HIGH YIELD: Atrial Myxoma

High Yield Info. No fluff. Here's some of the key features to know (for the boards)...



GENERAL INFO

THE BASICS:

  • Benign tumor, Curable by resection

TYPICAL CLINICAL PICTURE:

SPORADIC TYPE (most common):

  • OLDER female (50 yo) presents with a SINGLE mass in her LEFT ATRIUM near the fossa ovalis, appears MOBILE . Can cause symptoms similar to mitral valve stenosis



FAMILIAL (CARNEY COMPLEX) TYPE:

  • YOUNGER female (avg 26 yo) with MULTIPLE cardiac masses, can involve the RIGHT ATRIUM ; tend to recur more often than in sporadic myxomas.


HIGH YIELD ASSOCIATIONS:


CARNEY COMPLEX (7% of cases)= Autosomal Dominant

  1. Myxomas (atrial & cutaneous)

  2. Abnormal skin pigmentation

  3. Endocrine OVERactivity (adrenal, pituitary, thyroid)

NAME

  • Nevi, Atrial Myxoma, Ephelides

LAMB

  • Lentigenes, Atrial Myxoma, Blue nevi


BUZZ WORD(S):

  • Mobile mass in (left) atria with a myxoid stroma & atypical vessels on histology

KEY PATHOLOGY FINDINGS


  • Ball-shaped or papillary/elongated mass attached to endothelial surface (of atrium) by a stalk (this is why it is mobile)

  • Loose myxoid stroma

  • Plump, stellate, or spindled cells arranged in cords

  • Primitive-appearing vessels

  • +/- hemorrhage/ hemosiderin & inflammatory cells in the background

A rarely seen feature, but good to know about...Heterologous elements (glands or extramedullary hematopoeisis) can be present in 2% of cases. This has NO clinical significance, but DON'T OVERCALL B9 GLANDS AS SOME SORT OF ADENOCARCINOMA!




- CLICK HERE TO EXAMINE A VIRTUAL SLIDE -

(Courtesy of PathPresenter.net - link opens in new window)




ANCILLARY STUDIES

(EX: ADDITIONAL TESTS TO CLUE YOU IN TO THE DIAGNOSIS)

Endothelial markers (CD31 & CD34) +
Calretinin +

(Helps DDx from atrial thrombus (which is Calretinin NEG)


NOTE: S100 is variably positive


NEG: Cytokeratin (but if heterologous glands are present, they will be +)


TOP DIFFERENTIAL DIAGNOSIS

  • ATRIAL THROMBUS: Grossly has similar appearance, but a thrombus usually is NOT MOBILE. It can have myxoid degenerative changes. Calretinin NEGATIVE


And there you have it...


Reference: Jay H. Lefkowitch. Anatomic Pathology Board Review. 2006, Elsevier Inc. pg 9.

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These posts contain high yield information collected from various educational resources including textbooks, journal articles, educational websites and more. They are intended for educational use only and should NOT be taken as medical advice. I strongly believe the spreading of knowledge and depth of learned information should be encouraged in today's society rather than coveted. Membership is required to view these posts  and should be used solely for educational purposes only.