Unusual Case of Right Ventricular Intravenous Leiomyoma

HomeCirculation: Cardiovascular ImagingVol. 14, No. 8Unusual Case of Right Ventricular Intravenous Leiomyoma Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toSupplementary MaterialsFree ReportPDF/EPUBUnusual Anna Pfenniger, MD, PhD, Robert A. Silverberg, Jon W. Lomasney, Andrei Churyla, MD and Kameswari Maganti, PfennigerAnna Pfenniger Division Cardiology (A.P., R.A.S., K.M.), Northwestern University Feinberg School Medicine, Chicago, IL. Search for more papers by this author , SilverbergRobert Silverberg LomasneyJon Lomasney https://orcid.org/0000-0002-0438-2427 Pathology (J.W.L.), ChurylaAndrei Churyla Cardiac Surgery (A.C.), MagantiKameswari Maganti Correspondence to: Pavilion, Suite 8-503G, 201 E Huron St, IL 60611. Email E-mail Address: [email protected] https://orcid.org/0000-0002-0449-1754 Originally published13 Aug 2021https://doi.org/10.1161/CIRCIMAGING.119.010363Circulation: Imaging. 2021;14:e010363Other version(s) articleYou are viewing the most recent version article. Previous versions: August 13, 2021: Ahead Print A 54-year-old woman who was being screened before stem cell donation found have an abnormal ECG with nonspecific lateral ST- T-wave abnormalities. Medical history only remarkable untreated hypertension a hysterectomy 20 years ago uterine fibromas. She asymptomatic. Her physical examination unremarkable.She underwent transthoracic echocardiogram evaluate structural heart disease. This incidentally showed large, mobile mass in right-sided cardiac chambers that possibly attached tricuspid valve (Figure 1). The appeared multilobed, dimensions 2.2×1.7 cm (Movies I through III Data Supplement). otherwise unremarkable. magnetic resonance imaging performed further define mass. It confirmed presence highly spherical measuring 3.0×2.6 right ventricular wall via stalk 2). heterogeneous delayed enhancement felt be compatible myxoma IV V An enhancing lower lobe lung nodule also noted, prompting computed tomography chest. revealed >20 small, scattered pulmonary nodules up 9 mm, consistent metastatic disease or noncalcified granulomata. Tuberculosis ruled out.Download figureDownload PowerPointFigure 1. Echocardiography images depicting (RV) prolapsing into atrium valve.A B, Transthoracic 2-dimensional (2D) 3-dimensional (3D) demonstrating mobility within RV. C–F, Transesophageal 2D 3D clearly protruding from ventricle leaflets. See Movies Supplement.Download 2. attachment cine depict RV as shown 4-chamber view (left) modified 2-chamber (RA) (right). appears can seen oscillating between RA systole (top) diastole (bottom). Supplement.The patient admitted surgical removal Intraoperatively, it 5.0×4.7×2.6 cm, tan-pink, focally hemorrhagic, encapsulated 2.2×2.0×1.1 stalk, second smaller measured 1.3×1.2×0.8 at level insertion ventricle. valve, multiple tears noted septal posterior resected free margins. Tears were repaired, 26-mm MC3 annuloplasty ring inserted. microscopic evaluation Figure 3. Hematoxylin eosin staining whorls fascicles spindle cells, admixed collagen. cells stained positive desmin, smooth muscle actin CD34 vascular structures. Mitotic activity nonexistent. Further immunohistochemistry demonstrated estrogen progesterone receptors. was, therefore, leiomyoma origin. recovered well her intervention.Download Gross pathology.A, Photograph Micrograph hematoxylin showing C, Immunostaining ERs (estrogen receptors). D, receptors.Cardiac tumors represent diagnostic therapeutic challenge their overall incidence is rare compared other intracardiac masses such infective endocarditis thrombi often asymptomatic cause minor symptoms. They require integrative approach modalities ultimately tissue histopathology determine precise diagnosis. case certainly highlights importance multimodality narrowing differential diagnoses excision.Among tumors, primary neoplasms secondary tumors. Secondary 30× common than malignant etiology.1However, leiomyomas—a benign tumor mesenchymal origin—have been reported propagate venous circulation heart. Most cases leiomyomas originate uterus, embolize parauterine tributaries inferior vena cava, direct invasion, forming continuous pelvis chambers. These tend mobile, without do not adhere walls chambers.2 Leiomyomas confined extremely rare. Primary described, arising tunica media intramyocardial vessels.3 few reports determined these represented metastasizing leiomyoma, similarly known dissemination lungs.4 prior characteristic histopathologic features our patient’s suggest represents leiomyoma. raises concern on chest hormonal therapy may role preventing increase size.In summary, illustrates silent progressive growth intravascular leiomyomas, exclude possible diagnoses, crucial interdisciplinary approach. high index suspicion needs entertained when encountered female post-hysterectomy leiomyomas. curative treatment intravenous leiomyomatosis involving resection good outcome.Sources FundingNone.Supplemental MaterialsData Supplement I–VDisclosures None.FootnotesThe available https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.119.010363.For Sources Funding Disclosures, see page 831.Correspondence protected]eduReferences1. Lenihan DJ, Yusuf SW. Tumors affecting cardiovascular system.Mann DL, Zipes DP, Libby P, Bonow RO eds: In: Braunwald’s Heart Disease, 10th ed. Vol 85. Elsevier Saunders, 2015:1863–1875.Google Scholar2. Li R, Shen Y, Sun Zhang Yang J, Su Jiang B. extension: echocardiographic study literature review.Tex Inst J. 2014; 41:502–506. doi: 10.14503/THIJ-13-3533CrossrefMedlineGoogle Scholar3. H, Xu Zhu N, Dong L, Wang C. Multiple ventricle: form leiomyoma.Ann Thorac Surg. 2016; 101:e33–e35. 10.1016/j.athoracsur.2015.06.114CrossrefMedlineGoogle Scholar4. Pacheco-Rodriguez G, Taveira-DaSilva AM, Moss Benign leiomyoma.Clin Chest Med. 37:589–595. 10.1016/j.ccm.2016.04.019CrossrefMedlineGoogle Scholar Back top Next FiguresReferencesRelatedDetails 2021Vol Issue 8Article InformationMetrics © 2021 American Association, Inc.https://doi.org/10.1161/CIRCIMAGING.119.010363PMID: 34387098 publishedAugust Keywordsneoplasmsthoracic surgeryleiomyomatosishypertensionheart neoplasmsPDF download Advertisement SubjectsComputerized Tomography (CT)EchocardiographyImagingMagnetic Resonance Imaging (MRI)Ultrasound