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1.
Medicine (Baltimore) ; 98(51): e18386, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861001

RESUMO

RATIONALE: Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare. PATIENT CONCERNS: A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass. DIAGNOSIS: A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made. INTERVENTION: Right atrial and pulmonary artery embolectomy. OUTCOMES: The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful. LESSONS: RAMs should be considered unlikely reasons for fatal pulmonary embolisms.


Assuntos
Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Embolia Pulmonar/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Embolia Pulmonar/cirurgia
2.
Tex Heart Inst J ; 46(3): 215-218, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708707

RESUMO

Infected cardiac myxomas are rare and can have disastrous sequelae; urgent surgical resection is typically indicated. We report the case of a 43-year-old user of intravenous heroin who presented with weakness and dyspnea. He was diagnosed with infective endocarditis of a myxoma attached to the left ventricular lateral wall. The patient underwent successful surgical resection of the myxoma and then completed 4 weeks of antibiotic therapy. In addition to discussing this patient's case, we briefly review the relevant medical literature, in which we found only 4 previous reports of left ventricular myxoma associated with infective endocarditis.


Assuntos
Endocardite Bacteriana/etiologia , Neoplasias Cardíacas/complicações , Dependência de Heroína/complicações , Mixoma/complicações , Infecções Estafilocócicas/etiologia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Mixoma/diagnóstico , Mixoma/cirurgia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação
3.
Heart Surg Forum ; 22(5): E317-E318, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31596704

RESUMO

Cardiac myxoma typically is thought to be a slow-growing, benign primary. Atrial myxomas can lead to many complications and can also mimic mitral stenosis, infective endocarditis, and other vascular diseases associated with systemic embolization. A 75-year-old woman with a history of lung cancer (pT1cN1, adenocarcinoma), atrial fibrillation, and a cerebral infarction presented with dysarthria and visual disturbances. In our case, we had to consider some questionable issues with the left atrial mass, and whether the recurrence of cerebral events was due to the thrombotic material in the left atrium or from locally recurrent lung cancer from the stump margin of the previously resected left superior pulmonary vein. We present a case with a rapidly-growing left atrial myxoma with a growth rate of 12.60 mm/month, rather than a thrombus or local recurrence of tumor under a medication of non-VKA oral antagonists.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Mixoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Fibrilação Atrial/etiologia , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Diagnóstico Diferencial , Progressão da Doença , Endocardite/diagnóstico , Feminino , Átrios do Coração , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Estenose da Valva Mitral/diagnóstico , Mixoma/patologia , Mixoma/cirurgia
5.
Transplant Proc ; 51(9): 3189-3190, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31619343

RESUMO

A 43-year-old woman with chronic hypersensitivity pneumonitis was referred for lung transplant assessment. An echocardiogram as part of her work-up revealed a large left atrial myxoma, presenting a conundrum on how best to manage her combined pathology. Because of the level of pulmonary disease, early intervention to remove the myxoma was not thought be viable without postoperative support. Use of extracorporeal membrane oxygenation to bridge patients for lung transplant is feasible, yet risks increased perioperative mortality. We present the first reported case of simultaneous cardiac myxoma removal and lung transplant.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/cirurgia , Transplante de Pulmão/métodos , Mixoma/cirurgia , Adulto , Alveolite Alérgica Extrínseca/complicações , Alveolite Alérgica Extrínseca/cirurgia , Feminino , Neoplasias Cardíacas/complicações , Humanos , Achados Incidentais , Mixoma/complicações
7.
World Neurosurg ; 131: 32-37, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369881

RESUMO

OBJECTIVE: We have described the integrated use of a neuronavigation-guided system for frameless stereotaxy (VarioGuide [Brainlab AG, Munich, Germany]) with intraoperative magnetic resonance imaging (iMRI) and 5-aminolevulinic acid (5-ALA) and report the advantages and disadvantages that the use of these tools together can have in the treatment of various types of intracerebral lesions. METHODS: After the skin incision, creation of a burr hole at the entry point, and dura opening, the VarioGuide procedure was started. Initially, the wizard software will require positioning of the stereotactic arm over the burr hole and provides feedback regarding the correct position. The procedure is performed in an iMRI theater furnished with a surgical microscope (Kinevo [Carl Zeiss AG, Oberkochen, Germany]) supplied with a violet-blue excitation light for 5-ALA fluorescence. At the end of the surgery, iMRI was performed. We present 2 exemplary cases to describe the application and workflow of these tools. RESULTS: When used for traditional biopsy, the possibility of performing a new iMRI scan could be of paramount importance because the brain shift can be compensated for and an alternative trajectory can be calculated from the new images and fiber tracking reconstruction. The fluorescence of the tissue sample examined under the microscope filter can provide immediate information about the nature of the lesion, allowing for the possibility of converting the procedure to open craniotomy and tumor removal. CONCLUSION: The use of combination frameless stereotaxy with iMRI and 5-ALA has shown benefits in terms of safety and precision. Moreover, the use of these tools can simplify tumor removal after simple biopsy, widening the spectrum of indications.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Mixoma/cirurgia , Neuronavegação/métodos , Técnicas Estereotáxicas , Adulto , Idoso , Ácido Aminolevulínico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Feminino , Fluorescência , Glioblastoma/diagnóstico por imagem , Glioblastoma/patologia , Humanos , Cuidados Intraoperatórios , Imagem por Ressonância Magnética , Masculino , Mixoma/diagnóstico por imagem , Mixoma/patologia
8.
Mymensingh Med J ; 28(3): 562-566, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391427

RESUMO

Cardiac Myxoma is the most common benign intra-cardiac tumor of heart. We studied its incidence, clinical presentations, short term outcome, morbidity and mortality following surgery over a period of 17 years. The retrospective observational study was performed in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD) Dhaka, Bangladesh from 2000 to 2016. NICVD is the tertiary hospital for cardiovascular surgery in the Government sector. One hundred twenty nine (129) patients were of cardiac myxoma among 11,923 open heart surgery was done in this study period of 17 years. As a result, cardiac myxoma patients represent 1.08% of all open heart surgery. Pre-operative diagnosis was done on clinical presentations and 2D echocardiography, which is the most important tool for its diagnosis. Most of the patients presented at 4th to 5th decade of life. The patients presented with triad of valve obstructive features, embolic symptoms and constitutional symptoms alone or in combination. Among all myxoma patients, majority (86.6%) had left atrial myxoma. Cardiac myxoma forms a very small percentage of all cardiac diseases requiring surgical treatment. Immediate surgical excision is indicated in all patients to avoid life-threatening complications. Outcome of surgical treatment was excellent.


Assuntos
Neoplasias Cardíacas , Mixoma , Bangladesh , Átrios do Coração , Neoplasias Cardíacas/cirurgia , Humanos , Mixoma/cirurgia , Estudos Retrospectivos
10.
Echocardiography ; 36(6): 1191-1193, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31206792

RESUMO

A 59-year-old woman with episodes of chest pain was diagnosed with cardiac myxoma. Transesophageal echocardiography (TEE) showed a massive vascularized tumor and there was a blood stream spurting from the internal cavity of tumor into left atrium through an interconnected sinus tract. Coronary artery angiography (CAG) indicated that the mass was enhanced upon the administration of contrast media, which spouted into the cardiac chamber. This is the first case to report the development of the coronary artery steal syndrome due to hemorrhage and associated fistula formation in a left atrial myxoma, which was detected by TEE and confirmed by CAG.


Assuntos
Doença da Artéria Coronariana/etiologia , Neoplasias Cardíacas/complicações , Hemorragia/etiologia , Mixoma/complicações , Fístula Vascular/etiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Ecocardiografia Transesofagiana/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Síndrome , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
11.
Int. j. morphol ; 37(2): 677-681, June 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1002275

RESUMO

El angiomixoma de la pelvis es un tumor mesenquimal inusual; que dado su alto potencial de recidiva es relevante que la exéresis quirúrgica sea lo más radical posible. Por su parte, la endometriosis infiltrativa profunda, es otra entidad poco frecuente que requiere de tratamientos complejos. La co-existencia de ambas patologías representa una situación absolutamente infrecuente; de los que hay muy pocos casos reportado en la literatura occidental. Se presenta el caso de una mujer de 41 años de edad que desarrolló ambas entidades nosológicas de forma concomitante y que fue tratada quirúrgicamente con buenos resultados.


Angiomyxoma of the pelvis is an unusual mesenchymal tumor; that given its high potential for recurrence, it is relevant that the surgical resection be as radical as possible. For its part, to deep infiltrative endometriosis is another rare entity that requires complex treatments. The co-existence of both pathologies represents an absolutely infrequent situation; of which there are very few cases reported in western literature. We present the case of a 41-year-old woman who developed both clinical entities concomitantly and who was treated surgically with good results.


Assuntos
Humanos , Feminino , Adulto , Neoplasias Pélvicas/patologia , Endometriose/patologia , Mixoma/patologia , Neoplasias Pélvicas/cirurgia , Neoplasias Pélvicas/complicações , Colectomia , Endometriose/cirurgia , Endometriose/complicações , Mixoma/cirurgia , Mixoma/complicações
12.
World Neurosurg ; 128: 200-201, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100517

RESUMO

Cardiac myxomas are benign cardiac neoplasms that can send a shower of emboli to cerebral arteries and cause cerebrovascular complications including large, fusiform intracranial aneurysms. These aneurysms result from myxomatous cells invading and weakening the vessel wall and can develop years after myxoma resection. In this clinical image, we illustrate a symptomatic, giant fusiform aneurysm that was discovered and treated 5 years after successful surgical resection of atrial myxoma.


Assuntos
Aneurisma/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Mixoma/cirurgia , Aneurisma/etiologia , Aneurisma/terapia , Angiografia Cerebral , Embolização Terapêutica , Átrios do Coração , Neoplasias Cardíacas/complicações , Humanos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mixoma/complicações , Tomografia Computadorizada por Raios X
13.
BMJ Case Rep ; 12(5)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142482

RESUMO

We describe a case of a 44-year-old woman with locally advanced aggressive angiomyxoma with a novel translocation high-mobility group AT-hook 2-yes-associated protein 1 (HMGA2-YAP1) fusion, implying a t(11;12)(q22.1;q14.3) translocation. She was started on gonadotropin-releasing hormone agonist injection and an aromatase inhibitor for persistent disease, which responded to treatment; she was subsequently treated with radiation before a more definitive operation was conducted. This case report indicates that HGMA2-YAP1-translocated aggressive angiomyxoma is responsive to oestrogen antagonism and hopefully will allow for the development of diagnostics useful for this rare but often morbid neoplasm. This case also highlights the importance of appropriate workup of a soft tissue mass.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Proteína HMGA2/genética , Mixoma/genética , Fatores de Transcrição/genética , Neoplasias Vulvares/genética , Adulto , Anastrozol/uso terapêutico , Antineoplásicos/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Diagnóstico Diferencial , Antagonistas de Estrogênios/uso terapêutico , Feminino , Humanos , Leuprolida/uso terapêutico , Imagem por Ressonância Magnética , Mixoma/tratamento farmacológico , Mixoma/cirurgia , Doenças Raras , Translocação Genética/genética , Resultado do Tratamento , Neoplasias Vulvares/tratamento farmacológico , Neoplasias Vulvares/cirurgia
14.
World Neurosurg ; 127: 121-125, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30878747

RESUMO

BACKGROUND: A cardiac myxoma (CM) is the most common primary tumor of the heart. This case report highlights that for metastatic CMs, even after a successful total resection, there is a small but real risk of recurrence that can manifest as late as 10 years after initial tumor resection. CASE DESCRIPTION: We present the case of a 53-year-old woman who visited the emergency room after a 4-day worsening right-sided weakness. The patient was diagnosed with a left CM 10 years previously, and a complete surgical resection was performed at that time. A noncontrast computed tomography of the head revealed a left parietal hematoma and a contrast computed tomography scan of the head revealed an enlarged left parieto-occipital vein that was subsequently shown to be part of an arteriovenous fistula. After embolization of the fistula was performed, postprocedure magnetic resonance imaging of the brain showed redemonstration of acute intraparenchymal hemorrhage with vasogenic edema. The history of a previously resected CM and the multifocal distribution of brain lesions opened the possibility of slow-growing metastasis from the previous myxoma. CONCLUSIONS: Our case report demonstrates the metastatic nature of CMs to the central nervous system, even after successful gross total resection and no local relapsing mass in subsequent ultrasonographic follow-ups. A comprehensive evaluation on clinical and imagological grounds is mandatory to rule out the presence of myxomatous metastatic disease. Awareness and recognition of the potential neurologic manifestations of a metastatic CM will prevent unnecessary diagnostic workup and treatments.


Assuntos
Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Mixoma/complicações , Mixoma/cirurgia , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(11): e14866, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882689

RESUMO

RATIONALE: Cardiac myxoma is the most common cardiac neoplasm. Currently, there are not many reports on familial cardiac myxoma. Herein, we reported 2 first-degree relatives with left atrial myxoma. PATIENT CONCERNS: A 20-year-old female was admitted in our hospital for lapsing into a coma for 24 hours, and was diagnosed with recurrent left atrial cardiac myxoma. The patient's father also had a history of cardiac myxoma. DIAGNOSIS: The patient was diagnosed with left atrial myxoma using transthoracic echocardiography (TTE). Whole exome sequencing (WES) identified a p.Val164Aspfs (c.491-492delTG) mutation in the cAMP-dependent protein kinase A (PKA) regulatory (R) subunit 1 (PRKAR1A) gene for both the proband and her father, but not in her uncle and brother, who had not shown manifestation of cardiac myxoma by the time of this report. INTERVENTIONS: The myxoma resection was performed following the standard procedure of open chest surgery. OUTCOMES: The tumor was successfully removed along with the tuberculum. The patient recovered well and was discharged home. No recurrence occurred during 1-year follow-up. LESSONS: Our findings suggest that PRKAR1A mutation (c.491_492delTG) may be associated with cardiac myxoma, and genetic counseling and specific locus mutation tests may contribute to assessing the risk of cardiac myxoma.


Assuntos
Subunidade RIalfa da Proteína Quinase Dependente de AMP Cíclico/análise , Subunidade RIalfa da Proteína Quinase Dependente de AMP Cíclico/genética , Mixoma/genética , Subunidade RIalfa da Proteína Quinase Dependente de AMP Cíclico/sangue , Proteínas Quinases Dependentes de AMP Cíclico/análise , Proteínas Quinases Dependentes de AMP Cíclico/sangue , Ecocardiografia/métodos , Características da Família , Feminino , Aconselhamento Genético/métodos , Humanos , Mixoma/sangue , Mixoma/cirurgia , Adulto Jovem
17.
World Neurosurg ; 126: e77-e83, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30738938

RESUMO

BACKGROUND: Primary intracranial myxomas (PIMs) are extremely rare benign tumors that arise from the skull base. The aim of this study was to characterize the radiologic manifestation of PIMs in a series of 14 cases. METHODS: We reviewed the imaging and clinical data of 14 patients with pathologically proven PIMs. Assessed features of lesions include shape, margin, bony destruction, attenuation and/or signal intensity, and pattern of enhancement. RESULTS: Extremely high-density foci indicating calcification or bony debris within the tumors were observed in 5 cases on computed tomography images. On magnetic resonance images, the tumors demonstrated heterogeneous hypointensity on T1-weighted images (T1WI) and hyperintensity on T2-weighted images (T2WI). A honeycomb pattern on enhanced T1WIs was observed in 63.6% (7/11) of the cases. CONCLUSIONS: Radiologic findings of PIMs include calcified foci or bone debris on computed tomography, heterogeneous hypointensity on T1WI and predominantly hyperintensity on T2WI, and honeycomb appearance on enhanced T1WI.


Assuntos
Mixoma/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Adulto , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Aumento da Imagem/métodos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mixoma/cirurgia , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Tomografia Computadorizada Espiral , Resultado do Tratamento , Adulto Jovem
18.
Braz J Cardiovasc Surg ; 34(1): 22-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810670

RESUMO

OBJECTIVE: To disclose the relationships between the anatomic features of cardiac myxomas and plasma interleukin (IL)-6 levels. METHODS: Twelve patients undergoing cardiac myxoma resection at The First Hospital of Putian, Teaching Hospital, Fujian Medical University were enrolled into this study. Pre- and postoperative IL-6 levels were determined by an enzyme-linked immunosorbent assay method, and correlations between cardiac myxoma dimension or volume and plasma IL-6 levels were analyzed. C-reactive protein (CRP) levels were also evaluated. RESULTS: IL-6 and CRP levels were significantly decreased one month after cardiac myxoma resection in comparison to preoperative values. IL-6 and CRP levels did not differ between patients with a cardiac myxoma of irregular appearance and those with a myxoma of regular gross appearance, or between patients with a pedicled or a sessile myxoma. Decrement of IL-6 of patients with irregular cardiac myxomas was much higher than that of patients with regular ones, while no intergroup difference was noted in decrement of CRP. A close direct correlation was noted between IL-6 levels and maximal dimension (length) or volume of cardiac myxomas, whereas CRP levels only correlated with maximal dimension of cardiac myxomas. CONCLUSION: Anatomic features of cardiac myxomas (sessile, irregular appearance, maximal dimension, and volume) could be determinants of the patients' circulating IL-6 levels. IL-6 was likely to be a more sensitive biomarker than CRP in predicting the inflammatory status of patients with cardiac myxoma. Sessile and irregular cardiac myxomas might predict more severe inflammatory conditions for their more abundant endothelial cells and IL-6 overproduction.


Assuntos
Proteína C-Reativa/análise , Neoplasias Cardíacas/sangue , Interleucina-6/sangue , Mixoma/sangue , Idoso , Biomarcadores Tumorais/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Valores de Referência , Estudos Retrospectivos , Carga Tumoral
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