Intramural Hematoma and Oozing Rupture of Left Atrium after Resection of Wide‐Based Left Atrial Myxoma

We describe a rare complication after the resection of the left atrial (LA) myxoma. After tumor resection, a large defect of the endocardium was reinforced with an autologous pericardial patch. Transesophageal echocardiography demonstrated a hematoma and pulsatile flow beneath the patch, without patch perforation or detachment. Bleeding increased after closure of the sternum. Intramural hematoma and oozing rupture of the LA were diagnosed. A small intramural vessel of the LA was identified as the main causative site of bleeding. The pericardial patch was repositioned with fibrin glue. Fibrin sheets and glue were applied for reinforcement of the LA from outside.     

超声误诊阑尾低级别黏液性肿瘤1例

阑尾低级别黏液性肿瘤（Low- grade appendiceal mucinous neoplasm，LAMN）是阑尾黏液性肿瘤的一种少见类型，发生率占阑尾切除病例的0.2%~ 0.7%［1］，属于交界性或低度恶性肿瘤，破裂后易形成低级别腹膜假黏液瘤（PMP），临床症状个体差异大。LAMN起源于阑尾腺上皮，特点是由于粪石或者慢性炎症导致管腔狭窄，黏液物质聚积引起管腔扩张，黏液呈“推挤性”模式进入阑尾壁内或壁外［2］。超声表现：典型特征为“洋葱皮”样征象，大部分表现为囊实性包块，分隔纤细，部分病例内部回声呈胶冻状［3］，合并PMP时常伴有腹水。     

心脏黏液瘤的临床及超声特点探讨

目的探讨心脏黏液瘤的临床及超声特点。方法选取11例心脏黏液瘤患者,男5例、女6例,行多普勒超声检查,均经手术和病理证实,分析患者的临床特点及超声特点。结果 11例患者的临床表现包括胸闷、心悸、发热、晕厥、脑梗死、心律失常等,体征包括舒张期杂音、双期杂音、肿瘤扑落音等。11例患者均为单发,左房多见,超声表现为心房内稍高回声团块,边界清晰,部分呈分叶状,大部分内部回声较均匀,多数瘤体有蒂附着于房间隔上,随心动周期规律摆动,同时并发心房增大,下腔静脉增宽等。结论心脏黏液瘤临床表现个体差异极大,但超声表现较为典型,可以作为该病的首选检查方式。     

Two decades of atrial tumour

We have reported 19 patients with atrial tumour. The long follow-up(5–19 years, mean 10 years) of the 17 patients with leftatrial myxoma has been described. No patient showed evidenceof recurrence of the tumour, although three patients have unexplainedshadows—probably artifactual—on echocardiography.The limitations ofechocardiography and importance of clinicalindicators are stressed. One patient had a rhabdomyosarcoma of the left atrium and diedone year after operation. Certain features differentiated thispatient from those with myxoma. It is concluded that true atrial myxoma does not metastasize.Reports in the literature of metastasizing left atrial myxomaprobably refer to malignant tumours simulating myxoma. Variationsfrom the typical clinical and haemodynamic picture of atrialmyxoma should arouse suspicion of malignancy. Careful microscopicexamination of the tumour is essential.     

心房黏液瘤合并冠心病的诊断与外科治疗

目的 总结心房黏液瘤摘除同期行冠状动脉搭桥的临床治疗经验。方法 回顾性分析我科2013年1月至2019年3月18例同期行心房黏液瘤摘除+冠状动脉搭桥术患者的临床资料、手术方法及预后情况。结果 所有患者均在体外循环下行房黏液瘤摘除+冠状动脉搭桥术,根据手术所见,肿瘤位置与心脏超声所见位置一致。术中所见肿瘤大小不一,形态呈分叶状、不规则形、类圆形等,质脆,多数为胶冻样,少数有完整包膜,表面可有黏液渗出或出血,少数表面出现钙化。部分肿瘤瘤体可坠入二尖瓣口或三尖瓣口。术后无死亡病例。术后低心排综合征1例,经相应的治疗而治愈;术后新发心房颤动5例,均经用胺碘酮后转复正常;二次开胸止血2例。术后随访1年,18例患者均未见瘤体复发,心功能恢复到 NYHAⅠ~Ⅱ级。结论 心房黏液瘤摘除同期行冠状动脉搭桥是治疗心房黏液瘤合并冠心病的有效方法,可取得良好的预后效果。     

Familial cardiac myxoma with multifocal recurrences: a case report and review of the literature

We report a case of myxoma with multiple recurrences in both the atrium and ventricle in a 26-year-old woman five years after the surgical removal of left atrial myxoma.Her 52-year-old mother had a similar medical history.To our knowledge,this was the first familial case who suffered multifocal cardiac myxoma recurrences without any sign of the myxoma complex.Based on our understanding of the mechanism of recurrence,the approaches to prevent the recurrence,and markers to predict recurrence,we propose that multifocal recurrences,as reported herein,may result from a combination of familial predisposition and multifocal onset.The bi-atrial surgical approach and transesophageal echocardiography are preferred for patients with recurrent cardiac myxomas,especially for those with multiple recurrences and familial myxoma.Immunological and genetic screenings may help to identify family members at risk for developing this disease.     

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis

We report the case of a 56-year-old woman with a history of rheumatic heart disease. The clinical, electrocardiographic, and radiologic findings suggested mitral stenosis. Left atrial obstructive myxoma simulating a thrombus was found by transthoracic echocardiography (TTE). The diagnosis was established by use of transesophageal echocardiography (TEE), confirmed after surgery and by anatomical investigation. Cardiac myxoma associated with mitral stenosis may be difficult to diagnose accurately using TTE. The advantage of TEE in this case and in patients with mitral stenosis is emphasized.     

Stromal tumours of the ovary: an update

Stromal tumours of the ovary are reviewed emphasizing recently described entities and new or uncommon aspects of well known neoplasms. The first, the luteinized thecoma with sclerosing peritonitis, a rare lesion, is controversial with regard to whether it is neoplastic or non-neoplastic an unsettled issue. It often occurs in the young and has distinctive pathologic features. The second, the microcystic stromal tumour has as a main histologic feature the presence of microcysts that may only be focal. Hyaline plaques are common but in contrast to most stromal tumours they are inhibin and calretinin negative but show β-catenin alterations. Sclerosing stromal tumour although having relatively uniform typical morphology, can pose some diagnostic difficulty, especially when seen in pregnant patients. Thecoma and fibroma are the most common stromal tumours but thecoma, in particular, may cause diagnostic difficulty particularly with granulosa cell tumour. Finally, two rare tumours, the signet-ring stromal tumour and myxoma are briefly considered.