Search Results (108)

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical–Etiological–Anatomical–Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes. Full article

Objectives: Intramuscular myxomas (IMMs) are rare benign soft tissue tumors arising within large skeletal muscles. Their etiology is incompletely understood, but they are frequently associated with mutations (e.g., GNAS) and may occur in syndromic conditions such as Mazabraud and McCune–Albright syndromes. This study retrospectively analyzed clinical, radiological, histopathological, and molecular features of IMMs, including syndromic associations. Methods: A retrospective analysis was performed on 41 patients diagnosed with IMM who underwent biopsy or surgical resection between September 2011 and September 2022. Clinical, imaging, histopathological, and molecular data were evaluated using descriptive statistics. Results: The cohort included 27 females and 14 males with a mean age of 52.8 years. The most common tumor location was the quadriceps femoris, followed by other thigh muscles. Most patients presented with mild symptoms due to slow tumor growth. MRI was performed in all but one case, with additional imaging in 12 patients. Radiological differential diagnoses commonly included soft tissue sarcoma and hematoma. Complete tumor resection was achieved in 90.2% of patients. Immunohistochemistry was performed in 78.0%, most frequently showing CD34 positivity. GNAS mutation analysis was conducted in 85.4% of cases and was positive in 57.1%. Complications occurred in 9.8%, and no recurrences were observed during follow-up. Conclusion: IMMs are rare benign tumors that can be reliably diagnosed using histology supported by immunohistochemistry and GNAS mutation analysis. Complete surgical resection provides excellent outcomes with a low risk of complications or recurrence. Mazabraud syndrome should be considered in patients with multiple or recurrent IMMs and GNAS mutations. Full article

Background and Clinical Significance: Atrial myxomas are rare, benign cardiac tumors, most commonly originating in the left atrium, with potential for serious embolic and obstructive complications. Case Presentation: We report a 67-year-old woman presenting with acute chest pain and NSTEMI whose coronary angiography results were normal. Echocardiography revealed a large, heterogeneous, stalk-attached left atrial mass, confirmed by transesophageal imaging. Surgical resection was performed two days after diagnosis, and histopathology confirmed it was an atrial myxoma. Postoperative recovery was uneventful, with reassuring follow-up echocardiography. Conclusions: Echocardiography remains an invaluable tool for the identification of atrial myxomas and early surgical excision is critical, as they have an excellent prognosis. Full article

The occurrence of cysts and tumors in pediatric patients varies across different age groups. Follicular and dentigerous cysts are among the most common lesions. However, typical odontogenic tumors in juvenile patients are not frequently observed. Early stages of cyst and odontogenic tumor development might exhibit some similar characteristics due to the presence of unerupted teeth or their relationship with various stages of tooth formation and eruption. Many small lesions are discovered accidentally on routine orthopantomography (OPG), while the bigger ones manifest themselves as bone swelling, cortical perforation, or displacement and mobility of teeth. Each odontogenic tumor has characteristic clinical and radiological features. Biopsy of larger lesions, or incisional biopsy of smaller lesions, allows detailed histopathological evaluation to determine tumor type and growth behavior and guide appropriate treatment planning. In some cases, atypical signs on OPGs, like asymmetry in dental follicles, occurrence of round or oval bone lesions near impacted or retained teeth, and visibility of irregular radiolucent, radiopaque, or mixed jawbone lesions, might suggest the occurrence of some possible odontogenic tumor in juvenile patients. Each case should be handled individually. In this case, we demonstrate how atypical appearances of dental follicles on panoramic radiographs may not correspond with cone-beam computed tomography findings and may indicate the early stages of odontogenic myxoma in a juvenile patient. Full article

The adenosine 3′,5′-cyclic monophosphate–protein kinase A (cAMP-PKA) signaling pathway is highly utilized in human physiology. It is a crucial component of development and is vital to cellular function in nearly all tissues. Indeed, genetic mutations to cAMP-PKA machinery are found in many pathologies, including multiple cancers, cardiac myxoma, neurodevelopmental disorders, and hypercortisolism. Cyclic AMP and PKA were first identified as vital components in cortisol synthesis over 50 years ago, yet the cellular mechanisms connecting PKA to cortisol production are still not well understood. This article will review evidence for PKA’s roles in adrenal gland zona fasciculata steroidogenesis and consider recent studies of the stress hormone disease adrenal Cushing’s syndrome to synthesize a current model for cAMP-PKA actions in cortisol production. Full article

Background: Primary cardiac tumors are exceedingly rare, with myxomas representing the most common benign type among these tumors, predominantly located in the left atrium. Biatrial involvement is an exceptional presentation, reported in less than 2.5% of cases. The terms bilateral and biatrial atrial myxoma are often confused and used interchangeably. We present a rare case of atrial myxoma involving both chambers, resected via a minimally invasive endoscopic approach, accompanied by a literature review. Case Presentation: A 52-year-old male with a three-month history of progressive fatigue and exertional dyspnea was found, on transthoracic echocardiography and cardiac MR, to have two intracardiac masses affecting both atria. Intraoperative transesophageal echocardiography confirmed the presence of mirror-image myxomas attached to the interatrial septum, in the absence of any septal defect. The tumors were excised en bloc, including the septal attachment, using a minimally invasive endoscopic approach. Histopathological examination confirmed the diagnosis of atrial myxoma, and the postoperative course was uneventful. Conclusions: Bilateral and biatrial atrial myxomas are exceedingly rare forms of cardiac tumors. In many cases, the first clinical manifestations may arise from cerebral or peripheral embolic events or from pulmonary thromboembolism. For this reason, screening echocardiography may be useful, particularly in cases of familial myxoma. Transthoracic and transesophageal echocardiography, combined with careful inspection of all cardiac chambers, play a crucial role in preventing recurrence by detecting small or overlooked tumor fragments. The minimally invasive endoscopic approach offers a safe and effective surgical option for biatrial myxomas, providing excellent visualization and facilitating thorough exploration of the cardiac cavities. Full article

Background: Primary cardiac tumors are exceedingly rare, accounting for less than 0.2% of cases in autopsy series. Myxomas represent the majority, while hemangiomas are exceptionally uncommon, accounting for less than 2% of benign cardiac tumors. Their rarity, nonspecific clinical presentation, and overlapping imaging features make preoperative diagnosis particularly challenging. Case presentation: We report the case of a 47-year-old woman with exertional dyspnoea and a large right atrial mass initially suggestive of myxoma on transthoracic echocardiography. Coronary angiography revealed a small fistulous connection, raising suspicion of a vascular lesion. Surgical resection was performed, and histopathological examination confirmed a cavernous hemangioma. The postoperative course was favorable, with no residual mass on follow-up imaging. Discussion: Cardiac hemangiomas are often misdiagnosed as myxomas due to similar clinical and echocardiographic appearances. This case illustrates the diagnostic challenges posed by cardiac hemangiomas and the importance of correlating multiple imaging modalities when assessing atypical atrial masses. Our case highlights the potential role of multimodal imaging, including contrast echocardiography, cardiac MRI, and coronary angiography, in differentiating vascular from non-vascular cardiac tumors. Based on recurrent patterns in the literature, we outline a conceptual diagnostic framework that may assist preoperative evaluation. Conclusions: Although rare, cardiac hemangiomas should be considered in the differential diagnosis of atrial masses. Multimodal imaging may improve diagnostic accuracy, but additional data from multicenter registries are required to establish validated diagnostic pathways. Full article

Background: Odontogenic myxoma (OM) is a rare, benign, but locally aggressive tumor of odontogenic mesenchymal origin. This study aims to expand current knowledge by integrating a concise literature review with a detailed case report of a surgically complex pediatric OM, treated using a biologically advantageous reconstructive technique. Methods: In this study, we report the case of an eight-year-old girl presenting with a large OM that caused complete disruption of the architecture of the left hemimandible. Due to the tumor’s size and bone involvement, radical resection was necessary. A modified extraoral facelift approach was employed to ensure adequate surgical access while avoiding intraoral incisions and minimizing visible scarring. Immediate mandibular reconstruction was performed using an autologous costochondral graft. Discussion: Although infrequently used in modern surgical practice, the costochondral graft offers unique advantages in pediatric patients due to its inherent growth potential and capacity for long-term biological integration. In this case, the graft allowed restoration of mandibular continuity and form with minimal donor site morbidity, demonstrating its viability even today. Conclusions: This case underlines the importance of tailored reconstructive strategies in pediatric OM. The costochondral graft provided excellent functional and esthetic results, with four-year follow-up confirming stable anatomical remodeling and bone regeneration. Full article

Objectives: This study aimed to compare survival and outcomes between robotic-assisted and conventional sternotomy myxoma resection. Methods: This retrospective single-center study included 16 consecutive patients undergoing left atrial myxoma resection between April 2019 and June 2024. All procedures were performed by the same surgical team. The robotic approach involved peripheral cardiopulmonary bypass (CPB), Custodiol^® cardioplegia, and DaVinci Xi^® via right mini-thoracotomy. The primary endpoint was 30-day cerebrovascular accident-free survival. Secondary outcomes included 5-year survival, stroke, pacemaker implantation, bleeding, Intensive care unit, and hospital stay. Results: Sixteen patients were included (8 robotic, 8 sternotomy); median age was 58.0 [IQR 53.2–67.8] in the robotic group and 66.6 [62.0–71.0] years in the sternotomy group, with a similar sex distribution between groups. No significant baseline differences between groups except a lower EuroSCORE II in the robotic group (0.8% vs. 1.3%, p = 0.004). Robotic surgery resulted in significantly longer CPB time (181 vs. 46 min, p < 0.001) and cross-clamp time (67 vs. 31 min, p < 0.001), but similar intensive care unit stay (2.5 vs. 2.6 days, p = 0.95) and hospital stay (8.5 vs. 8.4 days, p = 0.87). At 30 days, stroke-free survival was 100% in both groups (p > 0.9). At 5 years, survival remained 100% in the robotic group versus 86% in the sternotomy group (p = 0.47). No conversions, reinterventions, or major postoperative complications were observed. Conclusions: Robotic-assisted resection of left atrial myxomas appears to be feasible and safe in a selected low-risk cohort, when compared with conventional sternotomy, with excellent mid-term survival despite longer operative times. Full article

Primary cardiac tumors are rare, with an estimated incidence of 0.001% to 0.3% in autopsy series. Most are benign, the most common being cardiac myxomas, which typically originate in the left atrium. Right ventricular myxoma is among the rarest primary cardiac tumors, and its true incidence is difficult to determine, as most data come from isolated case reports. This paper aims to report a case of right ventricular myxoma in a young woman with a history of childhood malignancy and to discuss the possible association between the two conditions. Echocardiography, thoracic computed tomography (CT), and pulmonary CT angiography were used to assess the presence, location, and size of the tumor. The definitive diagnosis was established by histopathological examination. A 34-year-old woman, with a past medical history of acute lymphoblastic leukemia (ALL) in childhood, presented with a dry cough and exertional dyspnea persisting for three weeks. Transthoracic echocardiography revealed a mass located in the right ventricular outflow tract (RVOT), attached near the tricuspid valve and intermittently prolapsing into the pulmonary trunk. CT imaging confirmed the presence of the tumor in the RVOT and the main pulmonary artery. Because of the high risk of massive pulmonary embolism, the patient underwent urgent surgical excision of the tumor. Histopathological analysis confirmed the diagnosis of cardiac myxoma. The postoperative recovery was uneventful, and the three-month follow-up showed no recurrence or signs of pulmonary embolism. The patient’s history of ALL raised the question of a possible association; however, a review of the literature revealed no previously reported link. In conclusion, right ventricular myxomas are extremely rare. The occurrence of cardiac myxoma in this patient following childhood ALL appears to be incidental. Further research is needed to determine whether ALL survivors have an increased predisposition to subsequent cardiac tumors. Full article

Background and Objectives: Cardiac myxoma (CM) is the most common primary benign neoplasm of the heart. This study’s objective was to analyse diagnostic features of CM, surgical data and postoperative courses of patients over a 20-year period in a single institution. Materials and Methods: We conducted a retrospective analysis of patients with diagnosed and pathologically confirmed CM who underwent surgical resection in our hospital from 1 January 2004 to 1 January 2024. Data was assessed and analysed from medical records. Results: The study included 76 patients (mean age, 61.7 ± 12.6 years; 60.5% female). The majority of patients (93.7%) had symptoms, most commonly presenting with dyspnoea (64.5%), chest pain (39.5%) and arrhythmias (35.5%). Myxomas were found in the left atrium (89.5%), right atrium (9.2%) and left ventricle (1.3%). Isolated tumour extirpation surgery was performed in 50 patients (65.8%). During the early postoperative period, arrhythmias were the most common complication (n = 16, 21.1%). Early in-hospital mortality occurred in two patients due to cardiopulmonary failure. In the late postoperative period, 11 deaths (14.9%) were observed 4 to 17.5 years after surgery. No recurrence of CM was found in any patient during the follow-up period, yet tumours of other localisations were detected in nine patients. Conclusions: Surgery is the first-line treatment for CM, with a good prognosis. Although during the late postoperative period no cardiac tumour recurrence was observed in our study, 12.2% patients were newly diagnosed with non-cardiac neoplasms. Therefore, we suggest monitoring patients not only for cardiac disorders but also for the occurrence of extracardiac tumours. Full article

Echocardiography remains a vital part of the initial assessment and monitoring of oncological patients. It allows for proper treatment selection but can also reveal life-threatening complications, including impaired left ventricular function or thromboembolism. It can rarely detect intracardiac masses that require further investigation. In the presented case, a 51-year-old female patient with left-sided breast cancer, who had undergone neoadjuvant chemotherapy, was hospitalised due to a right atrial mass identified via routine transthoracic echocardiography (TTE). Initial anticoagulation therapy showed no clinical improvement. Follow-up TTE revealed a 12 × 19 mm hyperechogenic, mobile mass in the right atrium (RA). Computed tomography angiography (CTA) ruled out pulmonary embolism and revealed that the mass was located close to the tip of the vascular access port. Transoesophageal echocardiography showed that the lesion was not connected to the vascular port. Based on location and mobility, the lesion was most consistent with a cardiac myxoma. After the Heart Team made a decision, endovascular intervention using a vacuum-assisted device was performed without complications. Histopathological examination excluded thrombosis and myxoma, revealing a fibro-inflammatory lesion. A multimodality approach is necessary to assess RA masses. However, even an extensive evaluation could be misleading, so treatment options should always be subject to the Heart Team’s decision. Full article

We report an original case of pulmonary hypertension with artery aneurysms due to the cell proliferation of a right atrial myxoma with multi-modality imaging. Only three cases have been reported in the literature. The description of endoluminal cells proliferation in pulmonary arteries is rare on imaging, and this observation could be very useful in demonstrating not only the usefulness of multi-modality imaging, but also the combined performance of the dual-energy scanner. Full article

Complete detachment of a cardiac myxoma represents an exceptionally rare but potentially catastrophic complication. This case report describes a young female patient who developed acute abdominal pain following vigorous physical exertion, with rapid progression to visceral ischemia and bilateral lower limb ischemia within an extremely short timeframe. Comprehensive diagnostic imaging and postoperative pathological examination confirmed this as a remarkably rare case of complete cardiac myxoma detachment. This condition has been reported in only a handful of cases in the existing medical literature. Full article

Background and Clinical Significance: Cardiac myxomas, though typically benign and asymptomatic, can rarely present with acute cardiovascular compromise. We report a case of a left atrial myxoma presenting as acute pulmonary edema in a patient with prior normal cardiac imaging. Case Presentation: A 55-year-old male, with a history of thrombolyzed myocardial infarction and normal coronary angiography and echocardiography five years earlier, was admitted with acute dyspnea and pulmonary edema. Bedside transthoracic echocardiography (TTE) revealed a left atrial mass causing severe mitral inflow obstruction. Emergency surgical excision was performed, and the mass was submitted for histopathological analysis. Discussion: Histology confirmed cardiac myxoma. The procedure and recovery were uneventful, and follow-up at one month confirmed no recurrence. Conclusions: This case illustrates the potential for cardiac myxoma to manifest suddenly with life-threatening symptoms, even after previously normal investigations. Echocardiography remains pivotal in diagnosing intracardiac masses and guiding timely intervention. Full article