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Clinical Investigations: CARDIOLOGY |

Clinicopathologic Study and DNA Analysis of 37 Cardiac Myxomas*: A 28-Year Experience

Elvira Acebo; J. Fernando Val-Bernal; J. Javier Gómez-Román; J. Manuel Revuelta
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*From the Department of Anatomical Pathology (Drs. Acebo, Val-Bernal, and Gómez-Román) and the Service of Cardiovascular Surgery (Dr. Revuelta), Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain.

Correspondence to: J. Fernando Val-Bernal, MD, PhD, Departamento de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla 1, E-39008 Santander, Spain; e-mail: apavbj@humv.es



Chest. 2003;123(5):1379-1385. doi:10.1378/chest.123.5.1379
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Purpose: This study was performed to identify morphologic features of cardiac myxomas related to embolism and to provide a better understanding of the biology of these tumors, mainly in relation to their interleukin (IL)-6 expression and DNA content.

Patients and methods: A total of 37 cardiac myxomas were reviewed retrospectively in a clinicopathologic study that included the correlation of echocardiographic and pathologic findings in 25 cases, together with immunohistochemical evaluation of IL-6 expression and flow cytometric DNA analysis of 35 tumors.

Results: There were 24 female patients and 13 male patients. The mean (± SD) age was 52 ± 15 years. Fifty-four percent of patients presented with dyspnea, 51% presented with increased erythrocyte sedimentation rate (ESR), and 27% presented with embolic episodes, which were significantly associated with villous surface tumors. Atrial fibrillation was registered in 19% of patients and was significantly associated with large left atrial myxomas. Echocardiography proved to be a reliable method for preoperative diagnosis and for predicting tumor size and morphology. There was no perioperative mortality or long-term recurrences. The frequency of early surgical complications was associated with a longer mean ischemic time. Seventeen percent of tumors had abnormal DNA content, and 74% of tumors showed immunohistochemical expression of IL-6. Neither of these factors showed a significant association with embolism or constitutional illness.

Conclusions: Villous surface myxomas are related to embolism, and large left atrial tumors are related to atrial fibrillation. Echocardiography is a reliable method with which to predict tumor size and morphology. Myxoma cells usually express IL-6, and some tumors have abnormal cellular DNA content. Surgical excision of the tumor is a safe and effective treatment.

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