Ann Thorac Surg 2000;69:283-284
© 2000 The Society of Thoracic Surgeons
Case Reports
Metastatic atrial myxoma to the skin at 15 years after surgical resection
Yasushi Terada, MDa,
Yasuhiko Wanibuchi, MDa,
Masayuki Noguchi, MDa,
Toshio Mitsui, MDa
a Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
Address reprint requests to Dr Terada, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki-ken 305-8575, Japan
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Abstract
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Metastasis from atrial myxoma is uncommon. We report on a patient who developed metastasis of the left atrial myxoma to the skin at 15 years after surgical resection. The primary lesion had not recurred. The myxoma has the potential for metastatic growth.
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Introduction
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Atrial myxomas are generally benign tumors. Late recurrences or distant metastases may rarely occur [1, 2]. We report on a patient with atrial myxoma metastatic to the skin at 15 years after resection without evidence of intracardiac recurrence.
A 31-year-old woman, who had suffered a stroke 2 months earlier, was diagnosed as having a nonfamilial left atrial myxoma. Through the biatrial approach, the gelatinous, lobulated tumor which arose from a short stalk in the atrial septum was resected, together with removal of adequate margins in November 1983. The diagnosis of atrial myxoma was made by pathohistologic examination (Fig 1). The myxoma consisted of a myxoid matrix composed of mucopolysaccharide, in which were spindle and stellate-shaped tumor cells with scant eosinophilic cytoplasm. The nuclear atypia was mild and mitotic figures were rarely seen.
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Fig 1. Pathohistologic features of the primary lesion. The tumor had a myxoid matrix with spindle and stellate-shaped cells with scant cytoplasm (hematoxylin and eosin; original magnification x 10).
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The patient had yearly echocardiographic follow-up with no recurrence of the myxoma. She noted that a soft tumor had been present on the anterior chest wall for several years. The tumor was about 1.0 x 1.0 x 1.5 cm in size and resembled a cauliflower in shape. Permission was given for excisional biopsy and the tumor was resected. Histologic features of the tumor strongly resembled those of the original left atrial myxoma (Fig 2). Mitotic figures were also rarely seen. There were several areas which were more cellular with increased atypica of the spindle tumor cells. The diagnosis was a metastatic atrial myxoma to the skin.
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Fig 2. The myxoma metastasized to the skin of the anterior chest. The histological features of the tumor resembled those of the primary myxoma except that it was more cellular, with increased atypica of tumor cells (hematoxylin and eosin; original magnification x 10).
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Comment
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Cardiac myxomas may recur locally or rarely may metastasize. Metastases to the brain, arteries, bones, and soft tissue of the back have been reported [1–3]. Metastatic myxomas grow and invade the organs, which suggests that the myxomas are true neoplasms. Metastatic growth of the myxoma was slower [1], but the interval between surgical resection and evidence of metastasis is not clearly shown. The recurrence usually occurred within 5 years of operation [4], but late recurrence has also been reported [5]. Because the myxoma had the potential for metastatic growth late after surgical resection, long-term follow-up is necessary for not only recurrence, but also metastasis.
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References
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Read R.C., White H.J., Murphy M.L., Williams D., Sun C.N., Flanagan W.H. The malignant potentiality of left atrial myxoma. J Thorac Cardiovasc Surg 1974;68:857-868.[Medline]
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Budzilovich G., Aleksie S., Greco A., Fernandes J., Harris J., Finegold M. Malignant cardiac myxoma with cerebral metastases. Surg Neurol 1979;11:461-469.[Medline]
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Bjessmo S., Ivert T. Cardiac myxoma. Ann Thorac Surg 1997;63:697-700.[Abstract/Free Full Text]
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McCarthy P.M., Piehler J.M., Schaff H.V., et al. The significance of multiple, recurrent and "complex" cardiac myxomas. J Thorac Cardiovasc Surg 1986;91:389-396.[Abstract]
Accepted for publication June 3, 1999.
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Abstract
Introduction
