CARDIAC MYXOMA
first manifestations
myocardial
of
myxoma
is
evidenced by
infarct.
INTRODUCTION
Myxoma is the most common benign cardiac primitive
neoformation (over 50% of all cardiac tumors) with
intercavital localization and net prevalence of presence
in the female sex. This neoplasia has a relatively easy
diagnosis and gets its name from its principal
component, myxoid cells. Myxoma is not strictly
related to risk factors such as smoking or nutrition but
it seems, according to recent studies, to have a
component of a familiar characteristic. The main
complications that cardiac neoplasia can cause are
disturbances in blood circulation, emboli (clotted
arteries),
sudden
death.
Figure 1 Presentation of myxoma in the left atrium
DISCUSSION (par. 1.1; 1.2)
Myxoma presents as benign neoplasia prominently
found in the left atrium (78% of cases), but also
localized in the right atrium (18%) or in the two
ventricles
(4%).
This
primitive
endocardiac
neoformation has a papillomatous or polypoid
appearance,
substantially
pedunculated.
Histologically, it consists of a myxoid matrix full of
mucopolysaccharides with star-shaped cells, or stars,
reticulated fiber, collagenous and elastic; on the
surface the tumor presents covered with endothelial
cells. Clinical diagnosis is achieved with tests such as
two-dimensional
transthoracic
echocardiography
scans, with which the doctor can evaluate the
dimension, site, and mobility of the tumor, in addition
to hypothetical involvement of surrounding cardiac
structures (for example, when the myxoma is in the left
atrium, it is easy to present with an obstruction of
transmitral flux not forcefully connected to a
compromising structure of the tricuspid valve). Other
exams that favor the diagnosis are TAC and magnetic
resonance imaging, which offer major specificity of the
tissue characteristics of the tumor and its anatomical
relationship with surrounding cardiac structures. The
principal symptoms that evidence the presence of
cardiac neoplasia are cardiac failure, syncope, acute
pulmonary edema, fever, weight loss, anemia,
asthenia, myalgia and, according to recent studies,
sudden increase of Interleukin-6, which normalizes
after surgical intervention of tumor removal. In some
patients, as it is reported in the literature, one of the
Figure 2 Myxomatous cells under the microscope

SURGERY AND RESULTS (1,1)
The only solution currently contemplated is surgical
intervention of tumoral exeresis. In the preoperative
phase through excessive increase of Interleukin-6 and
friable consistency of the tumoral mass, the risk of
cerebral or coronary embolization is elevated (in this
case the myocardial infarct is verified). During the
operation phase, the surgeon will bring the patient to
extracorporeal circulation, moderate hypothermia and
cardioplegic arrest, and afterwards will proceed to
aortic clamping. In regard to the surgical approach to
the tumor, influential are the position of the myxoma
itself and its friability which increases emboligine
potential. According to the cases of Jones, the
techniques more used are: biatrial incision (38%), left
atrium incision (34%) and transectal incision (28%).
Independently of this in the operation phase, it is
important to reduce at a minimum myxoma
manipulation, to guarantee its exposure to practice
total resection and to inspect cardiac cavities, to
reduce to a minimum the risk of recidivism.
Postoperative results are comforting and the risks of
recidivism
are
low
(4%-14%).
Figure 3 Surgical resection of myxoma

CASE REPORT (1.2)
In the study of myxoma through the years, controversy
has developed among scientists in regard to the nature
and istogenesis of the process of tumoral formation.
One field of thought describes neoplasia of formation of
endothelial endocardiac coating, another maintains
that it is regarding a fibroblastic tumor with an
interstitial production of mucin. According to G.
Mikuz,
papillomatous
formations
correspond
hystologically to endotelomia, whereas polypoid
formations
to
miofibromi,
tumors
rich
with
intracytoplasmic filaments of actinomiosina, which
abound with mucopolysaccharides (this demonstrates
the
origin
of
the
immature
subendocardiac
connection). According to Albertini, it is plausible that
both fields of thoughts are valid and thus there is a
dual presence of endothelial cells and myofibroblasts,
which would offer a unifying vision of endocardiac
tumors, endocardioma.
CONCLUSION
Myxoma is the principal primitive benign cardiac
neoplasia presented mostly in the female sex with
intercavitary localization, especially in the left atrium.
Diagnosis of the cardiac tumor is relatively easy and
thus it is followed by a program of surgical intervention
to practice total resection of the myxoma and to riduce
to a minimum the risk of reoccurrence. Surgical
results are satisfactory, the percentages of reoccurence
are low, and surgical risks are relatively moderate.
REFERENCES
Dr. W. Jones. Biatrial approach to cardiac myxomas. Murray
GF, 1995.
Dr. R. Scrofani and Dr. C. Antona. Cardiac myxoma in a
clinical follow up of 15 years.
Dr. G. G. Lanza. Histopathology of tumors.
Dr. G. Mikuz. The so called endocardial myxoma. Virchows
Arch. Anat. & Histol, 1978.
Studente: ANNA GIORDANO
Matricola: 1060100573