Left atrial myxoma associated with acute myocardial infarction and multiple cerebral infarctions: Report of a case

We report a case of left atrial myxoma associated with acute myocardial infarction (AMI) in a 63-year-old man. Percutaneous coronary intervention was performed immediately, and we removed white intracoronary particles by using a thrombectomy catheter. The postinterventional course was uneventful; however, on hospital day 5, pathological examination revealed platelet thrombus and myxomatous tissue from the particles aspirated by thrombectomy catheter, and transesophageal echocardiography showed a gelatinous mass in the left atrium. Based on these findings, we diagnosed AMI caused by coronary embolization from a left atrial myxoma, and excision of the myxoma was scheduled. However, preoperative magnetic resonance imaging revealed multiple subacute cerebral infarctions, and the tumor was successfully excised on hospital day 13. Although coronary embolization induced by cardiac myxoma is rare, it should be considered in a young to middle-aged patient presenting with signs of AMI without coronary risk factors.     

Triple myxoma (right and left atrial,left ventricular)

An 11-year-old boy presented to our hospital with episodes of palpitations of short duration. 2-Dimensional echocardiography revealed tumors originating in left atrium and left ventricle. During surgery one more tumor was detected in right atrium. All three tumors were excised successfully.     

Undifferentiated pleomorphic sarcoma in the left atrium; report of a case

Primary cardiac sarcomas are rare. A 41-year-old woman complaining of dyspnea was admitted to our hospital. Echocardiography and computed tomography (CT) showed a primary cardiac tumor in the left atrium. During surgery, the tumor was noted to be arising from the anterior wall of the left atrium, under the aortic sinuses. Histological and immunohistochemical studies revealed an undifferentiated pleomorphic sarcoma. Eleven months later, echocardiography and CT showed recurrence of the cardiac sarcoma in the left atrium. The patient underwent wide resection of the left atrium and mitral valve replacement because the tumor extended to the mitral valve leaflet. The patient died 3 months after the 2nd surgery because of the 2nd recurrence of the cardiac sarcoma. Although most tumors that develop in the left atrium are benign myxomas, preoperative differential diagnosis is important. It is especially necessary to suspect a sarcoma in the case of a non-septal orgin of the mass.     

Infected left atrial myxoma; report of a case

We report a rare case of infected left atrial myxoma. A 69-year-old male was admitted to our hospital due to cerebral infarction accompanied by lower limb ischemia. Transesophageal echocardiography showed a mobile left atrial tumor. On the 16th hospital day, he sufferd from high fever and Klebsiella pneumoniae was positive by blood culture. We excised the left atrial tumor, preventing systemic embolism and progression of sepsis. Histological examination showed a typical myxoma and organized thrombus with Gram-positive bacterial colonies, which disagreed with those in blood culture. After he recovered from sepsis, the 3rd toe of the right foot was amputated and then right femoro-popliteal bypass was done because of failure of wound healing. He was discharged from the hospital on the 74th postoperative day in good condition.     

Renal hemangiopericytoma discovered at a health screening: a case report

We report a case of renal hemangiopericytoma which was incidentally discovered by ultrasonography at a health screening. A 58-year-old man was admitted to our hospital for close examination of the renal tumor. Computed tomography revealed the left renal tumor, 60 x 50 mm in size, which was well enhanced with contrast medium. Magnetic resonance imaging revealed an isointensity mass (T1-weighted) and high-intensity mass (T2-weighted) at the left kidney. Radical nephrectomy was performed on suspicion of left renal cell carcinoma. Histopathological examination revealed renal hemangiopericytoma. The present case is the 7th in the Japanese literature.     

Ventricular pseudo-false aneurysm after myocardial infarction; report of a case

A 72-year-old man was admitted to our hospital with chest discomfort and syncope. The echocardiography showed the left ventricular aneurysm. The coronary arteriography revealed a complete occlusion at distal portion of the right coronary artery and anterior aneurysm of the left ventricle was demonstrated. We diagnosed that it was false aneurysm because of communicating with the left ventricle through a small orifice. Surgical repair was carried out after resection of the aneurysm of the left ventricle. The postoperative course was uneventful and discharged on the 33rd day after surgery. Pseudo-false ventricular aneurysm of the left ventricle was diagnosed by histological examination.     

Superselective fibrinolysis for a middle cerebral artery embolism caused by a left atrial myxoma: case report

A case of successful treatment by local fibrinolysis of a middle cerebral artery embolism caused by a thrombus from a left atrial myxoma is reported. A 62-year-old woman using a pacemaker and suffering from sick sinus syndrome was admitted on December 29th 1996, complaining of transient restlessness. CT and cerebral angiography revealed no abnormal vascular lesions. Eighteen months after the initial episode, she suffered a sudden onset of left hemiparesis and loss of consciousness. CT scan performed during the second episode revealed no lesions and, in particular, no early CT infarction sign, but emergent cerebral angiography revealed a right middle cerebral artery embolic occlusion. Local fibrinolysis using a tissue plasminogen activator was performed within 3 hours after the beginning of the episode, and partial recanalization was obtained within one hour after initiation of the fibrinolytic therapy. On the first hospital day, though CT revealed a small low-density area in the right basal ganglia, motor deficits gradually improved. Considering the possibility of a cardiac source of the embolism, trans-esophageal echocardiography was performed and revealed a left atrial tumor suspected to be a myxoma. It was removed by surgery on the 34th hospital day. Histological examination proved it to be a myxoma. Nine months after local fibrinolytic therapy, the patient returned to work. The diagnosis of cerebral embolism caused by cardiac myxoma is difficult to make at the time when the patient is first examined after admission. It is also hard to discover during emergent cerebral angiography with fibrinolytic therapy. Therefore, in the case of patients with cerebral embolism for which local fibrinolysis is ineffective, it should be presumed that cardiac myxoma is the source of the embolus. Direct PTA alone may be effective for such tumoral embolism.     

Licorice-induced pseudoaldosteronism in a patient with a non-functioning adrenal tumor]

A 72-year-old man was diagnosed with hypertension, hypokalemia, and left adrenal tumor at another hospital, and was referred to our hospital on suspicion of primary aldosteronism. Investigations revealed low plasma aldosterone concentration, and the left adrenal tumor proved to be nonfunctioning, not hyperfunctioning. "Licorice" had been prescribed for the treatment of recurrent cramps in his calf. After stopping the licorice, his condition changed to normokalemia strongly suggesting that his pseudoaldosteronism had been caused by the drug. We reviewed 140 reports on licorice-induced pseudoaldosteronism in Japan, and found a second patient who might have suffered a similar coincidental nonfunctioning adrenal tumor.     

Metachronous bilateral testicular tumors in a case of male infertility

A 42-year-old man referred to our hospital with the chief complaint of a solid mass of right scrotal contents. As ultrasonography revealed a right testicular tumor, right high orchiectomy was performed and the pathlogical diagnosis was testicular seminoma. At the age of 35-year-old, he was admitted to another hospital for male infertility due to azoospermia. Because left testicular tumor was found, left high orchiectomy was performed, with right testicular biopsy and testicular sperm extraction of the right testis at the same time. Pathological diagnosis revealed left testicular seminoma and no malignancy of the right testicular biopsy specimen. After the second operation, he has been receiving androgen replacement therapy, with no evidence of tumor recurrence.     

Adenocarcinoma of the sigmoid segment 38 years after sigmoidcystoplasty : a case report

A 60-year-old woman presented at another hospital with a complaint of voiding difficulty. She had had left nephrectomy and bladder augmentation using the sigmoid colon for treatment of urinary tract tuberculosis 38 years ago. Left ovarian tumor was found by computed tomography and she was referred to our hospital. Another tumor which involved the uterus, bladder, and urethra was revealed by magnetic resonance imaging. An anterior pelvic exenteration was performed with preoperative diagnosis of left ovarian cancer with peritoneal dissemination. Histopathological examination revealed a clear cell adenocarcinoma of the left ovary and a sigmoid cancer arising in the augmented bladder. The sigmoid cancer arose from the anastomotic site between the bladder and sigmoid segment. This is the 34th case of neoplasms following augmentation enterocystoplasty reported in Japan.     

Transesophageal echocardiography in renal cell carcinoma: an accurate diagnostic technique for intracaval neoplastic extension

Between 4 and 10% of patients with renal cell carcinoma have tumor involving the inferior vena cava and many of these patients have suprahepatic extension. In patients with intracaval neoplastic extension precise definition of the superior aspect of the tumor thrombus is critical. Transabdominal ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI) and inferior venacavography are all currently used to evaluate the inferior vena cava in these patients. Intraoperative transesophageal echocardiography was used to image the inferior vena cava in 5 patients with renal cell carcinoma and intracaval neoplastic extension. In each patient transesophageal echocardiography correctly revealed the superior extent of tumor thrombus. In 3 patients tumor thrombus was found at a higher level by transesophageal echocardiography than by CT, MRI and inferior venacavography. In all patients tumor imaging by transesophageal echocardiography correlated well with the gross appearance and extent of tumor found at operation. Echocardiography also documented the absence of residual gross tumor after resection. Transesophageal echocardiography was also useful to assess left ventricular function. Although each of these patients had a pulmonary artery catheter as well transesophageal echocardiography can be useful in situations when right atrial tumor thrombus prevents right heart catheterization. This small series demonstrates that intraoperative transesophageal echocardiography can accurately evaluate the extent of tumor thrombus and provides a means to assess myocardial function complementary to the pulmonary artery catheter.     

A case of adenomatoid tumor of the testis treated by testis-sparing surgery: a case report

A 44-year-old man was referred to our hospital with a chief complaint of a painless left intrascrotal mass, palpable at the lower portion of the left testis. Serum levels of tumor markers, human choriogenic gonadotropin (hCG), hCG-beta, and alpha fetoprotein were within the normal limits. Ultrasonography revealed a hyperechoic mass 13 mm in diameter, which was demonstrated as a hypovascular tumor by Gadrinium-enhanced magnetic resonance imaging. Since the tumor was diagnosed as a benign tumor by frozen section examination intraoperatively, testis-sparing surgery was performed. Histological examination revealed adenomatoid tumor originating from the tunica alubuginea of testis. Adenomatoid tumor of the testis is a rare benign tumor, and the present case is the 36th one in the Japanese literature.     

An atypically localized atrial myxoma: a case report

Atypical cardiac myxomas are rare occurrences and may present with a variety of clinical manifestations depending on the location and morphology. A 46-year-old woman had a 4 x 3 x 2-cm myxoma originating from the superior wall of the left atrium, found by echocardiography and multislice tomography. The tumor was successfully treated by surgical excision. The resected tumor was a well-defined encapsulated mass with a narrow-base stalk originating from the right wall of the left atrium in between the right upper and lower pulmonary vein. The patient recovered without complication and was discharged 6 days after the operation. At 1-year follow-up, echocardiography revealed normal cardiac function without reccurence in terms of mass. Although up to 80% of myxomas are localized in the left atrium, of which 75% involve in the interatrial septum, it should not be forgotten that myxomas can appear in an atypical localization, as occurred in our case.     

Giant cell tumor of the ribs that required emergency surgery due to massive hemothorax; report of a case

A 63-year-old man with a left rib tumor, which had been diagnosed as a giant cell tumor 2 years previously, had been followed up at another hospital after embolization of a feeding artery of the tumor. He was admitted to the emergency room of our hospital with complaints of breathing difficulties. A chest computed tomography (CT) revealed a left chest wall tumor, about 11 cm in size, originating from the 8th rib and a massive left hemothorax. Emergency operation was performed to releave hemorrhagic shock. Bleeding from the tumor was confirmed at thoracotomy. Tumor was removed with combined resection of the adjacent chest wall and diaphragm. His postoperative course was uneventful and he was discharged on the 8th postoperative day.     

Embolism at the iliac bifurcation secondary to an atrial myxoma

A 73-year-old woman presented a clinical picture of bilateral acute ischemia of the lower limbs. After embolectomy, transthoracic echocardiography revealed left atrial tumor. The picture was complicated by the onset of compartment syndrome in the lower extremities requiring decompressive fasciotomy. The excised atrial tumor proved to be a cardiac myxoma. Atrial myxoma, the most common benign cardiac tumor, leads to systemic, cardiac and embolic sequelae. Transthoracic echocardiography is the main diagnostic technique available, proving more useful than transesophageal echocardiography for small tumors. Such techniques can also be used during surgery, particularly in cases where preoperative assessment has left doubts about tumor location. We also argue in favor of early use of transesophageal echocardiography when peripheral arterial embolism is the diagnosis, in order to locate a cardiac focus as the cause of the clinical picture.     

Huge Localized Fibrous Tumor of the Pleura Resembling a Mediastinal Tumor: Report of a Case

A 67-year-old man was admitted to our hospital because of an abnormal chest echoic lesion detected incidentally by echocardiography. A chest roentgenogram showed the presence of a giant mass, and computed tomography of the chest confirmed the presence of a mass with a nonhomogeneous density in the left mediastinum, just adjacent to the left ventricle of the heart. Percutaneous aspiration cytology of the mass showed benign fibrous cells and a small amount of lymphocytes. The preoperative diagnosis of the tumor suggested a thymoma, and the patient underwent a thoracotomy. A pedunculated tumor arose from the visceral pleura of the left upper lobe of the lung, and it was capsulated within the pleura. The tumor measured 15 × 12 × 8cm in size and it was successfully resected. The pathological diagnosis of the tumor was benign localized fibrous tumor of the pleura.     

Successful repair of a cardiac lipoma of the left ventricular free wall--a case report

We recently encountered a patient with a very rare type of cardiac lipoma, which occurred at the left ventricular free wall and grew into the left ventricular cavity. No surgical treatment of this type of cardiac lipoma has been reported in literature. The patient was a 63-year-old woman who visited our hospital with a chief complaint of palpitation. At the outpatient clinic of our hospital, a tumor of the left ventricle was disclosed by echocardiography. After hospitalization, the patient was diagnosed as cardiac lipoma by CT scans and MR images. She was operated as follows. The apex of the left ventricle was incised and the cardiac cavity was exposed. The lipoma had its root approximately in the center of the posterior free wall of the left ventricle and had grown into the left ventricular cavity with a size of 2.5 X 2.5 X 1.8 cm and a weight of 2.8 g. After removal, the postoperative course was uneventful, but the chief complaint (palpitation) still persisted. Postoperative Holter electrocardiography disclosed that the patient had suffered from sick sinus syndrome and that palpitation had not originated from the cardiac lipoma.     

Mixed gonadal dysgenesis with seminoma: a case report

A case of mixed gonadal dysgenesis with anaplastic seminoma is reported. A 43-year-old, female, who was brought up as a female, was admitted to our hospital for swelling of left inguinal region. The physical examination revealed a short stature, ambiguous external genitalia but no Turner's stigmata. A child's head-sized tumor was noticed in the left inguinal region by CT scan. The histopathological diagnosis of this tumor was anaplastic seminoma. The right gonad was removed at laparotomy with lymph node dissection in the pelvis. Histological examination of right gonad revealed streak gonad and immature uterine with fallopian tube. In the Japanese literature, 7 cases including our case of mixed gonadal dysgenesis with gonadal tumor have been reported.     

Mediastinal granular cell tumor arising from the left recurrent nerve; report of a case

Granular cell tumor is found in various organs but is rare in the mediastinum. We report a case of 36-year-old woman with a granular cell tumor in the left upper mediastinum. She was admitted to our hospital because of hoarseness. Laryngoscopic examination revealed left vocal cord paralysis. Chest computed tomography (CT) showed a 3.0 x 2.0 cm well circumscribed tumor at the left side of the trachea in the left upper mediastinum. As hoarseness was suspected to be attributable to the mediastinal tumor, tumor resection was performed. It was found that the tumor involved the left recurrent nerve. The tumor was completely excised with combined resection of the left recurrent nerve. Histopathologically, the tumor consisted of cells with eosinophilic granules and S-100 protein positive materials in the cytoplasm, and diagnosed a granular cell tumor.     

Chest wall lipoma mimicking a well differentiated liposarcoma; report of two cases

We experienced 2 cases of chest wall lipoma mimicking a well differentiated liposarcoma. The 1st case was a 60-year-old female. She admitted to our hospital with abnormal shadow detected by chest X-ray. Positron emission tomography combined with computed tomography (PET-CT) revealed fatty tumor penetrating left chest wall without significant accumulation of fluoro-2-deoxy-D-glucose (FDG). Resection of the tumor with partial resection of the 6th and 7th ribs with were performed, because the tumor was suspected to invade surrounding tissues by surgical findings. The other case was a 41-year-old male. He admitted to our hospital with abnormal shadow detected by chest X-ray. PET-CT revealed fatty tumor penetrating left chest wall and its standard uptake value (SUV) was 1.2. The tumor was resected with surrounding periosteum and intercostal muscle without thoracotomy. Both cases were diagnosed as lipoma by pathology.