https://orcid.org/0000-0001-8038-9076
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Francesca Coccina, Domenico Angelucci, Manuela Mereu, Gabriele Di Giammarco, Sante D Pierdomenico, Left atrial cluster mass, European Heart Journal - Cardiovascular Imaging, Volume 21, Issue 5, May 2020, Page 587, https://doi.org/10.1093/ehjci/jez287
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Extract
An 88-year old woman was admitted because of dyspnoea. History included ischaemic heart disease treated with coronary artery bypass surgery, permanent atrial fibrillation on anticoagulation, and permanent pacemaker implant. Laboratory examination revealed Troponin I 0.086 ng/mL (no significant change during time) and N-terminal pro-brain natriuretic peptide 11129 pg/mL. Electrocardiogram displayed atrial fibrillation. Chest X-ray did not show pulmonary congestion/oedema. Transthoracic echocardiogram showed a cluster mass in the left atrium prolapsing into the mitral valve [Panels A and B (LA, left atrium; LV, left ventricle), Supplementary data online, Movies S1 and S2]. Thoracic computed tomography scan did not show extra-cardiac involvement. Consulting cardiac surgeon recommended urgent surgical resection. Various roundish neoplasms of about 2-cm diameter originating from the left auricle were detected and removed. At macroscopic examination, multiple whitish neoplasms of weak consistency were observed. Microscopic examination documented sparse areas of hyaline myxoma and Type AB thymoma composed of oval epithelial cells admixed with a large number of lymphocytes (Panel C); immunohistochemistry with cytokeratins (CKAE1/AE3) was positive on thymocytes (Panel D), that with CD3 showed a rich T-lymphocytic infiltrate (Panel E) and that with CD34 indicated positive vascular design in the absence of thymocytes staining (Panel F). Immunohistochemical panel excluded a vascular or a left atrial solitary fibrous tumour. Cells with multipotent differentiation capabilities have been reported within cardiac myxomas, or ectopic tissues, such as thymic rests, have also been described. To our knowledge, this is the first report describing a thymoma arising within an atypical atrial myxoma and giving rise to a cluster mass.
