PMC2945675_01
Magnetic resonance scan showing a large tumor mass (T) at the junction of the right atrium (A) and inferior vena cava in association with congested liver (L).
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IVC junction with a size of 35 x 38 mm in cross-sectional dimensions (Figure 1). In addition, there was large thrombus in the IVC extending below the level of renal veins, causing liver congestion and ascitis. 
Transesophageal echocardiogram showing the homogenous echogenic mass (tumor) attached to the posterior wall of the right atrium (RA) above the tricuspid valve (TV), RV: right ventricle.
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Intraoperative transoesophageal echocardiography confirmed the location of tumor within the right atrium (Figure 2).
The cut section of excised tumor mass.
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The tumor was excised completely (Figure 3).
(a) and (b) Histopathology of tumor showing proliferation of myofibroblasts, inflammatory cells, spindle, and fusiform cells in a myxoid stroma (hematoxylin & eosin, x100 & x400 magnifications). (c) Immunophenotype:Vimentin expression in myofibroblastic population (immunoperoxidase, x200). (d) Immunophenotype:Smooth muscle actin coexpression (immunoperoxidase, x200)
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Histopathology of the tumor revealed presence of myofibroblasts, fusiform and spindle cells, modest inflammatory infiltrates, and myxoid stroma in the background of small lymphocytes, plasma cells, and eosinophils (Figures 4(a) and 4(b)). The immunostain marker profile showed productivity for vimentin, smooth muscle actin isoforms, and MyoD, but negativity for desmin, ALK-1 protein, and S-100 protein (Figures 4(c) and 4(d)).