[Association of a myxoma of the left atrium and a mitral stenosis : About a case]

Atrial myxoma is a rare and benign clinical entity. It remains common in women and mainly affects the left atrium. Its clinical picture is polymorphic. We report the case of a 53-year-old woman who consulted for dyspnea with cardiac failure's picture. The diagnosis of myxoma of the left atrium was made on echocardiography which also objectified the existence of mitral stenosis. The patient underwent surgical excision and mitral valve replacement with good postoperative outcomes.

Pseudo-tumeur inflammatoire cardiaque mimant un myxome

La pseudo-tumeur inflammatoire de localisation cardiaque est une entité rare et bénigne. Elle peut souvent mimer une tumeur maligne dans sa présentation clinique et radiologique, pouvant entrainer un retard diagnostic. Nous rapportons le cas d'un patient âgé de 20 ans, sans antécédents médicaux, admis dans le service pour l'exploration d'une fièvre prolongée. Un myxome du ventricule droit a initialement été suspecté sur l'imagerie. Une résection complète de la masse cardiaque a été effectuée. L'étude histopathologique a conclu à une pseudo-tumeur inflammatoire. Ce cas vise à présenter les caractéristiques cliniques, radiologiques, histologiques ainsi que la prise en charge d'une pseudo-tumeur inflammatoire cardiaque.

[Cardiac metastasis of a lung adenocarcinoma mimicking atrial myxoma]

Les tumeurs cardiaques secondaires demeurent une pathologie sévère et assez rare et sont typiquement associées à un stade évolué de la tumeur primitive et, de fait, à un pronostic péjoratif. Les présentations cliniques sont variables et potentiellement déroutantes. Nous rapportons les cas d’une patiente de 76 ans chez laquelle la présentation échocardiographique évoquait, en premier lieu, un myxome de l’oreillette gauche, mais le diagnostic définitif était celui d’un envahissement par un adénocarcinome pulmonaire. Nous abordons le tableau clinique, le résumé de la littérature et la prise charge.

[Intracardiac myxoma complicated by acute aortic occlusion (case report)]

We report the case for a 44-year-old patient without medical history, admitted in our department for bilateral acute limb ischemia (H6). The patient was hemodynamically stable and the physical examination shows limb sever ischemia (no femoral arterial pulses, coldness, cyanosis and paralysis). Abdominal CT angiography showed a complete occlusion of the infra renal abdominal aorta compatible with embolus. An embolectomy with Fogarty catheters was performed. Echocardiography showed a mass in the left atrium. Pathological examination of the material embolic confirmed the diagnosis of the cardiac myxoma. The clinical course was marked by the development of a sever syndrome of revascularization, death occurred the third day of hospitalization. Cardiac myxomas are the most common primary cardiac tumor. The mobility of the tumor and its gelatinous and crumbly consistency generates peripheral emboli.

[Myxoid tumors of deep soft tissues]

Myxoid soft tissue tumors form a heterogeneous group. Their biological potential encompasses the whole spectrum from benign to highly malignant. The present article focuses on myxoid tumors of the deep soft tissues: myxofibrosarcoma, low-grade fibromyxoid sarcoma, myxoma, myxoid liposarcoma, extraskeletal myxoid chondrosarcoma and nodular fasciitis. The last two decades have brought into practice multiple powerful tools that support pathologists in making precise diagnoses, even on small incisional biopsies: detection of fusion transcripts by rt-PCR, detection of chromosomal fusion or breakpoint by FISH, detection of point mutations by PCR and expression of specific markers by immunohistochemistry. Conventional morphology remains the mainstay of diagnosis, and it is essential to obtain adequate clinical and radiological information before interpreting small incisional biopsies. The present article is a summary of morphologic features used to diagnose the most common tumors of the deep soft tissues.

[Intracardiac thrombosis during celiac disease]

Thrombotic events occurring in the course of celiac disease are frequently reported in the literature. The localization is often unusual, mainly affecting the hepatic veins. To our knowledge, this is the first report of intracardiac thrombosis occurring in a patient with celiac disease. A 32-year-old patient with celiac disease adhered poorly to his gluten-free diet. He suffered an ischemic stroke revealing an intracardiac thrombus, which, on radiological imaging, simulated a multiple myxoma. Histological examination of the resected tumor enabled the correct diagnosis. Biological findings revealed severe protein C and S deficiency. The patient improved with anticoagulant therapy and gluten-free diet.

[Nerve sheath myxoma of the hyponychium]

BACKGROUND

Nerve sheath myxoma is a rare benign tumour of the extremities that was long confounded with neurothekeoma. Herein, we describe a rare case of interest because of its site on the hyponychium.

PATIENTS AND METHODS

A 31-year-old woman presented with a painless distal tumour on the right ring finger that had been present for 3 to 4 years. It consisted of a firm, round nodule under the nail and spreading to the fingertip. Complete excision was carried out after cutting away the distal nail plate. Histological examination revealed a myxoid tumour comprising very clearly delineated lobules containing pale fusiform cells with small nuclear inclusions. These cells expressed S100 protein but no CD34 or epithelial membrane antigen (EMA). Complete excision was performed and a full recovery was made.

DISCUSSION

This type of tumour is characteristic of nerve sheath myxoma, and is almost certainly of Schwannian origin, although distinct from Schwannoma. It is rare, occurs after the age of 35 years and is preferentially located in the extremities of the limbs. There has only been one other description of its occurrence under the fingernail, in which it was described as neurothekeoma. However, neurothekeoma is entirely different, being more cellular, with no expression of protein S100, and marked by the NKIC3 antibody; it occurs in children or young adults, and is frequently found on the face. These two tumours were confused for some time, but today they must be completely distinguished from one another. These myxomas must be completely excised because of the risk of relapse. Finally, they should be distinguished from other myxoid tumours of the digits, certain of which can be malignant.