla, California; Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy (F.R.); and Department of Biochemistry, University of Kassel, Kassel, Germany (F.W.H.)
| | - Nadia Arang
- Department of Pharmacology (D.J.R., N.A., J.S.G.), Department of Chemistry and Biochemistry (S.S.T.), and Moores Cancer Center (D.J.R., N.A., J.S.G.), University of California, San Diego, La Jolla, California; Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy (F.R.); and Department of Biochemistry, University of Kassel, Kassel, Germany (F.W.H.)
| | - Friedrich W Herberg
- Department of Pharmacology (D.J.R., N.A., J.S.G.), Department of Chemistry and Biochemistry (S.S.T.), and Moores Cancer Center (D.J.R., N.A., J.S.G.), University of California, San Diego, La Jolla, California; Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy (F.R.); and Department of Biochemistry, University of Kassel, Kassel, Germany (F.W.H.)
| | - Susan S Taylor
- Department of Pharmacology (D.J.R., N.A., J.S.G.), Department of Chemistry and Biochemistry (S.S.T.), and Moores Cancer Center (D.J.R., N.A., J.S.G.), University of California, San Diego, La Jolla, California; Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy (F.R.); and Department of Biochemistry, University of Kassel, Kassel, Germany (F.W.H.)
| | - J Silvio Gutkind
- Department of Pharmacology (D.J.R., N.A., J.S.G.), Department of Chemistry and Biochemistry (S.S.T.), and Moores Cancer Center (D.J.R., N.A., J.S.G.), University of California, San Diego, La Jolla, California; Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy (F.R.); and Department of Biochemistry, University of Kassel, Kassel, Germany (F.W.H.)
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15
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Autophagy in cardiac myxoma: An important puzzle piece in understanding its inflammatory environment. Pathol Res Pract 2021; 226:153609. [PMID: 34537518 DOI: 10.1016/j.prp.2021.153609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac myxomas are rare, predominantly sporadic tumors that can cause heart failure and systematic inflammatory symptoms, and increase the risk of emboli. Their pathophysiology remains poorly understood, but intra-tumoral inflammation and senescence seem to be implicated in it. One of the principal cellular mechanisms implicated in tumor progression is autophagy, largely unknown in myxomas. Thus, our study aimed to investigate the presence of autophagic markers in myxomas and to correlate it with their immune microenvironment. METHODS Twenty-five cardiac myxomas were studied for the autophagic markers LC3B and p62/sequestosome 1 and were compared with markers of the immune microenvironment. RESULTS Most myxomas showed expression of both autophagic markers. We found a positive correlation between LC3B and PD-L1, as well as CD163, and a negative correlation between LC3B and CD8, CD20, CD138, and CD117 infiltration. CONCLUSION Our data not only confirm the presence of autophagic markers within cardiac myxomas but also suggest a possible association with their immune microenvironment.
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16
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Minami Y, Ogawa Y, Tsukamoto K. Painful Palmar and Plantar Purpura. JAMA Dermatol 2021; 157:993-994. [PMID: 34190960 DOI: 10.1001/jamadermatol.2021.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yoshihito Minami
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.,Department of Dermatology, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Youichi Ogawa
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Katsuhiko Tsukamoto
- Department of Dermatology, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
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17
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Gams P, Dolenc Stražar Z, Šoštarič M, Bošnjak M, Kšela J. Cardiac Melanoma Metastasis with ERBB2 Gene Amplification: A Potential for Future Targeted Therapy. Case Rep Oncol 2021; 14:622-627. [PMID: 33976644 PMCID: PMC8077454 DOI: 10.1159/000514981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/15/2023] Open
Abstract
Cardiac tumors are rare, and their treatment differs interindividually regarding the histopathological proprieties and the stage of disease. Authors present a case of symptomatic cardiac melanoma metastasis that expressed an ERBB2 (HER2) gene amplification in a course of the disease that has not yet been reported. The frail patient with a history of pulmonary and renal carcinoma, was admitted to the hospital due to a symptomatic left atrial tumor mass. The patient underwent a tumor-resecting cardiac surgery. At first mistaken for myxoma on echocardiography, the histopathological examination of the tumor revealed a melanoma of acral or mucosal origin. The melanoma metastasis was negative for common genetic mutations in BRAF, NRAS or KIT genes, and for the presence of NTRK genes fusions, but carried ERBB2 (HER2) gene amplification. The absence of standard gene mutations rendered it unresponsive to treatment with BRAF and MEK inhibitors. This molecular finding is rare in melanomas and represented a therapeutic target for off-label systemic treatment with drugs, primarily aimed at ERBB2 positive breast, gastric, and gastroesophageal junction cancers. A rare finding like this justifies molecular genetic analysis of unusual tumor specimen and guarantees optimal treatment for uncommon types of cardiac metastatic tumors.
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Affiliation(s)
- Polona Gams
- Department of Anesthesiology and Intensive Care, Surgery Bitenc, Golnik, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Maja Šoštarič
- Department of Anesthesiology and Intensive Care, Surgery Bitenc, Golnik, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Clinical Department of Anesthesiology and Intensive Care, University Medical Centre, Ljubljana, Slovenia
| | - Matic Bošnjak
- Institute of Pathology, Faculty of Medicine, Ljubljana, Slovenia
| | - Juš Kšela
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Cardiovascular Surgery, University Medical Centre, Ljubljana, Slovenia
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18
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Karpathiou G, Dumollard JM, Camy F, Sramek V, Dridi M, Picot T, Mobarki M, Peoc'h M. Senescence, immune microenvironment, and vascularization in cardiac myxomas. Cardiovasc Pathol 2021; 52:107335. [PMID: 33762213 DOI: 10.1016/j.carpath.2021.107335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS Cardiac myxomas are rare tumors of incompletely elucidated pathogenesis. The aim of this study is to explore the possible presence of a senescence phenotype in cardiac myxomas, associated with an inflammatory and vasculogenic tumor microenvironment. METHODS AND RESULTS This is a retrospective study of 29 cardiac myxomas with immunohistochemical detection of various inflammatory, vascular, and senescence markers. We show that all myxomas contain tumor cells in senescence overexpressing p16, and a fraction of senescent endothelial cells. Macrophages are the principal inflammatory cell population, followed by cytotoxic T cells, with fewer plasma cells, mastocytes, and B lymphocytes. These populations are found in different intratumoral localizations. Larger tumor volume is associated with a lower percentage of myxoid matrix, higher cellularity, higher macrophage, and lower number of mast cells as well as higher PD-L1 expression by inflammatory cells. Higher vascular density is associated with higher percentage of B cells, a lower number of macrophages and higher number of mastocytes, and lower PD-L1 expression by inflammatory cells. Tumors with higher vascular density and higher cellularity show higher amounts of p16 senescent endothelial cells. CONCLUSIONS Myxoma tumor cells are in senescence and reside inside a tumor microenvironment with a distinct inflammatory profile rich in macrophages and cytotoxic T cells, and a rich vasculature, probably attributed to a senescence-associated secretory phenotype.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Florian Camy
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Viviana Sramek
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Maroa Dridi
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Tiphanie Picot
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Mousa Mobarki
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France; Faculty of Medicine, Jazan University, Jazan, Saudi Arabia; Pathology Department, East Hospital, University Hospital of Lyon, Lyon, France
| | - Michel Peoc'h
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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19
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Durieux R, Tchana-Sato V, Lavigne JP, Radermecker MA, Moonen M, Scagnol I, Gennigens C, Defraigne JO. Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma? J Card Surg 2020; 36:357-362. [PMID: 33225534 DOI: 10.1111/jocs.15200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/08/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
Cardiac intimal sarcoma is extremely rare and aggressive primary malignant cardiac tumors. Here, we reported the case of a young man initially operated for a tumor of the left atrium, causing a dynamic obstruction of the mitral valve and (mis-)diagnosed as a myxoma at the histopathological analysis. Patient presented a local recurrence at 3 months and was reoperated. Pathology revealed this time the presence of an intimal sarcoma. Patient received adjuvant chemotherapy. Despite a good local control, the 1-year follow-up positron emission tomography scan revealed the presence of a metastasis in the left adrenal gland that was surgically resected. This article aims to highlight the risk of misdiagnosis in case of cardiac tumors, the hypothetical concept of malignant transformation of a cardiac myxoma, the aggressive course of the extremely rare cardiac intimal sarcoma, and the therapeutic modalities available to treat this pathology.
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Affiliation(s)
- Rodolphe Durieux
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Vincent Tchana-Sato
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Paul Lavigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marc A Radermecker
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marie Moonen
- Department of Cardiology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Irène Scagnol
- Department of Pathology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Christine Gennigens
- Department of Medical Oncology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
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20
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Cardiac Myxoma: Review and Update of Contemporary Immunohistochemical Markers and Molecular Pathology. Adv Anat Pathol 2020; 27:380-384. [PMID: 32732585 DOI: 10.1097/pap.0000000000000275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiac myxoma is an uncommon benign mesenchymal neoplasm of the heart. It usually arises in the left atrium, near the valve of the fossa ovalis, and most frequently affects adults in the third through the sixth decades of life. It is hypothesized to arise from subendothelial vasoformative reserve cells or primitive cells that differentiate along the lines of the endothelium, but this remains speculative. Microscopically, the neoplastic cells are arranged individually, and nests, and are oriented in single or multiple layers around vascular channels. The neoplastic cells are immunoreactive for vimentin, calretinin, S100, nonspecific enolase, factor VIII, CD31, and CD34. The tumor can have diverse clinical presentations depending on its location and extent of disease and is predisposed to embolization. The current treatment is prompt surgical excision.
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21
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Scali E, Presta I, Donato A, Schipani G, Dastoli S, Rossi M, Mignogna C, Malara N, Nisticò SP, Donato G. Mycosis fungoides and gastric T-cell lymphoma: A case report. Mol Clin Oncol 2020; 13:15. [PMID: 32754329 PMCID: PMC7391825 DOI: 10.3892/mco.2020.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
Mycosis fungoides (MF) is a cutaneous malignant lymphoma with an extended clinical course. MF presents in series of dermatological manifestations, beginning with patches and plaques of the skin, and eventually evolving into tumours. Often MF can occur for extended periods without worsening of external symptoms, while the disease advances internally in organs such as lymph nodes, liver, spleen, lung, bone marrow, gastrointestinal tract, pancreas and kidney. The present report presents a clinical case in which gastrointestinal symptomatology occurred a decade after the first dermatological manifestation. Immunohistochemical analysis of the skin, along with small bowel biopsies revealed evidence of gastric T-cell lymphoma. To the best of our knowledge, the present study is the first to describe such a case in the literature.
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Affiliation(s)
- Elisabetta Scali
- Department of Health Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Ivan Presta
- Department of Health Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Annalidia Donato
- Department of Medical and Surgical Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Giusy Schipani
- Department of Health Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Stefano Dastoli
- Department of Health Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Marco Rossi
- Department of Clinical and Experimental Medicine, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Chiara Mignogna
- Department of Interdipartimental Services Center (CIS), University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Natalia Malara
- Department of Clinical and Experimental Medicine, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Steven Paul Nisticò
- Department of Health Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
| | - Giuseppe Donato
- Department of Health Sciences, University 'Magna Græcia' of Catanzaro, Catanzaro I-88100, Italy
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22
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Innate and Adaptive Immunity Linked to Recognition of Antigens Shared by Neural Crest-Derived Tumors. Cancers (Basel) 2020; 12:cancers12040840. [PMID: 32244473 PMCID: PMC7226441 DOI: 10.3390/cancers12040840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022] Open
Abstract
In the adult, many embryologic processes can be co-opted by during cancer progression. The mechanisms of divisions, migration, and the ability to escape immunity recognition linked to specific embryo antigens are also expressed by malignant cells. In particular, cells derived from neural crests (NC) contribute to the development of multiple cell types including melanocytes, craniofacial cartilage, glia, neurons, peripheral and enteric nervous systems, and the adrenal medulla. This plastic performance is due to an accurate program of gene expression orchestrated with cellular/extracellular signals finalized to regulate long-distance migration, proliferation, differentiation, apoptosis, and survival. During neurulation, prior to initiating their migration, NC cells must undergo an epithelial–mesenchymal transition (EMT) in which they alter their actin cytoskeleton, lose their cell–cell junctions, apicobasal polarity, and acquire a motile phenotype. Similarly, during the development of the tumors derived from neural crests, comprising a heterogeneous group of neoplasms (Neural crest-derived tumors (NCDTs)), a group of genes responsible for the EMT pathway is activated. Here, retracing the molecular pathways performed by pluripotent cells at the boundary between neural and non-neural ectoderm in relation to the natural history of NCDT, points of contact or interposition are highlighted to better explain the intricate interplay between cancer cells and the innate and adaptive immune response.
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23
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Rajeshwari M, Subramanian P, Suri V, Nambirajan A, Garg A, Vibha D, Phalak M, Sharma MC. Metastatic lesions of atrial myxoma. A pathologist can clinch them all. Neuropathology 2020; 40:295-301. [PMID: 32232866 DOI: 10.1111/neup.12640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
Atrial myxomas are the most common primary benign cardiac tumors. The embolization of tumor particles is not infrequent, and in nearly half of them, the cerebral arteries are affected, usually leading to embolic ischemic stroke. Formation of intracranial aneurysms, development of parenchymal brain metastasis, and intracerebral hemorrhage due to ruptured aneurysms are rarer. Diagnosis of such lesions in a previously undiagnosed case of myxoma may be challenging for a pathologist. Herein, we present two patients of cardiac myxoma with varied neurological manifestations and their pathological findings.
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Affiliation(s)
- Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Innate Immunity: A Common Denominator between Neurodegenerative and Neuropsychiatric Diseases. Int J Mol Sci 2020; 21:ijms21031115. [PMID: 32046139 PMCID: PMC7036760 DOI: 10.3390/ijms21031115] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 02/06/2023] Open
Abstract
The intricate relationships between innate immunity and brain diseases raise increased interest across the wide spectrum of neurodegenerative and neuropsychiatric disorders. Barriers, such as the blood–brain barrier, and innate immunity cells such as microglia, astrocytes, macrophages, and mast cells are involved in triggering disease events in these groups, through the action of many different cytokines. Chronic inflammation can lead to dysfunctions in large-scale brain networks. Neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, and frontotemporal dementia, are associated with a substrate of dysregulated immune responses that impair the central nervous system balance. Recent evidence suggests that similar phenomena are involved in psychiatric diseases, such as depression, schizophrenia, autism spectrum disorders, and post-traumatic stress disorder. The present review summarizes and discusses the main evidence linking the innate immunological response in neurodegenerative and psychiatric diseases, thus providing insights into how the responses of innate immunity represent a common denominator between diseases belonging to the neurological and psychiatric sphere. Improved knowledge of such immunological aspects could provide the framework for the future development of new diagnostic and therapeutic approaches.
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Presta I, Donato A, Chirchiglia D, Malara N, Donato G. Cardiac myxoma and neural crests: a tense relationship. Cardiovasc Pathol 2019; 44:107163. [PMID: 31760243 DOI: 10.1016/j.carpath.2019.107163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 01/30/2023] Open
Abstract
In cardiac myxomas, the malignant transformation process, selecting incidental gene mutations and leading to loss of proliferation control, has not a so drastic effects in terms of growth rate of tumor mass, but frequently the particular location of lesion engrosses the high risk for health. For accurate cancer cell profiling, it is important to establish the embryologic origin of malignant cells and their initial commitments, above all, in the sight of therapeutic strategies and solutions. Here, we advance, for cardiac myxoma, the hypothesis of an origin from cardiac neural crest cells and we attempt to support it by an integrated discussion of current knowledge about embryological characteristics of neural crest cells and most recent studies focusing cardiac myxomas. We discuss the relationship between the basic plasticity of cardiac neural crest cells and some typical mutations arising in neoplastic lesions as well as the expression of typical cell markers of neural crests derivatives. Dysfunctions in proliferative and migratory programs, focused in other studies, are evaluated in the context of the topological and histopathological characteristics of cardiac myxomas.
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Affiliation(s)
- Ivan Presta
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy.
| | - Annalidia Donato
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Domenico Chirchiglia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Natalia Malara
- Department of Clinical and Experimental Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppe Donato
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
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Wang X, Wang C, Ma D, Jin J, Zhang B, Zhu C, Chen B. An atrial septal aneurysm with an organized thrombus in an asymptomatic patient: A case report. Medicine (Baltimore) 2019; 98:e18074. [PMID: 31770224 PMCID: PMC6890302 DOI: 10.1097/md.0000000000018074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION An atrial septal aneurysm (ASA) is a rare congenital cardiac deformity characterized by interatrial septum protruding into atria forming a saccular structure. PATIENT CONCERNS In our case, a 42-year-old female patient presented to our hospital complained of palpitation. DIAGNOSIS Transthoracic echocardiography detected a 3.4 × 3.4 cm circular mass attached to the interatrial septum in right atrium complicated with a 6 mm secundum atrial septal defects (ASD). INTERVENTIONS The patient received a cardiopulmonary bypass surgery to remove the mass and close the ASD. OUTCOMES The mass turned out to be an organized thrombus with calcium deposition and fibrinoid necrosis. CONCLUSION ASA is a potential location of atrial thrombus because of the stagnation of blood. Systemic embolism events are the main complications of ASA. Surgery or anticoagulation is both recommended in patients with ASA with thrombus.
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Presta I, Donato A, Zaffino P, Spadea MF, Mancuso T, Malara N, Chiefari E, Donato G. Does a polarization state exist for mast cells in cancer? Med Hypotheses 2019; 131:109281. [PMID: 31443770 DOI: 10.1016/j.mehy.2019.109281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022]
Abstract
The data of literature are discordant about the role of mast cells in different types of neoplasms. In this paper the authors propose the hypothesis that tumor-associated mast cells may switch to different polarization states, conditioning the immunogenic capacities of the different neoplasms. Anti-inflammatory polarized mast cells should express cytokines such as interleukin-10 (IL-10) and then mast cells number should be inversely related to the intensity of inflammatory infiltrate. On the contrary, when mast cells do not express anti-inflammatory cytokines their number should be directly related to the intensity of the inflammatory infiltrate. In this paper we briefly argue around feasible approaches, based on the retrospective studies of tumor tissue samples from neoplasms considered "immunologically hot" and neoplasms considered "immunologically cold", through immunohistochemistry and immunofluorescence techniques (confocal microscopy). The establishment of the actual existence of a polarization interchange of mast cells, could lead to a new vision in prognostic terms, useful to contrive new approaches in immunotherapy of tumors.
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Affiliation(s)
- Ivan Presta
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy.
| | - Annalidia Donato
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Zaffino
- Department of Clinical and Experimental Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Maria Francesca Spadea
- Department of Clinical and Experimental Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Teresa Mancuso
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Natalia Malara
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Giuseppe Donato
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
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Taverna D, Mignogna C, Santise G, Gaspari M, Cuda G. On‐Tissue Hydrogel‐Mediated Nondestructive Proteomic Characterization: Application to fr/fr and FFPE Tissues and Insights for Quantitative Proteomics Using a Case of Cardiac Myxoma. Proteomics Clin Appl 2018; 13:e1700167. [DOI: 10.1002/prca.201700167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/10/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Domenico Taverna
- Research Center for Advanced Biochemistry and Molecular BiologyDepartment of Experimental and Clinical MedicineMagna Graecia University of CatanzaroCampus “S. Venuta,”Viale EuropaLoc. Germaneto 88100 Catanzaro Italy
| | - Chiara Mignogna
- Department of Health ScienceInterdepartmental Service CentreMagna Graecia University of CatanzaroViale Europa 88100 Catanzaro Italy
| | - Gianluca Santise
- Cardiothoracic Surgery UnitSant'Anna Hospital 88100 Catanzaro Italy
| | - Marco Gaspari
- Research Center for Advanced Biochemistry and Molecular BiologyDepartment of Experimental and Clinical MedicineMagna Graecia University of CatanzaroCampus “S. Venuta,”Viale EuropaLoc. Germaneto 88100 Catanzaro Italy
| | - Giovanni Cuda
- Research Center for Advanced Biochemistry and Molecular BiologyDepartment of Experimental and Clinical MedicineMagna Graecia University of CatanzaroCampus “S. Venuta,”Viale EuropaLoc. Germaneto 88100 Catanzaro Italy
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Jia H, Xing Y, Zhang S, Wang Y. Hemodynamic management of a patient with a huge right atrium myxoma during thoracic vertebral surgery: A case report. Medicine (Baltimore) 2018; 97:e12543. [PMID: 30278547 PMCID: PMC6181536 DOI: 10.1097/md.0000000000012543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Myxoma is the most common primary benign cardiac tumor, which could lead to some fatal complications because of its strategic position. PATIENT CONCERNS The patient was admitted to our hospital due to sudden onset of palpitation, chest tightness, mild fever, night sweats, accompanied with bilateral lower extremities adynamia, and paralysis for 5 days, but no obvious syncope and edema. DIAGNOSES Transthoracic echocardiography showed a giant mobile myxoma (72 × 58 mm) in the right atrium (RA). Magnetic resonance imaging revealed an erosive space-occupying lesion located between the first and third thoracic vertebrae. INTERVENTIONS Thoracic vertebral lesions were resected immediately to rescue the incomplete paraplegia. After the patient was placed in the prone position, significant hemodynamics changes were observed due to the displacement of the huge RA myxoma. OUTCOMES Stable hemodynamics was maintained during the operation through control of fluid infusion combined with vasoactive drugs. LESSONS Change in body position may lead to obstruction of intracardiac blood flow in patients with giant myxoma. This clinical manifestation is rarely reported.
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Abstract
OBJECTIVE to investigate the morphological and phenotypic features of cardiac myxoma (CM), to discuss argumentative issues on the sources of its growth. SUBJECTS AND METHODS The investigation included 176 sporadic and familial myxomas originating from different cardiac chambers (96% from the atria). The histological, ultrastructural, and immunohistochemical features of the cells and vessels of this tumor were studied. RESULTS The morphological and phenotypic features of the embryonic endothelium resembling the cells of the primary cardiovascular network were found in the cells and vessels of CM. No signs of other mesenchymal derivatives were detected. DISCUSSION The authors anticipate that there is focal cessation of maturation of the embryonic endocardial endothelium and its persistence - hamartia. Postnatal proliferation of embryonic hamartia forms the tumor hamartoma. Differentiated cells may retain the phenotypic (but not morphological) features of closely related cells that have a common precursor. CONCLUSION The results of the study have allowed the authors to consider CM to be hamartoma, a monohistioid benign embryonic endocardial endothelioma. Our findings do not exclude the possibility of developing CM from pluripotent mesenchymal cells.
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Affiliation(s)
- K A Rogov
- Research Institute of Human Morphology, Moscow, Russia; People's Friendship University of Russia ,Moscow
| | - L V Kaktursky
- Research Institute of Human Morphology, Moscow, Russia
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Acute heart failure related to a large left atrial myxoma. Proc AMIA Symp 2018; 31:331-333. [PMID: 29904302 DOI: 10.1080/08998280.2018.1446641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/15/2018] [Accepted: 01/27/2018] [Indexed: 12/21/2022] Open
Abstract
An association between atrial myxoma and left ventricular failure is rarely described, is not completely understood, and may have multiple etiologies. We present a 49-year-old man with no history of cardiovascular disease who was admitted to our hospital with pulmonary edema. He was in atrial fibrillation with rapid ventricular response. Echocardiography showed a 10.5-cm left atrial myxoma, which had been asymptomatic until the onset of congestive heart failure in the presence of severe left ventricular systolic dysfunction. Left ventricular inflow obstruction associated with the giant atrial mass could not be the only cause for acute heart failure.
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Dong D, Zhu T, Yang X, Zhu J. A patient with an unusual cyst of the inter-atrial septum and atrial sepal defect. Echocardiography 2018; 35:876-879. [PMID: 29756329 DOI: 10.1111/echo.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hepatic and renal cysts are relatively common among healthy people, but there are few published reports of primary cysts of the atrial septum. Here, we report a case of an unusual cyst of the atrial septum accompanied by atrial septal defect (ASD) in a 42-year-old woman. Microscopic examination showed the deposition of calcium salts within the tissue mass and an organized thrombus surrounded by a fibrous capsule. The case was discussed with reference to the relevant published literature and compared to other documented types of atrial septal cysts. The final diagnostic conclusion was a primary atrial septal cyst.
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Affiliation(s)
- Daye Dong
- The Affiliated Taizhou Hospital of Wenzhou Medical University, Zhejiang, China
| | | | | | - Jia Zhu
- Taizhou Hospital, Zhejiang, China
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Malik AK, Filobbos R, Manoharan A, Harvey N, O’Reilly DA, de Liguori Carino N. A case report of an angiomyxoma in the liver. Ann R Coll Surg Engl 2018; 100:e81-e84. [PMID: 29543047 PMCID: PMC5958866 DOI: 10.1308/rcsann.2018.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 12/11/2022] Open
Abstract
Angiomyxomas are uncommon myxoid tumours arising most commonly from the pelvis. A 46-year-old woman with a history of polycystic kidney disease presented asymptomatically for surveillance ultrasonography; changes were noted in the size and morphology of her liver cysts. Subsequent radiological assessment displayed features suspicious of malignancy and a right hemihepatectomy was performed with curative intent. Pathological examination of the resected specimen found histology consistent with an angiomyxoma arising primarily from the liver parenchyma. Follow-up review of the patient has been uneventful with annual imaging showing no evidence of recurrence. Angiomyxomas do not characteristically invade other tissues. However, any liver lesion displaying suspicious features of malignancy should be resected in the absence of disseminated disease.
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Affiliation(s)
- AK Malik
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | - R Filobbos
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | | | - N Harvey
- Central Manchester University Hospitals NHS Foundation Trust, UK
| | - DA O’Reilly
- Central Manchester University Hospitals NHS Foundation Trust, UK
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Di Vito A, Santise G, Mignogna C, Chiefari E, Cardillo G, Presta I, Arturi F, Malara N, Brunetti F, Donato A, Maisano D, Leonetti S, Maselli D, Barni T, Donato G. Innate immunity in cardiac myxomas and its pathological and clinical correlations. Innate Immun 2017; 24:47-53. [PMID: 29145790 PMCID: PMC6830761 DOI: 10.1177/1753425917741678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiac myxomas are the most common benign cardiac tumor. We investigated the
immunohistochemical properties of 11 surgically excised cardiac myxomas, in
order to analyze the correlation between macrophages and mast cell populations
and clinical parameters. CD68+/CD163−/iNOS−
(M0) cells represent the most abundant macrophage phenotype; however,
CD68+/CD163+ cells (M2) were also frequent.
CD68+/iNOS+ (M1) elements were rare. Mast cells,
defined as a population of c-kit (CD117)+ and/or tryptase+
cells were also detected. Statistical analysis showed significant correlations
between c-kit (CD117)+ and tryptase, CD68 and erythrocyte
sedimentation rate (ESR), ESR and red blood cell count (RBC), and prothrombin
time and platelet count. The inverse correlation between RBCs in peripheral
blood and ESR suggested that anemia associated with chronic inflammatory disease
is a noncasual event in patients suffering from cardiac myxoma. Mechanical
hemolysis may be only a minor component of anemia, according to the lack of
correlation between echographic surface and RBCs. Moreover, tumor size did not
correlate with ESR, showing that inflammatory state may depend from both tumor
cells population and inflammatory infiltrate. In the future, modulation of
macrophage polarization in cardiac myxomas might represent important therapeutic
target.
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Affiliation(s)
- Anna Di Vito
- 1 Department of Experimental and Clinical Medicine, 9325 Magna Græcia University , Catanzaro, Italy
| | - Gianluca Santise
- 2 Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy
| | - Chiara Mignogna
- 3 Department of Health Science, 9325 Magna Græcia University , Catanzaro, Italy
| | - Eusebio Chiefari
- 3 Department of Health Science, 9325 Magna Græcia University , Catanzaro, Italy
| | - Gabriella Cardillo
- 3 Department of Health Science, 9325 Magna Græcia University , Catanzaro, Italy
| | - Ivan Presta
- 3 Department of Health Science, 9325 Magna Græcia University , Catanzaro, Italy
| | - Franco Arturi
- 4 Department of Medical and Surgical Sciences, 9325 Magna Græcia University , Catanzaro, Italy
| | - Natalia Malara
- 1 Department of Experimental and Clinical Medicine, 9325 Magna Græcia University , Catanzaro, Italy
| | | | - Annalidia Donato
- 4 Department of Medical and Surgical Sciences, 9325 Magna Græcia University , Catanzaro, Italy
| | - Domenico Maisano
- 6 Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
| | | | - Daniele Maselli
- 2 Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy
| | - Tullio Barni
- 1 Department of Experimental and Clinical Medicine, 9325 Magna Græcia University , Catanzaro, Italy
| | - Giuseppe Donato
- 3 Department of Health Science, 9325 Magna Græcia University , Catanzaro, Italy
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Taverna D, Mignogna C, Gabriele C, Santise G, Donato G, Cuda G, Gaspari M. An optimized procedure for on-tissue localized protein digestion and quantification using hydrogel discs and isobaric mass tags: analysis of cardiac myxoma. Anal Bioanal Chem 2017; 409:2919-2930. [PMID: 28190108 DOI: 10.1007/s00216-017-0237-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/20/2017] [Accepted: 01/31/2017] [Indexed: 01/22/2023]
Abstract
An optimized workflow for multiplexed and spatially localized on-tissue quantitative protein analysis is here presented. The method is based on the use of an enzyme delivery platform, a polymeric hydrogel disc, allowing for a localized digestion directly onto the tissue surface coupled with an isobaric mass tag strategy for peptide labeling and relative quantification. The digestion occurs within such hydrogels, followed by peptide solvent extraction and identification by liquid chromatography coupled to high-resolution tandem mass spectrometry (LC-MS/MS). Since this is a histology-directed on-tissue analysis, multiple hydrogels were placed onto morphologically and spatially different regions of interest (ROIs) within the tissue surface, e.g., cardiac myxoma tumor vascularized region and the adjacent hypocellular area. After a microwave digestion step (2 min), enzymatically cleaved peptides were labeled using TMT reagents with isobaric mass tags, enabling analysis of multiple samples per experiment. Thus, N = 8 hydrogel-digested samples from cardiac myxoma serial tissue sections (N = 4 from the vascularized ROIs and N = 4 from the adjacent hypocellular areas) were processed and then combined before a single LC-MS/MS analysis. Regulated proteins from both cardiac myxoma regions were assayed in a single experiment. Graphical abstract The workflow for histology-guided on-tissue localized protein digestion followed by isobaric mass tagging and LC-MS/MS analysis for proteins quantification is here summarized.
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Affiliation(s)
- Domenico Taverna
- Research Center for Advanced Biochemistry and Molecular Biology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Campus "S. Venuta", Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy.
| | - Chiara Mignogna
- Department of Health Science, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Caterina Gabriele
- Research Center for Advanced Biochemistry and Molecular Biology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Campus "S. Venuta", Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy
| | - Gianluca Santise
- Cardiothoracic Surgery Unit, Sant'Anna Hospital, Via Pio X, 111, 88100, Catanzaro, Italy
| | - Giuseppe Donato
- Department of Health Science, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giovanni Cuda
- Research Center for Advanced Biochemistry and Molecular Biology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Campus "S. Venuta", Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy
| | - Marco Gaspari
- Research Center for Advanced Biochemistry and Molecular Biology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Campus "S. Venuta", Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy
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Anvari MS, Sabagh M, Goodarzynejad H, Ziaei S, Boroumand MA, Pourgholi L, Jenab Y, Abbasi K. Association between herpes simplex virus Types 1 and 2 with cardiac myxoma. Cardiovasc Pathol 2017; 27:31-34. [PMID: 28081512 DOI: 10.1016/j.carpath.2016.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/23/2016] [Accepted: 12/29/2016] [Indexed: 11/15/2022] Open
Abstract
Most cases of atrial myxoma are sporadic, and the exact etiology is unknown. We examined if herpes simplex virus (HSV)-1 and HSV-2 antigens and/or DNA could be detected in a cohort of Iranian patients with cardiac myxomas. From July 2004 to June 2014, among a total of 36,703 patients undergoing open heart surgeries, consecutive patients with cardiac myxoma who were treated by surgical excision at our center included in this study. Of 73 patients studied, 56% were female with a mean age of 54 years (ranging from 23 to 77 years). Seventy-four myxomas were surgically removed from 73 patients, since one patient had two myxomas which were located on both the right atrium and right ventricle. The materials for this analysis were retrospectively gathered from extracted tumors that stored in a pathology bank of tissue paraffin blocks. The formalin fixed paraffin embedded tissue samples were investigated for HSV genomic DNA by both immunohistochemistry (IHC) and polymerase chain reaction (PCR) analysis. In all 74 cases there was no presence of HSV 1 and HSV 2 infection. This suggests that HSV may not play a role in sporadic cardiac myxomas; however, evidence for such association is currently lacking, and further studies are required to determine such a role.
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Affiliation(s)
- Maryam Sotoudeh Anvari
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran..
| | - Moud Sabagh
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Goodarzynejad
- Department of Clinical and Experimental Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Ziaei
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Boroumand
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leyla Pourgholi
- Department of pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kyomars Abbasi
- Department of cardiac surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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de Nijs MI, Vink A, Bergmann W, Szatmári V. Left ventricular cardiac myxoma and sudden death in a dog. Acta Vet Scand 2016; 58:41. [PMID: 27334273 PMCID: PMC4917938 DOI: 10.1186/s13028-016-0222-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/10/2016] [Indexed: 12/15/2022] Open
Abstract
Background Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. Case presentation A previously healthy 12-year-old male West Highland white terrier was found dead during its 1-week stay in a kennel. The dog was known to have a cardiac murmur. On necropsy, a pedunculated neoplasia was found attached to the interventricular aspect of the left ventricular outflow tract, resulting in almost complete obstruction of the aorta. As this was the only abnormality identified, the tumor was considered as the cause of sudden death. Histopathologic findings were compatible with a myxoma. Conclusions Benign intraluminal tumors of the heart are very rare in dogs, but may have fatal consequences. Echocardiography could have revealed the cause of the cardiac murmur of this previously asymptomatic dog. Surgical removal could have been possible, as the tumor was pedunculated.
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Meurgey A, Henaine R, Bouvagnet P, Chalabreysse L. [About a case of a recurrent glandular cardiac myxoma in a child]. Ann Pathol 2016; 36:214-7. [PMID: 27234518 DOI: 10.1016/j.annpat.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/21/2015] [Accepted: 01/31/2016] [Indexed: 10/21/2022]
Abstract
Primary cardiac tumors are extremely rare and mainly benign. The majority of these are myxomas (40%). Myxoma are generally sporadic tumors which occur most commonly in adult females between 30 and 40 years, and are seldom found in the paediatric population (5%). Seven percent are associated with igenetic diseases. We report the case of an eight-year-old boy presenting a recurrent glandular cardiac myxoma. In 2011, he presented a deterioration of the general state. An echocardiography highlighted a left atrial mass on the interatrial septum, with a pedicular insertion. On the microscope, it consisted of a proliferation of stellate cells isolated or clustered in rudimentary vessels in a myxoid stroma presenting haemorrhage changes. These cells expressed CD34 and calretinine. Glandular elements without atypia were clustered within the myxomatous proliferation. They expressed cytokeratin (CK) 7. Surgical resection was macroscopically complete. In 2014, the boy had a sudden neurological deficit during a football match. An echocardiography revealed a recurrence at the same location. The lesion was excised and addressed in several fragments. Classical myxoma was associated with glands without atypia. This last component expressed CKAE1/AE3 and CK7. Ki67 index of proliferation was low. The surgical reintervention was macroscopically complete. The final diagnosis was glandular cardiac myxoma. A genetic survey was conducted, showing the presence of Carney complex. This is the first description in the litterature of a recurrent glandular cardiac myxoma occuring in a child.
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Affiliation(s)
- Alexandra Meurgey
- Service d'anatomie et cytologie pathologique, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France
| | - Roland Henaine
- Unité médico-chirurgicale des cardiopathies congénitales adultes et enfants, groupement hospitalier Est, hospices civils de Lyon, 69677 Lyon, France
| | - Patrice Bouvagnet
- EA 4173, laboratoire cardiogénétique, groupement hospitalier Est, hospices civils de Lyon, université Lyon 1 et hôpital Nord Ouest, 69677 Lyon, France
| | - Lara Chalabreysse
- Service d'anatomie et cytologie pathologique, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France.
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Shi P, Fang C, Pang X. Astrocyte elevated gene-1 regulates CCL3/CCR5-induced epithelial-to-mesenchymal transition via Erk1/2 and Akt signaling in cardiac myxoma. Oncol Rep 2015; 34:1319-26. [PMID: 26134542 DOI: 10.3892/or.2015.4081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/09/2015] [Indexed: 11/06/2022] Open
Abstract
In recent years, astrocyte elevated gene-1 (AEG-1) has been reported as a key mediator that is involved in the epithelial-to-mesenchymal transition (EMT) process. However, the mechanisms underlying CCL3/CCR5-AEG-1 pathway-mediated EMT in cardiac myxoma (CM) has not been well featured till now. We used immnohistochemistry and immunoblotting to assess the expression of CCR5 and AEG-1 in 30 cases of CM tissues and cells. Subsequently, cultured CM cells were treated with si-AEG-1 or si-CCR5 and then subjected to in vitro assays. We observed that CCR5 and AEG-1 proteins were highly expressed in CM tissues (73.3 and 76.7%, respectively) and closely correlated with tumor size (>5 cm). Importantly, we validated the expression of AEG-1, p-Erk1/2, p-Akt, vimentin, N-cadherin and MMP2 increased in the CM cell with CCL3 treatment in a time- and concentration-dependent manner. When CM cells were treated with si-CCR5, the expression of AEG-1, p-Erk1/2, p-Akt, vimentin, N-cadherin and MMP2 was downregulated. In addition, when CM cells were treated with si-AEG-1, the expression of p-Erk1/2, p-Akt, vimentin, N-cadherin and MMP2 was also downregulated. Using the cell cycle and proliferation assay, the knockdown of AEG-1 inhibited the entry of G1 into S phase and the proliferation capacity of CM cells. In conclusion, AEG-1 mediates CCL3/CCR5-induced EMT development via both Erk1/2 and Akt signaling pathway in CM patients, which indicates CCL3/CCR5-AEG-1-EMT pathway could be suggested as a useful target to affect the progression of CM.
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Affiliation(s)
- Ping Shi
- Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Changcun Fang
- Department of Cardiosurgery, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Xinyan Pang
- Department of Cardiosurgery, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
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