PMC9346307_01
A: Transthoracic echocardiography in four-chamber view showing large mass in the left atrium (blue arrow) and a retro right atrial mass (yellow arrow). B: Transmitral valve gradient in continuous Doppler showing severe mitral stenosis.. LV: left ventricle, MV: mitral valve, RV: right ventricle.
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Transthoracic echocardiography (TTE) revealed 5 x 4 cm homogenous mass occupying nearly all the left atrium (LA), resulting in severe mitral valve obstruction (mean gradient = 17 mmHg) ( Figure 1).
Transesopheagal echocardiography showing a large mass, occupying nearly all the left atrium (blue arrow) and mitral obstruction.
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Following respiratory stabilization, transesophageal echocardiography confirmed TTE results and revealed an extended mass into LA via the right inferior pulmonary vein (RIPV) ( Figure 2).
CT (coronal reconstruction): Right pulmonary mass, slightly enhanced after injection of contrast product with extension to the LA via the RIPV.
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Cardiac computed tomography (CT) revealed a large (100 x 70 x 100) mediastino-pulmonary mass extending to LA via RIPV ( Figure 3).
Cardiac MRI (axial cine-MRI sequence): prolapse of the mass of LA via the mitral valve.
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T1-weighted imaging and high signal on T2-weighted imaging of the mediastino-pulmonary mass ( Figure 4). The patient accepted to undergo an urgent mass resection surgery to avoid total mitral valve obstruction and sudden death.
Mesenchymal pattern of a malignant phyllode tumor with a high stromal cellularity, nuclear atypia and mitosis (arrows) (HE stain x 400).
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The histological study of the resected mass confirmed the metastatic spread of malignant PTs to LA ( Figure 5).
CT (coronal reconstruction): huge relapse of mediastinal mass with cardiac and tracheal compression.
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However, three months after the surgery, she died from a huge relapse of mediastinal mass cardiac and tracheal compression ( Figure 6).