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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.
Medicine (Baltimore) ; 98(38): e17250, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567993

RESUMO

RATIONALE: Central retinal artery occlusion (CRAO) due to cardiac myxoma primarily occurs in elderly individuals. Early detection and surgical resection of myxoma are extremely important because CRAO causes complete blindness in most cases. However, due to the extremely low incidence of CRAO caused by cardiac myxoma in the pediatric age group, such condition is rarely reported. PATIENT CONCERNS: A 16-year-old female patient visited our hospital due to sudden onset of vision loss in the left eye, dysarthria, and right-sided hemiplegia. DIAGNOSES: She was diagnosed with CRAO via fundoscopy. Results showed a cherry-red spot, indicating CRAO. Brain magnetic resonance imaging (MRI) revealed multifocal diffusion-restricted foci, particularly in the left frontal lobe. Echocardiography revealed a left atrial mass measuring 4.21 cm × 2.25 cm. The mass was attached to the interseptum and moved along the inflow of the mitral valve. Cardiac computed tomography (CT) revealed an enhanced mass measuring 3 cm × 2.2 cm × 3 cm and with irregular margin on the anterior wall of the left atrium and the border of the fossa ovalis. INTERVENTIONS: The patient underwent surgical excision under general anesthesia. Intraoperative finding showed a huge, jelly-like, and extremely friable mass. Pathological examination confirmed myxoma. OUTCOMES: During a follow-up of 2 years after diagnosis, she did not present with other neurological deficits and no residual mass was observed on echocardiography. However, visual impairment of the left eye persisted. LESSONS: Most patients with CRAO may present with other mild symptoms that are often be neglected before CRAO development. We recommend that patients who present with frequent syncopal attack or symptoms of transient ischemic attack should undergo echocardiography.


Assuntos
Cegueira/etiologia , Átrios do Coração , Neoplasias Cardíacas/complicações , Mixoma/complicações , Adolescente , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/patologia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Tomografia Computadorizada por Raios X
3.
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
4.
BMC Med Imaging ; 19(1): 67, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416421

RESUMO

BACKGROUND: Myxoid tumors pose diagnostic challenges for radiologists and pathologists. All myxoid tumors can be differentiated from each other using fluorescent in-situ hybridization (FISH) or immunohistochemical markers, except for myxomas and myxofibrosarcomas. Myxomas and myxofibrosarcomas are rare tumors. Myxomas are benign and histologically bland, whereas myxofibrosarcomas are malignant and histologically heterogenous. Because of the histological heterogeneity, low grade myxofibrosarcomas may be mistaken for myxomas on core needle biopsies. We evaluated the performance of T1-weighted signal intensity (T1SI), tumor volume, and radiomic features extracted from magnetic resonance imaging (MRI) to differentiate myxomas from myxofibrosarcomas. METHODS: The MRIs of 56 patients (29 with myxomas, 27 with myxofibrosarcomas) were analyzed. We extracted 89 radiomic features. Random forests based classifiers using the T1SI, volume features, and radiomic features were used to differentiate myxomas from myxofibrosarcomas. The classifiers were validated using a leave-one-out cross-validation. The performances of the classifiers were then compared. RESULTS: Myxomas had lower normalized T1SI than myxofibrosaromas (p = 0.006) and the AUC using the T1SI was 0.713. However, the classification model using radiomic features had an AUC of 0.885 (accuracy = 0.839, sensitivity = 0.852, specificity = 0.828), and outperformed the classification models using T1SI (AUC = 0.713) and tumor volume (AUC = 0.838). The classification model using radiomic features was significantly better than the classifier using T1SI values (p = 0.039). CONCLUSIONS: Myxofibrosarcomas are on average higher in T1-weighted signal intensity than myxomas. Myxofibrosarcomas are larger and have shape differences compared to myxomas. Radiomic features performed best for differentiating myxomas from myxofibrosarcomas compared to T1-weighted signal intensity and tumor volume features.


Assuntos
Fibrossarcoma/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Mixossarcoma/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
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
8.
BMJ Case Rep ; 12(5)2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31118174

RESUMO

There is no consensus regarding the ideal treatment for odontogenic myxomas, an odontogenic mesenchymal neoplasm. Various authors have suggested en bloc resection due to a concern regarding inadequate clearance while others have suggested more conservative treatment. We present a case managed by buccal cortical resection and an iliac crest bone graft. The patient had no recurrence for over 7 years.


Assuntos
Ílio/transplante , Mixoma/terapia , Tumores Odontogênicos/terapia , Adulto , Feminino , Humanos , Mixoma/diagnóstico por imagem , Tumores Odontogênicos/diagnóstico por imagem , Procedimentos Cirúrgicos Bucais , Resultado do Tratamento
9.
Cardiovasc Pathol ; 41: 18-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31005792

RESUMO

Most primary cardiac tumors are benign neoplasms, which generally can be differentiated from malignant neoplasms via certain radiological features. We present briefly a case of a 26-year-old man undergoing resection of a right atrial mass that based on preceding radiologic findings represent a myxoma. After pathologic examination, the lesion was determined to be an epithelioid angiosarcoma with unique frond-like architecture and multiple pedicular attachments to the atrial wall.


Assuntos
Células Epitelioides , Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Imagem por Ressonância Magnética , Mixoma/diagnóstico por imagem , Adulto , Biomarcadores Tumorais/análise , Biópsia , Erros de Diagnóstico , Células Epitelioides/química , Células Epitelioides/patologia , Neoplasias Cardíacas/química , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/química , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Imuno-Histoquímica , Masculino , Mixoma/patologia , Valor Preditivo dos Testes
10.
Echocardiography ; 36(5): 837-843, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30934139

RESUMO

INTRODUCTION: Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma. METHODS: This single-center retrospective study enrolled 93 patients (mean age: 52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism. RESULTS: The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752-0.964; P < 0.001). CONCLUSION: The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism.


Assuntos
Ecocardiografia/métodos , Embolia/diagnóstico , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/complicações , Mixoma/diagnóstico por imagem , Adulto , Idoso , Fibrilação Atrial/complicações , Embolia/complicações , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Estudos Retrospectivos , Fatores de Risco , Carga Tumoral
11.
Rev. pediatr. electrón ; 16(1): 6-12, abr. 2019.
Artigo em Espanhol | LILACS | ID: biblio-998405

RESUMO

Los tumores cardiacos primarios fetales representan una entidad de baja incidencia en la práctica clínica. La gran mayoría corresponde a lesiones benignas, siendo el rabdomioma el tipo más común. Si bien, es frecuente la regresión espontánea de este tipo de lesiones durante el embarazo, los tumores cardiacos fetales pueden asociarse a complicaciones como obstrucción del flujo cardíaco, insuficiencia valvular, arritmias, insuficiencia cardíaca e hidrops fetal, pudiendo conducir incluso a la muerte fetal. El mayor desarrollo de técnicas imagenológicas ha permitido un aumento en el número y precisión de los diagnósticos prenatales de tumores cardiacos, generando al mismo tiempo, nuevos desafíos y alternativas en relación al abordaje terapéutico. El objetivo del presente artículo de revisión es exponer la evidencia actual en relación al diagnóstico prenatal, manejo, complicaciones y condiciones asociadas de los tumores cardiacos fetales más frecuentes.


Fetal primary cardiac tumors represent a low incidence entity in clinical practice. The vast majority corresponds to benign lesions, with rhabdomyoma being the most common type. Although spontaneous regression of this type of lesions during pregnancy is frequent, fetal cardiac tumors can be associated with complications such as obstruction of cardiac flow, valvular insufficiency, arrhythmias, heart failure and fetal hydrops, which can even lead to fetal death. The greater development of imaging techniques has allowed an increase in the number and precision of prenatal diagnoses of cardiac tumors, generating at the same time, new challenges and alternatives in relation to the therapeutic approach. The objective of this review article is to present the current evidence regarding the prenatal diagnosis, management, complications and associated condition s of the most frequent fetal cardiac tumors.


Assuntos
Humanos , Feminino , Gravidez , Feto/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Rabdomioma/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Ultrassonografia Pré-Natal , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/terapia , Mixoma/diagnóstico por imagem
12.
J Cancer Res Clin Oncol ; 145(5): 1283-1295, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30900156

RESUMO

PURPOSE: Heart myxomas have been frequently considered as benign lesions associated with Carney's complex. However, after surgical removal, myxomas re-emerge causing dysfunctional heart. METHODS: To identify whether cardiac myxomas may develop a metastatic phenotype as occurs in malignant cancers, a profile of several proteins involved in malignancy such as oncogenes (c-MYC, K-RAS and H-RAS), cancer-associated metabolic transcriptional factors (HIF-1α, p53 and PPAR-γ) and epithelial-mesenchymal transition proteins (fibronectin, vimentin, ß-catenin, SNAIL and MMP-9) were evaluated in seven samples from a cohort of patients with atrial and ventricular myxomas. The analysis was also performed in: (1) cardiac tissue surrounding the area where myxoma was removed; (2) non-cancer heart tissue (NCHT); and (3) malignant triple negative breast cancer biopsies for comparative purposes. RESULTS: Statistical analysis applying univariate (Kruskal-Wallis and Dunn's tests) and multivariate analyses (PCA, principal component analysis) revealed that heart myxomas (7-15 times) and myxoma surrounding tissue (22-99 times) vs. NCHT showed high content of c-MYC, p53, vimentin, and HIF-1α, indicating that both myxoma and its surrounding area express oncogenes and malignancy-related proteins as occurs in triple negative breast cancer. CONCLUSIONS: Based on ROC (receiver operating characteristics) statistical analysis, c-MYC, HIF-1α, p53, and vimentin may be considered potential biomarkers for malignancy detection in myxoma.


Assuntos
Transformação Celular Neoplásica , Neoplasias Cardíacas/etiologia , Neoplasias Cardíacas/patologia , Mixoma/etiologia , Mixoma/patologia , Fenótipo , Animais , Biomarcadores Tumorais , Ecocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Mixoma/diagnóstico por imagem , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Oncogenes , Proteoma , Proteômica/métodos , Curva ROC , Ratos
14.
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
16.
BMJ Case Rep ; 12(2)2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30804157

RESUMO

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.


Assuntos
Angiografia Coronária/métodos , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Adulto , Medicina Baseada em Evidências , Feminino , Neoplasias Cardíacas/irrigação sanguínea , Humanos , Mixoma/irrigação sanguínea , Sensibilidade e Especificidade
17.
Trop Doct ; 49(3): 227-229, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30803365

RESUMO

We present here the case of a three-year-old girl with a maxillary myxoma misdiagnosed as tuberculosis (TB). She was referred to our TB clinic with fever for seven months and swelling of the left cheek and a positive Mantoux test. Her mother was also on treatment for TB lymphadenitis. The child had been commenced on anti-tuberculous therapy (ATT) two months before, and because of its unusual location of the swelling, we did a Caldwell-Luc procedure and a white gelatinous tissue was obtained which, on histopathological examination, revealed myxomatous tissue and no granulomas. TB culture was negative. The patient was then referred to the ENT department for surgical excision. We present this case, as not all swellings with positive Mantoux test or contact with TB are TB and it is essential to have a tissue diagnosis of TB to prevent unnecessary treatment with ATT drugs.


Assuntos
Neoplasias do Seio Maxilar/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Tuberculose/diagnóstico , Pré-Escolar , Erros de Diagnóstico , Feminino , Humanos , Tomografia Computadorizada por Raios X
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