Intracardiac mass presenting as acute myocardial infarction

Figures

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  Figure 1. Echocardiographic evaluation showing a large, hyperechoic cardiac mass (white arrows) with irregular borders, attached at the level of the left ventricular posterior wall and posterior mitral valve leaflet in transthoracic parasternal long axis view (A), and apical 4-chamber view (B), and transesophageal 2-chamber view (C). Three-dimensional rendering of the cardiac mass by transthoracic (D) and transesophageal echocardiography (E). AS: Left atrium; VS: Left ventricle

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  Figure 2. Invasive coronary angiography showing no significant coronary lesions at the level of the right coronary artery (A), and left anterior descending artery (C), and with an embolic occlusion of a distal branch of the obtuse marginal branch of the left circumflex coronary artery (B, white arrow

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  Figure 3. Cardiac computed tomography. Arterial phase in short axis (A) and long axis (B) showing the cardiac mass with irregular borders localized at the base of the left ventricle, on the lateral wall, and posterior mitral valve leaflet. Venous phase in short axis (D) and long axis (E) showing the cardiac mass with low initial contrast uptake. Three-dimensional rendering of the cardiac mass (C and F).

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  Figure 4. Intraoperative images of the cardiac mass showing its relationship with the mitral valve (A and B), and the mitral valve replacement with a biological prosthesis (C). The macroscopic appearance of the tumor (D) with large dimensions, irregular borders, yellowish color, and areas of hemorrhage was suggestive of cardiac myxoma.

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  Figure 5. Overview of the tumor structure consisting of fusiform cells with multiple extensions, collagen fibers arranged in all directions, and amorphous conjunctival matrix. Hematoxylin–Eosin (HE) staining, ×100

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  Figure 6. Detail image from the previous figure. Among the fusiform connective cells, there are rare round cells of inflammatory type. HE staining, ×200

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  Figure 7. The tumor area formed by connective cells and collagen fibers with a plexiform arrangement. Goldner–Szekely (GS) trichrome staining, ×100

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  Figure 8. The tumor area formed mainly of amorphous conjunctival matrix. HE staining, ×100

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  Figure 9. Positive reaction of tumor cells to the anti-vimentin antibody. Immunostaining with anti-vimentin antibody, ×100

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  Figure 10. Tumor cells positive for the anti-alpha-smooth muscle actin (α-SMA) antibody. Immunostaining with anti-α-SMA antibody, ×100

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  Figure 11. Tumor cells intensely positive for the anti-cluster of differentiation (CD)34 antibody. Immunostaining with anti-CD34 antibody, ×200

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  Figure 12. Numerous macrophages unevenly distributed in the tumor stroma. Immunostaining with anti-CD68 antibody, ×200.