Sclerosing Polycystic Adenosis of Salivary Glands: A Review with Some Emphasis on Intraductal Epithelial Proliferations

This is a case report of an unusual odontogenic myxoma with calcifications, one of three reported in the literature. It had a typical radiographic appearance although it presented in an older patient. The presence of osteo-cementum-like calcification raises other differential diagnoses but does not in and of itself mitigate the diagnosis. The patient has not shown recurrence 14 months after resection and 11 months after reconstruction and continues to be closely monitored.     

Cytokeratin profile and neuroendocrine cells in the glandular component of cardiac myxoma

Glandular cardiac myxomas are very rare tumors of uncertain histogenesis that display glandular structures within otherwise typical myxomatous tissue. The origin of the glands has been attributed to epithelial differentiation of a totipotent cardiomyogenic precursor cell or to entrapped embryonal rests in the tumor. We studied four cases of glandular myxomas (three sporadic and one familial) to define the immunophenotypic profile of the glandular elements. The glands were either single and located within the myxoma cell islands (three cases) or in groups embedded in the myxomatous matrix. In the latter case, the glands featured villous projections, irregular profile, active inflammation or focal reactive cellular atypia (case 3) and had acidic and neutral mucins (mostly sialomucins). The cytokeratin expression profile (cytokeratin 7 and 20 co-expression) was similar to that of foregut derivatives. Scattered chromogranin-positive neuroendocrine cells were observed in case 3. Our findings indicate that the glandular component in cardiac myxoma is morphologically heterogeneous. In some cases, the scattered glands may derive from a divergent (epithelial) differentiation of myxoma cells; in others, entrapment of embryonic gastrointestinal rests (with mature neuroendocrine and mucous cell populations) could be the case.     

Concomitant occurrence of a left atrial myxoma and an adenocarcinoma of the lung

A 72-year-old previously healthy woman was found to have both a left atrial myxoma and a left lung mass during the evaluation for two cerebrovascular events. Resection of the atrial myxoma and a biopsy of the left lung mass were performed. Six weeks later she underwent a left upper lobectomy for adenocarcinoma of the lung. This case illustrates the concomitant occurrence of a left atrial myxoma and a primary lung cancer in a patient who underwent a successful staged treatment for both diseases.     

Left Atrial Myxoma Causing Coronary Steal: An Atypical Cause of Angina

Cardiac myxomas are rare primary cardiac tumors that usually present with dyspnea or manifestations of systemic embolization. Coronary steal is a rare phenomenon of unbalanced blood flow that is seen primarily in patients who have undergone coronary artery bypass grafting and have subclavian artery stenosis.We report the case of a 72-year-old woman who presented with fatigue, weakness, and exertional chest heaviness and had abnormal results on a cardiac stress test. The results of coronary angiography showed no obstructive coronary artery disease but revealed a large intracardiac left atrial mass that was supplied by 2 anomalous coronary arteries. The patient underwent successful ligation of the anomalous coronary arteries and resection of the mass, which was histologically an atrial myxoma. The patient''s symptoms resolved, and results of a repeat cardiac stress test were normal.To our knowledge, this is the first report of a highly vascularized atrial myxoma that caused coronary steal with objective evidence of ischemia, and with subsequent resolution after resection of the mass and ligation of the anomalous coronary arteries.     

MPO–ANCA-associated pseudovasculitis in cardiac myxoma

We describe a case of cardiac myxoma whose clinical presentation mimicked that of polyarteritis nodosa. The serum levels of MPO-ANCA and IL-6 were elevated on laboratory investigation and normalized after the removal of the tumor. We suggest that a 'true' vasculitic mechanism contributes to the pathogenesis of pseudovasculitis in cardiac myxoma.     

The modern diagnosis of cardiac myxoma: role of two-dimensional echocardiography

We reviewed our experience with the diagnosis of cardiac myxoma in 10 patients seen between 1960 and 1981. At surgery, large myxomas (greater than 5 cm) were found in the left atrium in 6 patients, right atrium in 3, and right ventricle in 1. The correct preoperative diagnosis was made in 9 patients: clinically in 3 and at catheterization and angiocardiography in 6. Diagnoses were falsely negative in 3/13 (23%) catheterizations and 2/10 (20%) angiocardiograms. Echocardiography (echo) was positive in 5/5 (100%). Gated blood-pool scans confirmed a right atrial myxoma in 1 patient. The interval between onset of symptoms and surgery was 30.5 months, (range, 2-120) and was not significantly different in the eras before and after echo. The age at diagnosis exceeded 40 years in 9 patients and was not significantly less in the echo era. The size and site of the tumor at surgery agreed with findings on M-mode echo (n=5) or two-dimensional (2-D) echo (n=2), but the size (85 vs. 88 cm3) and mass (81 vs. 88 g) of the tumors were similar in the 2 eras. Although 2-D echo facilitates the preoperative diagnosis of cardiac myxoma, earlier patient referral of suspicious cases for 2-D echo is still necessary.     

Four cardiac myxomas diagnosed three times in one patient.

A left atrial myxoma was surgically removed in a 58-year-old man following several embolic events. Five months later, a new myxoma was found in the right ventricular outflow tract and surgically removed. In this patient, we visualized two more recurrences 14 years later, one in the left atrium and the other in the left ventricle. A short review of the literature concerning recurrent cardiac myxomas is given.