RESUMEN
We report a case of a 25-year-old man present with acute ST-segment elevation myocardial infarction caused by a large left atrial myxoma. Nutrient vessels of the atrial mass showed a unique ''dye brushes'' sign on coronary angiography.
Asunto(s)
Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Adulto , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Humanos , Masculino , Mixoma/complicaciones , Mixoma/cirugía , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/etiologíaRESUMEN
Preoperative coronary angiography for cardiac myxoma not only excludes coronary artery disease but also detects the artery feeding the cardiac myxoma, which has several clinical implications. In this study, we examined cardiac myxoma cases in two tertiary hospitals using coronary angiography to identify the artery feeding the myxoma. We retrospectively reviewed 42 patients with cardiac myxoma who had undergone surgical removal between July 2008 and December 2015 in two tertiary hospitals, and recorded their baseline characteristics, echocardiographic findings, and coronary angiography. Among those 42 patients, 23 (55%) had coronary angiography before surgery and in no case was significant luminal narrowing observed. In 21 of the coronary angiograms, the artery feeding the cardiac myxoma had a vascular branch (100%), clusters of tortuous vessels with contrast medium pooling (67%), an arteriocavity fistula (33%), and a mobile feeding artery (67%). No significant relationship was found between coronary artery dominance type and the origin of the artery feeding the cardiac myxoma (P = 0.362). Identification of the artery feeding the cardiac myxoma, with a distinctive vascular appearance in coronary angiography, is important for several clinical applications such as helping to diagnose cardiac myxoma and to plan the surgical approach. Clin. Anat. 33:833-838, 2020. © 2019 Wiley Periodicals, Inc.
Asunto(s)
Angiografía Coronaria , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Myxoma is a common benign tumour found in the heart. On reviewing literature, we found some left atrial myxomas receive blood supply from the right coronary artery. Performing a coronary angiogram in a cardiac tumour has the following uses: (1) it shows the vascularity that can be ligated by the surgeon at operation; (2) if there is a blood supply visible, it may not be an intracardiac thrombus; (3) the coronary angiogram may detect a myxoma even before an echocardiogram does so; (4) some myxomas may bleed into the right atrium or left atrium and this may be seen on coronary angiography. We show here the neovascularity of a left atrial myxoma and its blood supply from the right coronary artery. We recommend that all routine coronary angiograms be reviewed carefully for any signs of tumour vascularity or tumour blush as this would prevent missing early myxomas. Echocardiography is the gold standard for detection of myxomas but literature has a number of intracardiac tumours that were detected only by the tumour blush. Some left atrial tumours have been treated by occluding their blood supply.The absence of a blood supply on coronary angiography could rule out a benign cardiac tumour that usually has a blood supply.
Asunto(s)
Angiografía Coronaria/métodos , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/diagnóstico por imagen , Adulto , Medicina Basada en la Evidencia , Femenino , Neoplasias Cardíacas/irrigación sanguínea , Humanos , Mixoma/irrigación sanguínea , Sensibilidad y EspecificidadRESUMEN
A 73-year-old woman presented with exertional chest pain and mild dyspnea for several months. In this case, preoperative coronary angiography showed neovascularization originating from the right coronary artery (RCA) and left circumflex (LCX). Vascular supply in left atrial myxomas usually originates from the LCX and sometimes from the RCA, but vascular supply from both the right and left coronary arteries is rarely seen.
Asunto(s)
Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Anciano , Procedimientos Quirúrgicos Cardíacos , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/cirugía , Humanos , Mixoma/irrigación sanguínea , Mixoma/cirugía , Enfermedades RarasRESUMEN
Aggressive angiomyxoma is an uncommon mesenchymal tumor that mostly involves the pelvic and perineal regions in young women.We herein report an extremely rare case of aggressive angiomyxoma in a 75-year-old man. The patient had undergone follow-up for an intraductal papillary mucinous neoplasm.In September 2015, CT detected a tumor measuring 33 mm in diameter around the pelvis, and the tumor showed gradual increase in size.MRI revealed a relatively sharply marginated tumor with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images.For treatment and diagnosis, we laparoscopically resected the tumor. Histopathologically, the specimen showed spindle tumor cells within a myxoid background and vascular structures.The tumor was diagnosed as aggressive angiomyxoma, and surgical margins were negative for tumor cells. The patient is currently doing well without any signs of recurrence as of 18 months postoperatively.
Asunto(s)
Mixoma/irrigación sanguínea , Neoplasias Pélvicas/irrigación sanguínea , Anciano , Humanos , Imagen por Resonancia Magnética , Masculino , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Neoplasias Pélvicas/diagnóstico por imagen , Neoplasias Pélvicas/cirugía , Resultado del TratamientoAsunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Isquemia Miocárdica/diagnóstico por imagen , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Biopsia con Aguja , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Angiografía Coronaria/métodos , Diagnóstico Diferencial , Ecocardiografía Transesofágica/métodos , Servicio de Urgencia en Hospital , Atrios Cardíacos/patología , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/patología , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Mixoma/irrigación sanguínea , Neovascularización Patológica/diagnóstico por imagen , Neovascularización Patológica/fisiopatología , Medición de Riesgo , Resultado del TratamientoAsunto(s)
Fístula/diagnóstico , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Fístula/etiología , Atrios Cardíacos , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/complicaciones , Humanos , Imagen por Resonancia Cinemagnética/métodos , Mixoma/irrigación sanguínea , Mixoma/inducido químicamente , Neovascularización PatológicaRESUMEN
OBJECTIVE: The aim of the present study was to determine and establish the immunohistochemical distribution of VEGF-A and ORM-1 protein in odontogenic myxomas to suggest a possible function in the biological behavior of odontogenic myxomas. MATERIALS AND METHODS: A total of 33 odontogenic myxoma cases and three tooth germs were included. Immunohistochemistry was performed to localize VEGF-A and ORM-1 proteins in tumor cells, endothelial cells and extracellular matrix in the odontogenic myxomas. The intratumoral microvessel density (MVD) was determined with CD34 and Factor VIII antibodies. RESULTS: Immunopositivity was strong in the endothelial cells, which compose various vessels, and in the randomly oriented stellate, spindle-shaped and round tumoral cells with long cytoplasmic processes. More than half of the extracellular matrix lacked expression of VEGF-A. ORM-1 expression was strong in both endothelial cells and tumor cells, and the myxoid extracellular matrix was positive, with moderate or strong immunoexpression in all cases. An important finding of this study was the statistically significant positive correlation between the expression of ORM-1 and VEGF-A in tumor cells (p=0.02). CONCLUSIONS: The results of this study suggest that the expression of VEGF-A and ORM-1 may be associated with two mechanisms (angiogenesis and tumor structural viscosity) that may influence tumor growth in odontogenic myxoma.
Asunto(s)
Mixoma/metabolismo , Tumores Odontogénicos/metabolismo , Orosomucoide/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Adulto , Células Endoteliales/metabolismo , Células Endoteliales/patología , Femenino , Humanos , Masculino , Mesodermo/metabolismo , Mesodermo/patología , Microvasos/patología , Mixoma/irrigación sanguínea , Mixoma/patología , Tumores Odontogénicos/irrigación sanguínea , Tumores Odontogénicos/patología , Estadísticas no ParamétricasRESUMEN
Superficial angiomyxomas are uncommon benign mesenchymal tumors. They often recur locally if partially removed. This case report demonstrates not only the characteristic pathological findings of a superficial angiomyxoma in a 33- year-old man, but also shows a unique dermatoscopic image, which in our estimation resembles a celestial red planet such as the blood moon seen during a lunar eclipse. We propose to call this the "red planet" sign for a superficial angiomyxoma on dermoscopic examination.
Asunto(s)
Mixoma/patología , Neoplasias Cutáneas/patología , Adulto , Dorso/patología , Dorso/cirugía , Biopsia , Dermoscopía , Humanos , Masculino , Mixoma/irrigación sanguínea , Neoplasias Cutáneas/irrigación sanguíneaRESUMEN
Although angiographically detectable neovascularity is being reported with increasing frequency in patients with cardiac myxoma, associated coronary fistula to the cardiac chamber has not been described. We report a 62-year-old woman in whom cardiac computed tomography (CT) enabled the noninvasive diagnosis of a left atrial myxoma with neovascularization arising from the left circumflex artery and the formation of an unusual fistula into the left atrial cavity, with concomitant evaluation of the coronary arteries. Careful suture ligation of a supplying coronary branch in the atrial septum was performed during tumor excision to prevent the development of intra-atrial steal.
Asunto(s)
Fístula/complicaciones , Atrios Cardíacos , Cardiopatías/complicaciones , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Tomografía Computarizada Multidetector , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Femenino , Neoplasias Cardíacas/complicaciones , Humanos , Persona de Mediana Edad , Mixoma/complicaciones , Neovascularización Patológica , UltrasonografíaRESUMEN
The patient was a 51-year-old male with a 3-year history of a slow-growing, asymptomatic, subcutaneous mass in the left temporal region. Magnetic resonance imaging revealed a well-defined extracranial lesion with heterogeneous enhancement and without invasion of the skull. A variety of soft tissue tumors were included in the differential diagnosis. The patient underwent total resection of the tumor, and a diagnosis of intramuscular myxoma was confirmed histologically. There was no evidence of recurrence at 6-month follow-up. The present case is the first characterization of the radiological appearance of intramuscular myxoma in the temporal muscle. I emphasize that increased awareness of this rare lesion and a careful clinical and radiological preoperative assessment are crucial in determining an appropriate treatment strategy for patients with a soft tissue tumor of the head.
Asunto(s)
Angiografía , Aumento de la Imagen , Imagen por Resonancia Magnética , Neoplasias de los Músculos/patología , Neoplasias de los Músculos/cirugía , Mixoma/diagnóstico , Mixoma/cirugía , Músculo Temporal/patología , Músculo Temporal/cirugía , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de los Músculos/irrigación sanguínea , Mixoma/irrigación sanguínea , Mixoma/patología , Músculo Temporal/irrigación sanguíneaAsunto(s)
Circulación Coronaria , Vasos Coronarios/fisiopatología , Neoplasias Cardíacas/irrigación sanguínea , Hemodinámica , Mixoma/irrigación sanguínea , Procedimientos Quirúrgicos Cardíacos , Vasos Coronarios/diagnóstico por imagen , Ecocardiografía , Femenino , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/etiología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Persona de Mediana Edad , Mixoma/complicaciones , Mixoma/diagnóstico , Mixoma/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Myxomas are the commonest cardiac tumours and are usually localised in the atria. Neovascularisation in cardiac myxomas has been shown in previous case reports. However, the clinical importance of neovascularisation in cardiac myxomas is not well understood. In our case report, we present a right atrial myxoma in a 46 year-old woman admitted to our hospital with exertional angina and dyspnea. Coronary angiography revealed the presence of tumour neovascularisation from the right coronary artery, with no evidence of coronary artery stenosis. We thus speculate that neovascularisation of myxoma may cause typical anginal symptoms as a result of coronary steal phenomenon. Coronary angiography might help in the evaluation of the neovascularisation process and also in indicating surgery.
Asunto(s)
Vasos Coronarios/cirugía , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico , Mixoma/irrigación sanguínea , Mixoma/diagnóstico , Neovascularización Patológica/diagnóstico por imagen , Angina Estable/etiología , Angiografía Coronaria , Disnea/etiología , Femenino , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Mixoma/complicaciones , Mixoma/cirugía , Neovascularización Patológica/complicacionesAsunto(s)
Diagnóstico por Imagen/métodos , Atrios Cardíacos , Neoplasias Cardíacas/diagnóstico , Neoplasias Pulmonares/secundario , Mixoma/diagnóstico , Células Neoplásicas Circulantes , Embolia Pulmonar/diagnóstico , Trombosis/diagnóstico , Angiografía Coronaria , Diagnóstico Diferencial , Embolectomía , Femenino , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/irrigación sanguínea , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Persona de Mediana Edad , Mixoma/irrigación sanguínea , Embolia Pulmonar/cirugía , Trombosis/cirugíaAsunto(s)
Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Neovascularización Patológica/diagnóstico por imagen , Puente Cardiopulmonar , Angiografía Coronaria , Femenino , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Mixoma/cirugíaRESUMEN
Cardiac myxomas are highly vascular tumors and there is no consensus on the use of coronary angiography to assess their vascularity. A 64-year-old male patient presented with complaints of exertional dyspnea, fatigue, arthralgia, weight loss, intermittent high fever, and palpitation. He had an 18-month history of stent implantation for the left anterior descending coronary artery. Echocardiography showed a mobile mass in the left atrium with regular contours. Coronary angiography was performed with the initial diagnosis of myxoma and vascular supply of the tumor by the proximal branches of the right coronary artery (RCA) was visualized. Re-evaluation of previous angiograms of the patient showed existence of the same mass, in significantly smaller size, and supply from the RCA. The mass which was 5.5x1x0.5 cm in size was removed by surgical resection and the branches of the RCA supplying the tumor were ligated. Histopathologic examination confirmed the diagnosis. During 20 months of follow-up, the patient was asymptomatic and echocardiographic examinations were normal.
Asunto(s)
Angiografía Coronaria , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Vasos Coronarios/patología , Vasos Coronarios/cirugía , Atrios Cardíacos , Neoplasias Cardíacas/cirugía , Humanos , Ligadura , Masculino , Persona de Mediana Edad , Mixoma/cirugía , Neovascularización Patológica/diagnóstico por imagen , Cuidados Preoperatorios , Stents , Resultado del Tratamiento , UltrasonografíaAsunto(s)
Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/cirugía , Mixoma/irrigación sanguínea , Mixoma/cirugía , Neovascularización Patológica , Procedimientos Quirúrgicos Cardíacos , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Humanos , Imagen por Resonancia Cinemagnética , Persona de Mediana Edad , Mixoma/diagnóstico , Mixoma/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Aggressive angiomyxoma is a rare mesenchymal neoplasm, which almost always occurs in the vulvovaginal region and which exhibits a marked tendency for local recurrence after excision. A wide range of other mesenchymal lesions occur in this region, which potentially mimic aggressive angiomyxoma to a variable extent. Because rearrangement of the HMGA2 gene has been shown in a significant percentage of aggressive angiomyxomas, we examined the expression of HMGA2 protein in this neoplasm and in a large number of other mesenchymal lesions occurring at this site, including many which were referred with a possible diagnosis of aggressive angiomyxoma. There was positive staining of tumor cell nuclei, mostly with a diffuse distribution, in all but 2 aggressive angiomyxomas (n=12). Blood vessel endothelial cells within the neoplasms, entrapped tissues, and surrounding normal tissues were negative. Ten of 23 leiomyomas were positive, as were occasional other neoplasms. Based on our study, we conclude that HMGA2 is positive in most aggressive angiomyxomas and is useful in diagnosis as most mesenchymal lesions which closely mimic this are negative. However, caution should be exercised as some other vulvovaginal mesenchymal lesions, especially, but not exclusively leiomyomas can be HMGA2-positive. As well as being of value in primary diagnosis, HMGA2 is useful in evaluating margins and in reexcision specimens of aggressive angiomyxoma in identifying foci of residual or recurrent tumor.