Erythematous Papules in a Patient with Cardiac Myxoma: A Case Report and Review of the Literature

A 35-year-old woman was followed up by a physician for one and a half years as a case of transient ischemic attack (TIA) due to thrombosis. She had a few erythematous papules on the dorsal side of her right forearm and on the right side of her neck. From the history of TIA and the transient erythematous papules, we suggested the possibility of cardiac myxoma. Echocardiogram demonstrated a large mass in her left atrium. An immediate operation was carried out, and the cardiac myxoma was excised surgically. Histological examination of the erythematous papule revealed myxoma emboli.     

The problems of surgical treatment for cardiac myxoma and associated lesions

Twenty-four patients with cardiac myxomas consisting of 22 left and 2 right atrial myxomas were operated on. All myxomas were removed with an excision of the attachment walls using a cardiopulmonary bypass. Two myxomas required a partial cardiopulmonary bypass from the femoral vein to the artery prior to operation because they were on the verge of becoming stuck in the atrioventricular valves and potentially causing shock. For embolic complications of myxoma, the embolus of the external carotid artery was extirpated before undergoing cardiac surgery. In a patient with pulmonary infarction, the infarcted lung was resected simultaneously. Another patient with a cerebral infarction received a clipping of an aneurysm which later appeared in the infarcted area. For associated cardiac lesions, two patients underwent a coronary artery bypass graft and one mitral valve replacement with tricuspid annuloplasty. In the former two cases, the myxoma was removed prior to coronary artery bypass grafting because the use of retrograde coronary perfusion was considered to be sufficient to protect the heart. In the latter case, the removal of the myxoma first disclosed a significant mitral lesion which had been masked by the huge myxoma. All patients but one, who died of pneumonia, showed a good recovery. In this series, the problems of surgical treatment for cardiac myxoma and associated lesions are also discussed.     

Left atrial myxoma and systemic AL-amyloidosis.

A case of left atrial myxoma with systemic AL-amyloidosis is described. Localized myxomas have the peculiar property of giving rise to constitutional symptoms, indicating a systemic disease process. The coexistence of AL-amyloidosis and an atrial myxoma in the same patient makes it tempting to suggest that an immunological defect is involved in the development of both diseases.     

Odontogenic tumors in Chile: a study of 362 cases.

BACKGROUND: Odontogenic tumors are infrequent lesions. Thus, the review of a large number of cases becomes a necessity for both the pathologist and the clinician. Studies on odontogenic tumors have been published in many parts of the world, but there is little information available in the English language literature on the relative frequency of odontogenic tumors in Latin America. The aim of this study was to determine the relative frequency of this heterogeneous group of lesions in a Chilean population, and to compare these data with previous reports. METHODS: We reviewed the records of 28,041 specimens from 1975 to 2000 in the Oral Pathology Referral Institute (IREPO), and using the criteria for histological typification published by the World Health Organization in 1992, we reclassified the odontogenic tumors. RESULTS: We confirmed a total of 362 odontogenic tumors. The frequency of odontogenic tumors as a percentage of all pathological specimens in our institute was 1.29%. The most frequent histological type was odontomas (44.7%), followed by ameloblastomas (20.4%) and myxomas (8.8%). CONCLUSIONS: Odontogenic tumors are uncommon lesions in the Chilean population and malignant odontogenic tumors are very rare. The relative frequency of various types of odontogenic tumors, as well as the age and gender distribution are similar to those reported in the North American series and different from those found in recently published Asian and African series.     

19例心房粘液瘤的免疫组化研究

为阐明CMS的组织起源,本文对19例CMS作了免疫组化研究。结果表明,全部病例的肿瘤血管及肿瘤间质细胞对Vimentin显阳性反应;成熟血管内皮细胞对UEA显阳性反应;部分粘液瘤的间质细胞与血管平滑肌细胞对Desmin和Myosin显阳性或弱阳性反应;少数病例的部分瘤细胞对S-100蛋白显弱阳性或阳性反应;全部CMS的上皮性标记物AE_1和AE_3均为阴性。研究表明,CMS具有多种间充质细胞成分,它们均可能同源于多潜能原始间叶组织。瘤细胞对免疫组化反应的差异,反映了肿瘤组织的分化和成熟程度可能有差异。文中对CMS的病理组织学和组织化学也作了观察和分析。     

Magnetic resonance imaging of myxoid containing tumors

Myxoid tissue forms part of many benign and malignant soft-tissue tumors. The advent of percutaneous needle biopsy has made it important to be aware of the diagnostic implications of biopsy samples containing myxoid tissue. To determine whether the magnetic resonance imaging (MRI) characteristics could help establish the diagnosis, we compared the MR images of 11 tumors containing myxoid tissue with the resected tumor tissue. In our small series of these rare tumors, the MRI characteristics allowed differentiation of intramuscular myxomas from malignant neoplasms containing myxoid tissue. Intramuscular myxomas meet the following conditions: (a) they are well circumscribed; (b) they arise within muscle; (c) T₁-weighted images demonstrate uniform, decreased signal intensity; (d) T₂-weighted images demonstrate uniform increased signal intensity; (e) contrast-enhanced images exhibit an inhomogeneous increase in signal intensity. If any of these conditions is not met, then a malignancy containing myxoid tissue should be suspected.     

Left atrial myxoma associated with rheumatic mitral stenosis

The rare occurrence of mitral stenosis and coexistent left atrial myxoma is reported. The patient had a 25-year history of rheumatic heart disease and was referred for evaluation of progressive mitral stenosis without clinical suspicion of left atrial myxoma. The tumor was discovered by routine echocardiography in the course of evaluation of mitral stenosis. However, prior to surgery the patient experienced an episode of embolization of the tumor without major clinical sequelae. The utility of echocardiography in this case and in patients with mitral stenosis is discussed as well as the patient's spontaneous "cure."     

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.     

In vitro screen of a small molecule inhibitor drug library identifies multiple compounds that synergize with oncolytic myxoma virus against human brain tumor-initiating cells

Background

Brain tumor-initiating cells (BTICs) are stem-like cells hypothesized to form a disease reservoir that mediates tumor recurrence in high-grade gliomas. Oncolytic virotherapy uses replication-competent viruses to target and kill malignant cells and has been evaluated in clinic for glioma therapy with limited results. Myxoma virus (MyxV) is a safe and highly effective oncolytic virus (OV) in conventional glioma models but, as seen with other OVs, is only modestly effective for patient-derived BTICs. The objective of this study was to determine whether MyxV treatment against human BTICs could be improved by combining chemotherapeutics and virotherapy.

Methods

A 73-compound library of drug candidates in clinical use or preclinical development was screened to identify compounds that sensitize human BTICs to MyxV treatment in vitro, and synergy was evaluated mathematically in lead compounds using Chou-Talalay analyses. The effects of combination therapy on viral gene expression and viral replication were also assessed.

Results

Eleven compounds that enhance MyxV efficacy were identified, and 6 were shown to synergize with the virus using Chou-Talalay analyses. Four of the synergistic compounds were shown to significantly increase viral gene expression, indicating a potential mechanism for synergy. Three highly synergistic compounds (axitinib, a VEGFR inhibitor; rofecoxib, a cyclooxygenase-2 inhibitor; and pemetrexed, a folate anti-metabolite) belong to classes of compounds that have not been previously shown to synergize with oncolytic viruses in vitro.

Conclusions

This study has identified multiple novel drug candidates that synergistically improve MyxV efficacy in a preclinical BTIC glioma model.