Vassiliadis N, Vassiliadis K, Karkavelas G
Department of Forensic Medicine, Aristotelian University of Thessaloniki, Greece.
Med Sci Law. 1997 Jan;37(1):76-8. doi: 10.1177/002580249703700116.
Primary tumours of the heart are rare, their incidence ranging from 0.0017 to 0.28 per cent in various autopsy series (Colucci and Braunwald, 1992). Thirty per cent of these tumours are cardiac myxomas (McAllister and Fenaglio, 1978). The latter are histologically benign but potentially lethal. Sudden death is reported in 15 per cent of cases and is mainly attributed to massive embolism or mechanical interference to blood flow within the heart by the tumour (Fisher, 1983). This incidence could be due to the absence of clinical manifestations of the disease or to the presence of non-specific or subtle ones that preclude early referral for specialist evaluation (Colucci and Braunwald, 1992). Such a poor prognosis is not altogether justified, however, considering the highly sensitive and accurate diagnostic techniques and the level of surgical treatment which can be offered today (Larsson et al., 1989; Roberts, 1989; Bortolloti et al., 1990; Lyons et al., 1991). We present a case diagnosed at post-mortem of an atrial myxoma which had subtle ante-mortem manifestations. This paper should alert the clinician with regard to the need to be aware of the rather obscure clinical presentation which may accompany this potentially treatable condition.
原发性心脏肿瘤较为罕见，在不同的尸检系列中，其发病率为0.0017%至0.28%（科卢奇和布劳恩瓦尔德，1992年）。这些肿瘤中有30%是心脏黏液瘤（麦卡利斯特和费纳廖，1978年）。后者在组织学上是良性的，但有潜在致命性。据报道，15%的病例会发生猝死，主要原因是大量栓塞或肿瘤对心脏内血流的机械干扰（费舍尔，1983年）。这种发病率可能是由于该疾病缺乏临床表现，或者存在非特异性或不明显的表现，从而妨碍了早期转诊进行专科评估（科卢奇和布劳恩瓦尔德，1992年）。然而，考虑到如今可提供的高度敏感和准确的诊断技术以及手术治疗水平（拉尔松等人，1989年；罗伯茨，1989年；博托洛蒂等人，1990年；莱昂斯等人，1991年），这样糟糕的预后并不完全合理。我们报告一例心房黏液瘤病例，生前表现不明显，死后才得以诊断。本文应提醒临床医生，需要注意这种潜在可治疗疾病可能伴随的相当隐匿的临床表现。
