Autocrine Regulation of Interleukin-6 via the Activation of STAT3 and Akt in Cardiac Myxoma Cells

Plasma concentrations of a pleiotropic cytokine, interleukin (IL)-6, are increased in patients with cardiac myxoma. We investigated the regulation of IL-6 in cardiac myxoma. Immunohistochemical staining and reverse transcription-polymerase chain reaction (RT-PCR) revealed that IL-6 and its receptors, IL-6 receptor (IL-6R) and gp130, co-existed in the myxoma cells. Myxoma cells were cultured, and an antibody array assay showed that a conditioned medium derived from the cultured myxoma cells contained increased amounts of IL-6. Signal transducer and activator of transcription (STAT) 3 and Akt were constitutively phosphorylated in the myxoma cells. An enzyme-linked immunosorbent assay (ELISA) showed that the myxoma cells spontaneously secreted IL-6 into the culture medium. Real-time PCR revealed that stimulation with IL-6 + soluble IL-6R (sIL6R) significantly increased IL-6 mRNA in the myxoma cells. Pharmacological inhibitors of STAT3 and Akt inhibited the IL-6 + sIL-6R-induced gene expression of IL-6 and the spontaneous secretion of IL-6. In addition, IL-6 + sIL-6R-induced translocation of phosphorylated STAT3 to the nucleus was also blocked by STAT3 inhibitors. This study has demonstrated that IL-6 increases its own production via STAT3 and Akt pathways in cardiac myxoma cells. Autocrine regulation of IL-6 may play an important role in the pathophysiology of patients with cardiac myxoma.

Kinase fusion positive intra-osseous spindle cell tumors: A series of eight cases with review of the literature

Mesenchymal spindle cell tumors with kinase fusions, often presenting in superficial or deep soft tissue locations, may rarely occur in bone. Herein, we describe the clinicopathologic and molecular data of eight bone tumors characterized by various kinase fusions from our files and incorporate the findings with the previously reported seven cases, mainly as single case reports. In the current series all but one of the patients were young children or teenagers, with an age range from newborn to 59 years (mean 19 years). Most tumors (n = 5) presented in the head and neck area (skull base, mastoid, maxilla, and mandible), and remaining three in the tibia, pelvic bone, and chest wall. The fusions included NTRK1 (n = 3), RET (n = 2), NTRK3 (n = 2), and BRAF (n = 1). In the combined series (n = 15), most tumors (73%) occurred in children and young adults (<30 years) and showed a predilection for jaw and skull bones (40%), followed by long and small tubular bones (33%). The fusions spanned a large spectrum of kinase genes, including in descending order NTRK3 (n = 6), NTRK1 (n = 4), RET (n = 2), BRAF (n = 2), and RAF1 (n = 1). All fusions confirmed by targeted RNA sequencing were in-frame and retained the kinase domain within the fusion oncoprotein. Similar to the soft tissue counterparts, most NTRK3-positive bone tumors in this series showed high-grade morphology (5/6), whereas the majority of NTRK1 tumors were low-grade (3/4). Notably, all four tumors presenting in the elderly were high-grade spindle cell sarcomas, with adult fibrosarcoma (FS)-like, malignant peripheral nerve sheath tumor (MPNST)-like and MPNST phenotypes. Overall, 10 tumors had high-grade morphology, ranging from infantile and adult-types FS, MPNST-like, and MPNST, whereas five showed benign/low-grade histology (MPNST-like and myxoma-like). Immunohistochemically (IHC), S100 and CD34 positivity was noted in 57% and 50%, respectively, while co-expression of S100 and CD34 in 43% of cases. One-third of tumors (4 high grade and the myxoma-like) were negative for both S100 and CD34. IHC for Pan-TRK was positive in all eight NTRK-fusion positive tumors tested and negative in two tumors with other kinase fusions. Clinical follow-up was too limited to allow general conclusions.

Excision of left atrial myxoma under perfused ventricular fibrillation with hypothermia after coronary artery bypass grafting

BACKGROUND

Redo heart surgery has become increasingly common but involves additional high surgical risk, especially redo surgery after coronary artery bypass grafting (CABG).

CASE PRESENTATION

In this study, we report the case of a 57-year-old Chinese male with left atrium myxoma who had previously undergone CABG. Common surgical methods usually include aortic cross-clamping, administering cold cardioplegia perfusion to protect the myocardium, opening the heart, and then removing the tumor. However, for patients with previous CABG, redo thoracotomy and ascending aortic cross-clamping present a greater risk of damage to the grafted vessels. In this study, we chose a right lateral mini-thoracotomy incision and hypothermia-induced ventricular fibrillation to minimize damage and avoid any adverse effects on the bridge vasculature. The patient recovered uneventfully and was discharged seven days after surgery.

CONCLUSIONS

For patients with previous CABG, minimally invasive right thoracotomy under perfused ventricular fibrillation with hypothermia is safe and reliable and can prevent potential damage to the ascending aorta and graft.

Dynamics of Humoral Immunity to Myxoma and Rabbit Hemorrhagic Disease Viruses in Wild European Rabbits Assessed by Longitudinal Semiquantitative Serology

Myxoma virus (MYXV) and rabbit hemorrhagic disease virus (RHDV) are important drivers of the population decline of the European rabbit, an endangered keystone species. Both viruses elicit strong immune responses, but the long-term dynamics of humoral immunity are imperfectly known. This study aimed to assess the determinants of the long-term dynamics of antibodies to each virus based on a longitudinal capture-mark-recapture of wild European rabbits and semiquantitative serological data of MYXV and RHDV GI.2-specific IgG. The study included 611 indirect enzyme-linked immunosorbent assay (iELISA) normalized absorbance ratios for each MYXV and RHDV GI.2 from 505 rabbits from 2018 to 2022. Normalized absorbance ratios were analyzed using log-linear mixed models, showing a significant positive relationship with the time since the first capture of individual rabbits, with monthly increases of 4.1% for antibodies against MYXV and 2.0% against RHDV GI.2. Individual serological histories showed fluctuations over time, suggesting that reinfections boosted the immune response and likely resulted in lifelong immunity. Normalized absorbance ratios significantly increased with the seroprevalence in the population, probably because of recent outbreaks, and with body weight, highlighting the role of MYXV and RHDV GI.2 in determining survival to adulthood. Juvenile rabbits seropositive for both viruses were found, and the dynamics of RHDV GI.2 normalized absorbance ratios suggest the presence of maternal immunity up to 2 months of age. Semiquantitative longitudinal serological data provide epidemiological information, otherwise lost when considering only qualitative data, and support a lifelong acquired humoral immunity to RHDV GI.2 and MYXV upon natural infection. IMPORTANCE This study addresses the long-term dynamics of humoral immunity to two major viral pathogens of the European rabbit, an endangered keystone species of major ecological relevance. Such studies are particularly challenging in free-ranging species, and a combination of longitudinal capture-mark-recapture and semiquantitative serology was used to address this question. Over 600 normalized absorbance ratios of iELISA, obtained from 505 individual rabbits in 7 populations over 5 years, were analyzed using linear mixed models. The results support a lifelong acquired humoral immunity to myxoma virus and rabbit hemorrhagic disease virus upon natural infection and suggest the presence of maternal immunity to the latter in wild juvenile rabbits. These results contribute to understanding the epidemiology of two viral diseases threatening this keystone species and assist in developing conservation programs.

[Superficial angiomyxoma in nasal vestibule: a case report]

This paper reported a case of superficial angiomyxoma in the region of the nasal vestibule. The clinical manifestation was swelling of the left nasal vestibular skin, while paranasal sinus CT showed swell soft tissue in the anterior and superior region to the left maxilla. Under general anesthesia, the left nasal vestibular mass was resected under nasal endoscopy. The postoperative pathological diagnosis was superficial angiomyxoma. The patient underwent a CT scan of the paranasal sinuses 4 months after the operation, and there was no recurrence of the tumor.

Severe dysplasminogenemia due to homozygous PLG Ala620Thr variant in a Korean woman without a history of venous thromboembolism: A case report and literature review

RATIONALE

Plasminogen plays an important role in fibrinolysis and is encoded by the PLG gene. The missense variant PLG Ala620Thr is the major cause of dysplasminogenemia in East Asian countries, including Korea. Although dysplasminogenemia was first reported in a Japanese patient with recurrent venous thromboembolism (VTE), subsequent studies have not demonstrated any clear association between the PLG Ala620Thr variant and the risk of VTE. To the best of our knowledge, this is the first report of a homozygous PLG Ala620Thr variant case from Korea.

PATIENT CONCERNS

Here, we report a Korean family with PLG Ala620Thr mutation. The proband was a 34-year-old man who presented with multiple thrombotic arterial embolism and cardiac myxoma.

INTERVENTIONS

Laboratory workup, including coagulation profile and PLG gene sequencing, was carried out for the affected family.

DIAGNOSIS AND OUTCOME

The proband carried a heterozygous PLG Ala620Thr variant with decreased plasminogen activity of 65%. His 53-year-old mother, who had no reported history of VTE, was homozygous for the PLG Ala620Thr variant with decreased plasminogen activity of just 25%. Decreased plasminogen activity indicates dysplasminogenemia.

LESSONS

We believe that this clinically silent homozygous case supports the previous findings that isolated PLG Ala620Thr variant does not confer a significant risk of VTE.

[Papillary Fibroelastoma Arising from the Left Atrial Wall:Report of a Case]

Papillary fibroelastoma (PFE) is a rare benign cardiac tumor generally arising from the valvular endocardium. We report an extremely rare case of PFE arising from the left atrial wall. A 70-year-old male patient was admitted to our hospital with a diagnosis of left atrial tumor. Echocardiography and enhanced computed tomography showed an approximately 14 mm mass on the left atrial wall. Moreover, the magnetic resonance imaging showed hyperintenseness on a T2-weighted image. We diagnosed the tumor as a myxoma. Intraoperatively, we found a mobile tumor on the left atrial wall. It had a sea anemone-like appearance and was suspected to be PFE. We performed the tumor resection including the left atrial wall. Histological examination confirmed PFE. His postoperative course was uneventful.

[Giant Left Atrial Myxoma Found with Congestive Heart Failure;Report of a Case]

We report a case of giant left atrial myxoma in a 52-year-old woman who developed congestive heart failure. By echocardiography, not only the myxoma but moderate degree of mitral and tricuspid regurgitation was also found. The tumor was extensively attached to the left atrial endocardium, and was excised completely together with the endocardium. No valve surgery was added. Postoperative echocardiography showed no myxoma and no mitral valve regurgitation. She was discharged in good condition on postoperative day 14.

[Penile angiomyxoma: a case report]

Angiomyxoma is a rare benign tumor prone to aggressive and invasive growth and relapse. Very few case reports of tumors with this morphology have been published in the world literature. In this paper, we report a rare case of penile angiomyxoma, which illustrates that any preoperative examination does not allow physicians to suspect this tumor type. This fact makes physicians be alert for cancer and use the active surgical tactics even if a tumor is supposed to be benign.

[Cystic Myxoma which Obstructed the Mitral Valve Orifice;Report of a Case]

A 44-year-old male presented to our hospital with exertional dyspnea. Transthoracic echocardiography revealed a large cystic mass in the left atrium obstructing the mitral valve orifice. Transesophageal echocardiography during emergency operation showed a large cystic mass along with a solid part near the stalk. The mass was resected en bloc including the margin of the left atrium around the stalk. His hemodynamics improved immediately after the operation and the patient was discharged shortly with uneventful postoperative course. While intra cardiac cystic mass has some possible pathologies including malignancy, pathological examination of this tumor revealed a myxoma with large hematoma which had probably grown up rapidly. This tumor was successfully eradicated under the guide of both transthoracic and transesophageal echocardiography.

[Surgical Experience of Papillary Fibroelastoma Revealed by Cerebral Infarction]

Primary cardiac tumors are relatively rare. Among them, papillary fibroelastoma (PFE) is the 2nd most common benign cardiac tumor after myxoma. However, despite its benign status, PFE may trigger fatal embolic events in some cases. Therefore, once PFE is diagnosed, immediate surgical resection of the tumor is recommended. We report our experience of 3 patients with cerebral infarction that were diagnosed as having PFE. All cases were complicated with cerebral infarction probably originating from a tumor embolus or thrombus. For that reason, after the tumor had been detected, urgent surgical resection of the tumor was considered to be necessary. Given the generally good postoperative outcomes, simple resection of the tumor while preserving valve function is considered sufficient to achieve a favorable outcome.

[Aggressive angiomyxoma - case report]

OBJECTIVE

We present a case report of 47-years old woman with a rare mesenchymal tumor misdiagnosed as a cyst Bartholins gland.

DESIGN

Case report.

SETTING

Department of Gynecology, Hospital Atlas, EUC, in ZlínConclusion: Aggressive angiomyxoma is a rare mesenchymal tumor, which is occuring more in women, affects the vulva, perineum and pelvis. Typical is slowly and infiltrative growth with high-risk of local recurence.

Brain Metastasis of Atrial Myxoma: Case report

Metastasis of an atrial myxoma to the brain is extremely rare. Thus far there are only 17 cases reported, including our present case. Most of the brain metastases manifest only in 3 to 6 decades, after an average time frame of one to two years after surgical removal of parental tumour. We present a case of brain metastases of atrial myxoma in a teenager of the youngest age among all reported cases, unusually as early as 15 years old. The progress of the metastatic process had been insidious for three years after heart surgery, The imaging demonstrated a rather sizeable tumour by the time when the patient is symptomatic. The location of the metastatic tumour is anyhow superficial to the cortical surface, enabling complete surgical excision of the tumour easily achievable with favourable outcome.

[Myxoma and myxoid chondrosarcoma of the nasal septum: two case reports]

Myxoid neoplasms are histopathologically divided into true myxomas and other tumors of myxomatous character. In the region of the nasal septum, this tumor entity is extremely rare. In the following two case reports, the unusual findings of a myxoma and a myxoid chondrosarcoma of the nasal septum are presented and discussed. At first visit, both patients reported a slowly progressing, bilateral nasal obstruction. In nasal endoscopy, both showed a smoothly surfaced, spheroid, soft tissue mass in the dorsal nasal septum. On CT-scans, a displacing growth was described for the first patient; in the second patient, a bony arrosion of the floor of the sphenoid sinus was suspected. Both lesions were surgically completely removed. The histopathological diagnosis was myxoma in the first and myxoid chondrosarcoma in the second patient. An early, locally recurrent tumor in the second patient could also be surgically removed. Both patients have been in full remission for more than a year. In spite of the similar symptoms and clinical findings, histopathologically different myxoid neoplasms of the nasal septum show marked variations in growth and recurrence.

A unique atrial primary cardiac lymphoma mimicking myxoma presenting with embolic stroke: a case report

An immunocompetent 29-year-old male presented with an embolic stroke from an unusual primary cardiac lymphoma. The cardiac lesion consisted of a polypoid, left atrial, mural fibrin thrombus with anaplastic tumor cells lining the surface of the clot. Histologic, immunophenotypic, and molecular characterizations were consistent with a diagnosis of CD30+ large B-cell lymphoma with anaplastic cytology. While tumor emboli from invasive primary cardiac lymphomas have been reported, this noninvasive fibrin thrombus-associated lymphoma appears to be unique and previously unreported.

Testicular tumors in Carney's complex

PURPOSE

Bilateral sex cord stromal testicular tumors are common in the syndrome of myxoma, spotty pigmentation and endocrine overactivity (Carney's complex). Large cell calcifying Sertoli cell tumor is the particular testicular tumor found in Carney's complex. A clinicopathological review of 26 patients is presented.

MATERIALS AND METHODS

We report 2 cases of Carney's complex with testicular tumors. An additional 24 patients with Carney's complex and testicular tumors were identified by MEDLINE search and review of the literature.

RESULTS

Bilateral testicular tumors were found in 16 patients (61%) with a familial occurrence in 10 (38%). A testicular mass was the most common presentation. The associated findings of Carney's complex included cardiac myxoma in 16 patients, skin myxoma in 16, skin pigmentation in 15, Cushing's syndrome in 8, acromegaly in 3 and schwannoma in 3. Excisional biopsy, surveillance, bilateral orchiectomy and unilateral orchiectomy were performed in 7, 4, 7 and 8 patients, respectively.

CONCLUSIONS

No local tumor recurrence or metastasis has developed in patients with bilateral and/or multifocal testicular tumors. Excisional biopsy or surveillance only are treatment options for bilateral testicular tumors in Carney's complex.

Mazabraud syndrome in two patients: clinical overlap with McCune-Albright syndrome

Mazabraud syndrome is a rare sporadic disorder, mainly characterized by bone fibrous dysplasia and intramuscular myxomas. We report here two new cases of Mazabraud syndrome. One of our patients (Patient 1) also had café-au-lait spots and multinodular goiter suggestive of McCune-Albright syndrome. We review the 37 previously reported cases with Mazabraud syndrome and discuss the 6/37 patients with criteria of Mazabraud and McCune-Albright syndromes. Based on the clinical overlap between the two syndromes, we tested the GNAS1 gene in blood leukocytes and skin fibroblasts of Patient 1, but found no evidence of an activating mutation in the GNAS1 gene.

Myxomas of the head and neck

PURPOSE

Myxomas are rare, locally infiltrative, benign, connective tissue tumors that are found in bone and somatic soft tissues. This article reports our experience with head and neck myxomas and provides a comprehensive literature review.

MATERIALS AND METHODS

Retrospective record review of head and neck myxoma cases seen at 2 tertiary referral centers in Houston, Texas, from 1970 to 1994. Comprehensive literature review and compilation of all myxomas reported in the head and neck.

RESULTS

We identified 7 cases of true head and neck myxoma treated in our centers and identified 169 cases reported in the literature. Most often, myxomas originated in bone (mandible or maxilla) and were most commonly found in adults. All tumors except 1 were treated surgically. Recurrence rates were 6% for local or wide excision and 28% for more conservative surgery such as enucleation or curretage.

CONCLUSIONS

Myxomas of the head and neck should be treated with complete excision of the tumor with clear margins.