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Interleukin-6 and the Lung
Published in Jason Kelley, Cytokines of the Lung, 2022
Ralph J. Zitnik, Jack A. Elias
Cardiac myxomas are classic examples of tumors of which systemic symptoms result, at least in part, from their ability to constitutively produce IL-6. It has long been known that myxomas are associated with fever, elevations in serum acute-phase proteins, and autoimmune phenomena, such as antinuclear antibody (ANA) and rheumatoid factor (RF) production. It has also been shown that, after successful resection of a myxoma, these abnormalities subside (Sutton et al., 1980). Hirano et al. (1987) and Jourdan et al. (1990) demonstrated that cultured cardiac myxoma cells produce IL-6 and that patients with myxomas have elevated serum IL-6 levels. A patient studied by Jourdan and associates had elevated polyclonal IgG levels, elevated C-reactive protein, hypoalbuminemia, positive ANA and RF assays, and polyclonal marrow plasmacytosis. These processes resolved and the patient’s IL-6 levels normalized after resection of the myxoma.
Cardiac Masses
Published in Takahiro Shiota, 3D Echocardiography, 2020
Sonia Velasco del Castillo, Miguel Angel García-Fernández
Sometimes sarcoma is presumed to be benign myxoma, and the suspicion of sarcoma is only made at the time of surgery due to its invasive nature. However, unlike myxomas, sarcomas are not related to the oval fossa via a pedicle. They are visualized as a mobile, broad-based, nonhomogeneous mass with hypoechoic/anechoic areas by necrosis and hemorrhage zones, which can be detected by 2D echocardiography or cropping in the 3D echocardiographic study (Figure 19.4). They tend to be large, to occupy the cavity, and to have multiple tumor implants (Figure 19.10). Due to their great size and mobility, they can produce hemodynamic compromise such as dyspnea or syncope as a consequence of the obstruction of the tracts of entry or exit of the chambers affected, visualized in an anatomical way by using 3D echocardiography (Figure 19.11, ). Surgery often has a palliative intent to remove the obstruction produced by the tumor. The prognosis is poor with a 1-year survival of less than 25%, with the best prognosis corresponding to cases of treatment with complete resection and chemotherapy.7
Soft tissue sarcomas
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Christina Messiou, Dirk Strauss, Eleanor Moskovic
The myxoid variant (Figure 23.3) is the commonest liposarcoma and contains abundant gelatinous material. This produces a deceptively benign cystic appearance on both MRI and CT, and an early tumour may be easily confused with a benign myxoma. Myxoid liposarcomas are considered intermediate in grade but can metastasize. Individuals with those arising in the limb have a 5-year survival rate of 85%.
Isolated intraosseous extra-gnathic orbital myxoma: a clinicopathologic case report
Published in Orbit, 2019
Fairooz P. Manjandavida, Shaifali Chahar, Brijal Dave
Myxoma (Greek ‘muxa’ for mucus) is a myxoid tumor of primitive connective tissue, arising from soft tissue and occasionally from a bone. According to Dutz and Stout, Virchow first used the term ‘myxoma’ in 1863 for a group of tumors that had the histologic resemblance to umbilical cord mucinous substance.6,7 Stout later redefined it in 1948 as true neoplasm composed of stellate cells set in a loose myxoid stroma.7 Soft-tissue myxoma can be intramuscular (typical), cutaneous (superficial angiomyxoma), juxta-articular, nerve sheath (neurothekeoma), and aggressive angiomyxoma. That are considered as mainstream myxomas.8 Those located outside the soft tissue include cardiac, odontogenic, renal, ovarian, sino-nasal, and ophthalmic myxomas.9 The most common site of occurrence is the heart, accounting for more than half of all primary cardiac tumors.
Acute heart failure related to a large left atrial myxoma
Published in Baylor University Medical Center Proceedings, 2018
Giovanni A. Chiariello, Piergiorgio Bruno, Christian Colizzi, Natalia Pavone, Marialisa Nesta, Federico Cammertoni, Andrea Mazza, Alfredo Posteraro, Gianluigi Perri, Massimo Massetti
Emergency open heart surgery was performed. Through a median sternotomy, on moderately hypothermic cardiopulmonary bypass with aortic and bicaval cannulation, the left atrium was entered through a right atriotomy and transseptal incision. A 10.5 × 9 cm myxoma was excised by resecting the pedicle implanted on the atrial roof (Figures 2a–2b). Mitral valve repair was performed with a 36-mm flexible ring annuloplasty and the left atrium appendage was closed by continuous running suture. The mass weighed 120 g. Microscopic examination of the surgical specimen confirmed the diagnosis of myxoma (Figure 2c). The patient's postoperative hospital course was uneventful, and he was discharged on the fifth postoperative day in sinus rhythm. At discharge, LV function had partially recovered (ejection fraction 43%). At 1-year follow-up, the patient was in good condition but had permanent atrial fibrillation. An echocardiogram excluded the recurrence of myxoma, the left ventricle remained dilated (LV end-diastolic diameter, 65 mm), and the ejection fraction was 45% (Figure 2d).
A rare emboligenic origin of ischaemic stroke
Published in Acta Cardiologica, 2018
F. Staels, F. Van Durme, F. Casselman, A. Heyse
Cardiac evaluation with transthoracic echocardiography showed a pedunculated mass (white arrow) on the atrial side of the mitral valve (panel B). Transesophageal echocardiography demonstrated a mobile polyglobular mass (white arrow) with the largest diameter of 9 mm, close to the anterior leaflet but attached to the posterior leaflet of the mitral valve (panel C, D). The valvular localisation is most consistent with a fibroelastoma. A thrombus on that location is unlikely. The echocardiographic appearance of the left atrial appendage was completely normal. We referred the patient for resection of the tumour. Surgery is usually indicated after embolic events and also in case of large (>1 cm) or highly mobile masses. She underwent a port-access operation with resection of the mass from the posterior leaflet without complications. The macroscopic appearance was suggestive for a myxoma. However, pathological specimen demonstrated a papillary fibroelastoma (panel E). Recurrence of papillary fibroelastoma has not been described.