PMC8116158_01
Transthoracic echocardiogram showing a large mass attached to the interatrial septum (a). The mass has a broad stalk and protrudes into the left ventricle during diastole and almost completely occludes the mitral valve (b).
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fig1
A transthoracic echocardiogram revealed a large mass attached to the interatrial septum (Figure 1(a)). The mass had a broad stalk, was freely mobile, and protruded into the left ventricle during diastole with almost complete occlusion of the mitral valve (Figure 1(b)).
A macroscopic picture of the specimen showing the bulk of the tumor consisting of friable gelatinous tan tissue fragments with a papillary surface (on the right) along with the site of attachment (atrial septal myocardium on the left).
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fig2
Hematoxylin and eosin stain showing the more typical cardiac myxoma cells with abundant eosinophilic cytoplasm and bland nuclei (a, b) and areas with glandular differentiation composed of bland columnar cells with basal nuclei and apical mucin (c-f). Myxoid stroma is obvious in both components, with occasional hemosiderin deposits (f) (original magnifications x40 (c), x100 (a), x200 (d), and x400 (B & E-F)).
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fig3
Both components were embedded in a myxomatous/hemorrhagic background with scattered hemosiderin deposits (Figures 3-4).
Special stains. Alcian blue (pH: 2.5) (a) and periodic acid-Schiff (PAS) (b) demonstrate mucin production within the glandular component of the tumor and the myxoid background of the tumor (original magnifications x400 (a) and x200 (b)).
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fig4
Both components were embedded in a myxomatous/hemorrhagic background with scattered hemosiderin deposits (Figures 3-4).
Immunohistochemical profile of the glandular epithelium showing strong immune reactivity to CK7 (a), CK19 (b), and EMA (c), while faintly and focally reactive for calretinin (d). There was no reactivity for CK20 (e) and CDX2 (f) (original magnification x400).
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fig5
Immunohistochemically, the glandular component showed diffuse reactivity for pan-CK, CK7, CK 19, epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) and focal reactivity for calretinin (Figure 5).