J Cardiovasc Ultrasound.  2016 Mar;24(1):71-74. 10.4250/jcu.2016.24.1.71.

Primary Multiple Cardiac Myxomas in a Patient without the Carney Complex

• Kataoka S
• Otsuka M
• Goto M
• Kahata M
• Kumagai A
• Inoue K
• Koganei H
• Enta K
• Ishii Y

• KMID: 2161000
• DOI: http://doi.org/10.4250/jcu.2016.24.1.71

Abstract

Cardiac tumors are rare, and multiple myxomas are even rarer. The latter phenomenon is mostly associated with the Carney complex, a dominantly inherited disease characterized by multiple primary cardiac myxomas, endocrinopathy, and spotty pigmentation of the skin. We report the rare case of a patient who did not have the Carney complex but had multiple primary cardiac tumors. A 78-year-old woman with a past history of breast cancer was referred to our hospital for further examination of multiple cardiac tumors. Echocardiography showed 4 tumors in the left atrium and left ventricle. We could not diagnose them preoperatively and decided to resect them surgically because they were mobile and could have caused embolism and obstruction. The postoperative pathological findings of all 4 tumors were myxomas, although the patient did not meet the diagnostic criteria of the Carney complex. Therefore, a rare case of multiple primary cardiac myxomas was diagnosed.

Keyword

Multiple cardiac tumors; Myxoma; Carney complex

MeSH Terms

Aged
Breast Neoplasms
Carney Complex*
Echocardiography
Embolism
Female
Heart Atria
Heart Neoplasms
Heart Ventricles
Humans
Myxoma*
Pigmentation
Skin

Figure

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  Fig. 1 Transthoracic echocardiography showing 4 masses in the left atrium and left ventricle connected to the interatrial septum (yellow arrows), anterior mitral leaflet (yellow arrowheads), posterior mitral leaflet (white arrows), and aortic valve (white arrowhead).

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  Fig. 2 Transesophageal echocardiography showing the exact position of the 4 tumors. A: An immobile tumor of size 15 × 15 mm at the interatrial septum (yellow arrow). B: A mobile tumor of size 24 × 6 mm (from the left atrium to the left ventricle) at the anterior mitral leaflet (yellow arrowhead). C: An immobile tumor of size 21 × 33 mm at the posterior mitral leaflet (white arrow). D: A mobile tumor of size 11 × 11 mm (from the left ventricular outflow tract to the aorta) at the left leaflet of the aortic valve (white arrowhead).

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  Fig. 3 Four tumors resected during the operation.

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  Fig. 4 Histopathological examination showing myxoma cells with a stellate appearance proliferate in a myxoid background in nests and linear syncytia (hematoxylin & eosin staining).

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