Cardiac myxoma as a potential trigger of takotsubo cardiomyopathy: A brief review on mechanistic and clinical perspectives

In clinical practice, cardiac myxomas constitute the majority of benign cardiac neoplasms, and might potentially present with a variety of embolic, obstructive as well as constitutional symptoms. On the other hand, these neoplasms might be potentially associated with the evolution of takotsubo cardiomyopathy (TTC) that is universally considered as a transient form of acute myocardial dysfunction. Accordingly, the present paper primarily aims to focus on potential mechanisms and associated clinical implications of TTC evolution in the setting of cardiac myxomas.

Primary Pulmonary Leiomyosarcoma in a Forty-Year-Old Woman

Primary pulmonary leiomyosarcomas (PPLs) are rare aggressive malignancies originating from the smooth muscle cells of the pulmonary interstitium, bronchial tree, or blood vessels. Accounting for <0.5% of lung tumors, PPLs are often initially undetected or misdiagnosed as pulmonary emboli, cardiac neoplasms, or as other more common lung cancer subtypes. Due to their aggressive and often lethal clinical profile, the diagnostic delay of PPL can significantly affect patient outcomes and must be avoided. Here we describe a case of PPL in a 40-year-old woman.

Giant left atrial myxoma presenting as cerebral embolism

Primary cardiac neoplasms are uncommon with an overall incidence of 0.0017 to 0.02%. The majority of these tumors are benign and half of these tumors are myxomas. About 75% of them are located in the left atrium. Acute embolic cerebral stroke is major problem with increased mortality and morbidity. Embolus arising from cardiac origin costitutes about 20% of ischemic strokes. Atrial fibrillation is cause of more than 50% of cardiogenic emboli. Congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic and rheumatic heart valvular disease, dilated cardiomyopathy and endocarditis are predisposing factors for cardiogenic emboli. Emboli from primary tumors of the heart are extremely rare, with an incidence of 0.02 %. Myxoma is a potential source of systemic embolization to the brain or peripheral arteries. Thus, cerebral stroke may be the first manifestation of the presence of left atrial myxoma.

Cross-species comparison of the oncogenomic landscape of canine and feline hemangiosarcoma shows novel parallels with human angiosarcoma

Angiosarcoma (AS) is a highly aggressive tumor of blood and lymphatic vessels in humans that carries a poor prognosis. The rarity of AS, together with its heterogeneous nature, and locations (skin, breast, visceral organs and deep soft tissues), makes understanding the pathogenesis of AS challenging. Dogs and cats spontaneously develop hemangiosarcoma (HSA), an aggressive tumor that shares many histopathological and clinical similarities to AS. To investigate the genetic suitability of spontaneously occurring HSA as a model for AS, we sequenced ∼1,000 cancer genes in 41 cases of HSA and matched germline tissue; 15 canine visceral HSAs, 13 canine skin HSAs and 13 feline skin HSAs. Analysis of visceral HSAs from dogs presenting with concurrent splenic and cardiac neoplasms showed that the tumors were not independent primaries, consistent with the highly metastatic nature of HSA. Comparison of canine and feline HSA to human AS revealed that several driver genes were recurrently mutated in both species, such as TP53, PIK3CA, ATRX, GRIN2A and LRP1B. In the germlines, by focusing specifically on canine and feline orthologs of human AS risk genes, we identified several candidate pathogenic variants. Similar to AS, a UV mutational signature was found in a subset of canine cutaneous HSAs. Furthermore, both AS and canine HSA show differing mutational profiles between tissue sites. Our characterization of canine and feline HSA demonstrate many important parallels to AS and provides hope that future studies on these cancers will benefit patients of all three species.

Сardiac myxoma: challenge in diagnostics. Case report

Cardiac myxoma is the most common primary benign cardiac tumor (up to 50% of all primary cardiac neoplasms). The implementation of the modern imaging techniques into the clinical practice, particularly, 2D echocardiography, computed tomography and magnetic resonance tomography (MRI) results to the prompt diagnosis of the myxoma. However, the absence of specific clinical features, insufficient awareness of this condition among the physicians along with a rare prevalence, may lead to a misdiagnosis. This case report is notable for the relatively late diagnosis of a giant left atrial myxoma due to a number of circumstances but with successful surgical treatment.

A malignant lymphoma growing inside a cardiac mixoma: a case report

Background: lymphomas arising in cardiac myxomas represent a particularly rare pathology, with only few cases reported in the literature. Case presentation: we report a completely exeresis of malignant lymphoma arising in a cardiac myxoma in a 44 years-old female patient. The myxoma presented like a floating mass within the left atrium with a maximum diameter of 3.5 cm. The clinical post-operative period was uneventful and the patient was dismissed on sixth post-operative day. Conclusions: This case reinforces the concept of a radical exeresis of cardiac neoplasms

Think ultrasound; could point of care ultrasound really change the management of critically ill patient?

Myxomas are the most common primary cardiac neoplasms. The prevalence of cardiac tumors at autopsy ranges from 0.001% to 0.3%. More than 50% of benign cardiac tumors are myxomas. Approximately 7% of these have genetic origin and arise as a component of a heritable disorder with some clinical manifestations. Over 72% of primary cardiac tumors are benign. In adults, the majority of benign lesions are myxomas. Its clinical manifestations are variable and nonspecific. Commonly observed symptoms and signs are dyspnea, orthopnea, paroxysmal nocturnal dyspnea, pulmonary edema, cough, hemoptysis, edema, and fatigue. Key words: POCUS; ARDS; Atrial myxoma; Pulmonary edema Abbreviations: ARDS: acute respiratory distress syndrome; CRP: C reactive protein; ABG: arterial blood gases; PEEP: positive end expiratory pressure; HFNC: high frequency nasal cannula; TTE: transthoracic echocardiography; P/F: ratio of partial pressure of oxygen to inspired oxygen fraction; CT: computed tomography; POCUS: point of care ultrasound Citation: Aisa T, Lal S, Thomas J, Singh V, Narayanan N. Think ultrasound; could point of care ultrasound really change the management of critically ill patient? Anaesth. pain intensive care 2021;25(1):105–108; DOI: 10.35975/apic.v25i1.1438 Received: 16 June 2020; Reviewed: 4 June 2020; Accepted: 21 June 2020