PMC9402287_01
Transesophageal echocardiography mid-esophageal 5-chamber view showing the left atrial mass.
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The chest CT scan showed a large left atrial mass with a tumor plug extending into the left inferior pulmonary vein, which was new in comparison to the computerized tomography scan from 2016 "5 years ago." She underwent trans-esophageal echocardiography that showed a large mass in the left atrium approximately 5 x 4 x 3.8 cm, blocking a significant portion of the left atrium ( Fig. 1 ), a contrast medium examination with SonoVue was utilized, and the color-Doppler suspected the presence of small vessels within the mass. 
Cardiac magnetic resonance imaging "axial view" revealed the left atrial mass, which pedunculated with tumor plug in the left inferior pulmonary vein.
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 Cardiac magnetic resonance imaging "CMRI" using native as well as contrast medium enhanced sequences showed 55 x 40 x 48 mm rounded pedunculated mass in the left atrium ( Fig. 2 ), with tumor plug in the left inferior pulmonary vein, left ventricular ejection fraction, and heart dimensions were normal ( Fig. 3 ).
Intraoperative picture demonstrating the resection of tumor. The head of the patient is at 6:00, the legs at 12:00.
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 The patient underwent surgical excision of the left atrial mass using cardiopulmonary bypass "CPB" ( Fig. 4 ).
Intraoperative close-up photography of the extracted tumor.
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The tumor was then resected ( Fig. 5 ).
(
A
) High myxoid areas with prominent vascular network (can be easily mistaken for myxoma). (
B
) High cellularity with pleomorphism and brisk mitotic activity. (
C
) Scattered MDM2 positive tumor cells.
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Histological examination revealed myxoid undifferentiated pleomorphic malignancy with variable myxoid areas, high cellularity with brisk mitotic activity in excess of 30 mitoses in 10 high power fields, and scattered immunoreactivity with MDM2 and CDK4 ( Fig. 6 ).