Ann Thorac Surg 2009;88:684. doi:10.1016/j.athoracsur.2008.10.046
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Giant Right Atrial Mass: Intracardiac Extension of Intravenous Leiomyoma 18 Years After Hysterectomy
Nasser M. Maylar, MDa,*,
Adam J. Piotrowski, MDb,
Raimund Erbel, MD, PhDa,
Klaus J. Schmitz, MD, PhDc
a Clinic of Cardiology, West German Heart Centre, University of Duisburg-Essen, Essen, Germany
b Department of Thoracic and Cardiovascular Surgery, West German Heart Centre, University of Duisburg-Essen, Essen, Germany
c Institute of Pathology and Neuropathology, University of Duisburg-Essen, Essen, Germany
* Address correspondence to Dr Maylar, Clinic of Cardiology, West German Heart Centre, University of Duisburg-Essen, Essen, Germany (Email: nasser.malyar{at}uk-essen.de).
A 72-year-old woman was admitted for diagnostic work-up of edema of the lower limbs. She had a history of hysterectomy for leiomyomatosis 18 years ago. Transthoracic echocardiography (Fig 1A) showed a pedunculated structure that was almost completely obstructing the dilated right atrium (RA) and was prolapsing in diastole into the right ventricle (RV). A contrast enhanced computed tomographic scan (Fig 1B) confirmed the giant tumor arising from the iliac vein at the pelvic level through the inferior vena cava and extending into the right atrium (dashed line). The normal-appearing left atrium (LA) and left ventricle (LV) are also identified in Figures 1A and 1B.
The discrepancy between the size of the tumor and the relatively asymptomatic clinical status of the patient was remarkable. The patient underwent a sternotomy with right atriotomy and the 90 x 65 mm solid tumor was removed from the right atrium (Figs 2A, 2B). Subsequent sectioning of the gross specimen and histologic examination (Fig 3A) demonstrated well-differentiated smooth muscle cells, and immunohistochemistry with antibodies against smooth muscle actin (Fig 3B) confirmed the diagnosis of an intravenous leiomyoma (hematoxylin & eosin staining x400). The patient's recovery was unremarkable and she was discharged 2 weeks after the surgery. One year later, the patient was free of complaints and follow-up imaging was without recurrence.
Intravenous leiomyomatosis with leimomyomas extending into the vena cava and the heart, although a rare condition, should be considered when detection of a right atrial mass is made, particularly in patients with a history of leiomyomatosis.
