Ann Thorac Surg 2005;79:329-330
© 2005 The Society of Thoracic Surgeons
Case report
Primary Pulmonary Myxoma
Hidehito Matsuoka, MD, PhDa,*,
Yukihiro Takata, MD, PhDa,
Sakan Maeda, MD, PhDb
a Departments of Surgery and Internal Medicine, Hyogo Prefectural Kaibara Hospital, Kaibara, Japan
b Department of Biomedical Informatics, Division of Molecular Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
Accepted for publication August 19, 2003.
* Address reprint requests to Dr Matsuoka, Department of Surgery, Hyogo Prefectural Kaibara Hospital, Kaibara 5208-1, Kaibara-cho, Hikami-gun, Hyogo, 669-3395, Hyogo, Japan
hmatsuoka1{at}mac.com
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Abstract
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We report a case of a primary pulmonary myxoma. The patient was a 69-year-old previously healthy human. Computed tomographic scan demonstrated a well-circumscribed tumor with a diameter of approximately 13 mm in the right upper lobe. We performed a right upper lobectomy under video-assisted thoracoscopy. Microscopic examination of the tumor disclosed elongated and stellate cells in a myxoid stroma, typical of myxoma.
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Introduction
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Myxoma is a morphologically benign tumor that frequently occurs in the left atrium. We describe a patient with a rare primary pulmonary myxoma.
A 69-year-old previously healthy human presented without symptoms. He was incidentally found, on medical checkup, to have an abnormal shadow on the chest roentgenogram film. There were no particular findings, such as cutaneous myxomas, pigmentation, or endocrine abnormalities, on physical examination. Biochemical and hematological blood analysis did not detect any abnormalities. A chest roentgenogram film revealed an abnormal shadow in the right upper lung area and a computed tomographic (CT) scan demonstrated a well-circumscribed homogeneous tumor, with a diameter of approximately 13 mm, in the right upper lobe (Fig 1). No other intrathoracic abnormalities were found. Cytologic examination under bronchofiberscopy did not demonstrate any malignancy and the patient refused to undergo preoperative needle biopsy. We suspected the tumor to be a carcinoid or hamartoma and scheduled resection. Surgery was performed by standard right upper lobectomy with lymph node dissection under video-assisted thoracoscopy.
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Fig 1. Computer tomographic scan demonstrating a well-circumscribed homogeneous tumor with a diameter of approximately 13 mm in the right upper lobe.
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Histologic examination of the tumor disclosed elongated and stellate cells in a myxoid stroma typical of myxoma (Fig 2). Some micro nodules on the periphery of the main tumor were thought to be infiltrating cells, but there was no metastasis on microscopic examination of the dissected lymph nodes. We also considered the possibilities of hamartoma and pulmonary chondroma. There were only myxoid features in the specimens and thus we excluded hamartoma, pulmonary chondroma, or other malignant myxoid tumors. Postoperative transthoracic echocardiogram did not demonstrate any evidence of both atrial myxomas. We performed transthoracic echocardiogram one month and six months after the operation. Eventually the patient was diagnosed with primary pulmonary myxoma. The patient had an uneventful postoperative recovery. He has survived without recurrence for eight months postoperatively.
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Fig 2. Histologic examination of the tumor disclosed elongated and stellate cells in a myxoid stroma typical of myxoma.
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Comment
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Myxomas are tumors formed by elongated and stellate cells in a myxoid stroma. Most occur in the heart, especially the left atrium. Soft tissue intramuscular, juxtaarticular, cutaneous myxoma, or myxomatous features in many types of sarcomas are also relatively common.
Dang and Hurley pointed out that malignancy of atrial myxomas is predicated on biological behavior rather than on histologic appearance [1]. In the cases of cardiac myxoma, metastases to the brain, arteries, bones, and soft tissue of the back have been reported [2–5], but it is difficult to sharply distinguish metastatic brain myxoma and myxoma emboli.
Recurrences in cardiac cases have occurred within 5 years of surgery; however, some late recurrences have been reported [4, 5]. Long-term follow-up is desirable for local recurrence and distant metastasis in other organ cases. Kaynak and associates treated nonresectable metastatic tumor with doxorubicin, ifosfamid, and mesna and regression of the masses was observed after 3 months [6].
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References
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- Dang CR, Hurley EJ. Contralateral recurrent myxoma of the heart. Ann Thorac Surg. 1976;21:59–62[Abstract/Free Full Text]
- Read RC, White HJ, Murphy ML, et al. The malignant potentiality of left atrial myxoma. J Thorac Cardiovasc Surg. 1974;68:857–867[Medline]
- Rankin LI, DeSousa AL. Metastatic atrial myxoma presenting as intracranial mass. Chest. 1978;74:451–452[Free Full Text]
- McCarthy PM, Piehler JM, Schaff HV, et al. The significance of multiple, recurrent and "complex" cardiac myxomas. J Thorac Cardiovasc Surg. 1986;91:389–396[Abstract]
- Terada Y, Wanibuchi Y, Noguchi M, et al. Metastatic atrial myxoma to the skin at 15 years after surgical resection. Ann Thorac Surg. 2000;69:283–284[Abstract/Free Full Text]
- Kaynak K, Besirli K, Arslan C, et al. Metastatic cardiac myxoma. Ann Thorac Surg. 2001;72:623–625[Abstract/Free Full Text]
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Abstract
Introduction
