Swartz Michael F, Lutz Charles J, Chandan Vishal S, Landas Steve, Fink Gregory W
State University of New York Upstate Medical University, Department of Cardiac Surgery, Syracuse, NY 13215, USA.
J Card Surg. 2006 Jul-Aug;21(4):435-40. doi: 10.1111/j.1540-8191.2006.00265.x.
Atrial myxoma is the most common cardiac neoplasm. Although not widely reported, two anatomic types have been observed: solid and papillary. We examined whether differences in gross or microscopic appearance and location correlated with symptomatology, specifically congestive heart failure (CHF), neurologic symptoms, and embolic events.
We performed a retrospective review of atrial myxomas removed from 1972 to 2002, recording the clinical presentation, diagnostic modality, tumor location, gross, and microscopic features for each patient. Twenty-six patients (16 females and 10 males) had atrial myxomas excised. Two patients (one female and one male) were excluded due to unavailable pathologic slides.
In 24 patients there were 15 solid and 9 papillary tumors. CHF was more prevalent in solid myxomas, while neurologic symptoms and embolic events were more common in papillary tumors. Tumor location further correlated with presenting symptoms. Ninety-two percent of patients presenting with CHF had tumors attached to the atrial septum. Extraseptal myxomas more frequently presented with neurologic (80% vs. 29%) and embolic features (50% vs. 25%). All patients exhibiting clefted tumor surface had a history of embolization. A higher percentage of solid myxomas (93%) showed hemorrhage within the tumor than with papillary (56%).
CHF was more common with solid myxomas, and neurologic and embolization events were more common in the papillary type. Septal tumor location showed strong association with CHF, while extraseptal location correlated with neurologic events. We speculate that the various gross and microscopic patterns reflect secondary changes within these neoplasms over the course of their natural history.
心房黏液瘤是最常见的心脏肿瘤。虽然报道不多，但已观察到两种解剖类型：实性和乳头状。我们研究了大体或显微镜下外观及位置的差异是否与症状相关，特别是与充血性心力衰竭（CHF）、神经系统症状和栓塞事件相关。
我们对1972年至2002年切除的心房黏液瘤进行了回顾性研究，记录每位患者的临床表现、诊断方式、肿瘤位置、大体和显微镜特征。26例患者（16例女性和10例男性）切除了心房黏液瘤。由于病理切片不可用，排除了2例患者（1例女性和1例男性）。
24例患者中有15例实性肿瘤和9例乳头状肿瘤。CHF在实性黏液瘤中更常见，而神经系统症状和栓塞事件在乳头状肿瘤中更常见。肿瘤位置与出现的症状进一步相关。出现CHF的患者中92%的肿瘤附着于房间隔。房间隔外黏液瘤更常出现神经系统症状（80%对29%）和栓塞特征（50%对25%）。所有肿瘤表面有裂隙的患者都有栓塞病史。实性黏液瘤（93%）肿瘤内出血的比例高于乳头状黏液瘤（56%）。
CHF在实性黏液瘤中更常见，而神经系统和栓塞事件在乳头状类型中更常见。肿瘤位于房间隔与CHF密切相关，而位于房间隔外与神经系统事件相关。我们推测，各种大体和显微镜下模式反映了这些肿瘤在其自然病程中的继发性变化。
