Case Report: A rare diffuse mitral valvular myxoma

Figures

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  Figure 1. Transthoracic echocardiography. Multiple iso-echoic masses with irregular shapes were observed on the atrial sides of both the anterior and posterior mitral leaflets. Left ventricle long axis view (A) and apical four chamber view (B).

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  Figure 2. Transesophageal echocardiography. Mid-esophageal mitral commissural view: multiple irregularly shaped masses with a broad base attached to the anterior and posterior mitral leaflets. These masses are characterized by non-smooth surfaces, with an uneven internal echo (A). Mid-esophageal long axis view: color doppler flow imaging indicated that the lesion has a soft and deformable texture, leading to moderate mitral regurgitation (B). Three-dimensional transesophageal echocardiography: a diffuse distribution of granular additional echoes on the left atrial surface in two-thirds of the area of the anterior and posterior leaflets of the mitral valve, as well as the commissural cusps. The lesions merge with each other and are characterized by a wider base and a rough surface (C,D).

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  Figure 3. Pathological specimen. A cauliflower-shaped protrusion is prominently observed that is extensively adhered to the atrial surface. The myxoma extensively affects the mitral valve leaflets, commissural cusps (red star), and sub-valvular chordae tendineae (yellow arrow) (A). No abnormalities are detected on the ventricular side of the leaflets (B). Image under optical microscope (×10): the affected cells exhibit spindle or stellate morphology and are situated within an abundant mucinous matrix. The cellular distribution is sparse, exhibiting mild morphology, with no clear indications of nuclear division present (C,D).