A Case Presentation Based on Incidental Diagnosis of Atrial Myxoma in a Patient Presenting With Atrial Fibrillation and Suspected Carney Complex

Abstract Background Atrial myxomas are generally considered benign neoplasms. The majority of tumors are sporadic and less than 10% are associated with an autosomal dominant condition known as the Carney complex, which is most often caused by germline mutation in the gene PRKAR1A. Whether this gene plays a role in the development of sporadic myxomas has been an area of debate, although recent studies have suggested that some fraction of sporadic tumors also carry mutations in PRKARIA. Extra-cardiac complications of atrial myxoma include dissemination of tumor to the brain; however, the dissemination of viable invasive tumor cells is exceedingly rare. Case presentation We present here a 48-year-old white woman who developed multiple intracranial hemorrhagic lesions secondary to tumor embolism that progressed to ‘false’ aneurysm formation and invasion through the vascular wall into brain parenchyma 7 months after resection of an atrial myxoma. Whole exome sequencing of her tumor revealed multiple mutations in PRKAR1A not found in her germline deoxyribonucleic acid (DNA), suggesting that the myxoma in this patient was sporadic. Conclusions Our patient illustrates that mutations in PRKAR1A may be found in sporadic lesions. Whether the presence of this mutation affects the clinical behavior of sporadic tumors and increases risk for metastasis is not clear. Regardless, the protein kinase A pathway which is regulated by PRKAR1A represents a possible target for treatment in patients with metastatic cardiac myxomas harboring mutations in the PRKARIA gene.

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CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

10.35988/sm-hs.2020.069 ◽

2020 ◽

Vol 30 (3) ◽

pp. 56-59

Author(s):

Jūratė Gudaitytė ◽

Justina Jermolajevaitė ◽

Martynas Judickas

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

General Population ◽

Metabolic Disorders ◽

Upper Airway ◽

Cardiovascular Complications ◽

Case Presentation ◽

Increased Risk ◽

Fluid Regulation ◽

Class Iv

Background and objectives: Acromegaly is endocrinal disorder which results in changes involving general appearance as well as upper airway abnormalities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to complications. We aim to discuss the challenges for anesthesiologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presented the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallampati score IV and ASA class IV. The complementary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for further monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthesia compared to general population due to difficult intubation, cardiovascular complications , OSA , alteration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and assessment are necessary to predict and prepare for possible difficulties in the surgery room.

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