Document Type : Case Report
Department of Pathology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
Associate Professor, Department of Cardiology, School of Medicine AND Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
School of Medicine, Birjand University of Medical Sciences, Birjand AND Department of Clinical Sciences, School of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
BACKGROUND: This study simultaneously reports bilateral atrial tumor masses including the concurrent occurrence of metastatic carcinoma, consistent with metastatic breast carcinoma, on the main cardiac myxoma mass in the left atrium (LA) and metastatic carcinoma consistent with metastatic breast carcinoma for the right atrial (RA) mass.CASE REPORT: These masses were observed in a 79-year-old female patient who had received her pacemaker 6 months ago due to electrical conduction disease. However, no tumor/mass was found in her echocardiogram at the time of the pacemaker reception and mild chest pain and dyspnea were the only signs of her huge masses. Bilateral interseptal atrial cardiac masses protruded to the LA and RA were observed in both atrial chambers in echocardiography, and she underwent the surgical resection of masses.CONCLUSION: The findings of the current study represented a novel condition for a patient. More precisely, the patient had two different huge cardiac masses, and at the same time, the metastasis of breast cancer was reported on the other cardiac tumor/myxoma as well. In addition, metastatic carcinoma should be suspected in patients with cardiac myxoma mass consistent with heart block. The simultaneous presence of multiple masses inside the heart is not always evidence of myxoma, rather can be a metastatic lesion.
- Das S, Mohapatra CR, Badkhal A, Dhande S, Pohekar P, Khatod A. Cardiac myxoma, a rare but most common encountered cardiac tumor: A single center experience. J Cardiothorac Med. 2018; 6(3): 344-9.
- McAllister HAJ, Fenoglio JJJ, Fine G. Tumors of the cardiovascular system. Am J Surg Pathol 1980; 4(3): 306.
- Xiao Z, Meng W, Zhu D, Zhang E. A typical bilateral atrial myxoma: A case report. Case reports in cardiology 2012; 2012: 460268.
- Diaz A, Di SC, Lawrence D, Hayward M. Left atrial and right ventricular myxoma: An uncommon presentation of a rare tumour. Interact Cardiovasc Thorac Surg 2011; 12(4): 622-3.
- Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol 1997; 80(5): 671-82.
- McAllister HA, Hall RJ, Cooley DA. Tumors of the heart and pericardium. Curr Probl Cardiol 1999; 24(2): 57-116.
- Vale Mde P, Freire SA, Sales MV, Teixeira MM, Cabral KC. Giant myxoma in the left atrium: case report. Rev Bras Cir Cardiovasc 2008; 23(2): 276-8.
- Croti UA, Braile DM, Souza AS, Cury PM. Right ventricle and tricuspid valve myxoma. Rev Bras Cir Cardiovasc 2008; 23(1): 142-4. [In Portuguese].
- Geiger TR, Peeper DS. Metastasis mechanisms. Biochim Biophys Acta 2009; 1796(2): 293-308.
- Basso C, Rizzo S, Valente M, Thiene G. Prevalence and pathology of primary cardiac tumours. J Cardiovasc Med 2012; 15(1): 18-29.
- Peachell JL, Mullen JC, Bentley MJ, Taylor DA. Biatrial myxoma: A rare cardiac tumor. Ann Thorac Surg 1998; 65(6): 1768-9.
- Arslan UY, Oksuzoglu B, Aksoy S, Harputluoglu H, Turker I, Ozisik Y, et al. Breast cancer subtypes and outcomes of central nervous system metastases. Breast 2011; 20(6): 562-7.
- Bendell JC, Domchek SM, Burstein HJ, Harris L, Younger J, Kuter I, et al. Central nervous system metastases in women who receive trastuzumab-based therapy for metastatic breast carcinoma. Cancer 2003; 97(12): 2972-7.
- Carey LA, Ewend MG, Metzger R, Sawyer L, Dees EC, Sartor CI, et al. Central nervous system metastases in women after multimodality therapy for high risk breast cancer. Breast Cancer Res Treat 2004; 88(3): 273-80.
- Taal BG, Peterse H, Boot H. Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma. Cancer 2000; 89(11): 2214-21.
- James JJ, Evans AJ, Pinder SE, Gutteridge E, Cheung KL, Chan S, et al. Bone metastases from breast carcinoma: histopathological - radiological correlations and prognostic features. Br J Cancer 2003; 89(4): 660-5.
- Haupt HM, Rosen PP, Kinne DW. Breast carcinoma presenting with axillary lymph node metastases. An analysis of specific histopathologic features. Am J Surg Pathol 1985; 9(3): 165-75.
- Gagnon Y, Tetu B. Ovarian metastases of breast carcinoma. A clinicopathologic study of 59 cases. Cancer 1989; 64(4): 892-8.
- De G, V, Grazzini M, Alfaioli B, Savarese I, Corciova SA, Guerriero G, et al. Cutaneous manifestations of breast carcinoma. Dermatol Ther 2010; 23(6): 581-9.
- Mewis L, Young SE. Breast carcinoma metastatic to the choroid. Analysis of 67 patients. Ophthalmology 1982; 89(2): 147-51.
- Amichetti M, Caffo O, Minatel E, Roncadin M, Valli MC, Lozza L, et al. Ocular metastases from breast carcinoma: A multicentric retrospective study. Oncol Rep 2000; 7(4): 761-5.
- Molnar IA, Molnar BA, Vizkeleti L, Fekete K, Tamas J, Deak P, et al. Breast carcinoma subtypes show different patterns of metastatic behavior. Virchows Arch 2017; 470(3): 275-83.
- Sandhu HS, Mahendrakar SKM, Ladhani SS, Khan AH, Loya YS. Superior vena cava as gateway to heart: metastatic breast carcinoma causing ball in a loop metastasis to right atrium. J Clin Diagn Res 2017; 11(7): XD03-XD05.
- Heidari A, Sabzi F. A case of mitral valve metastasis from breast carcinoma mimicking as a mitral valve regurgitation. Acta Med Iran. 2019; 57(1): 68-71.