Left Atrial Myxoma Presenting with Unusual Cystic Form
A 65-year-old woman was referred to our department because of a recently diagnosed left atrial (LA) mass. She presented with a five-month history of fever, malaise, and myalgia and had been diagnosed with ventricular septal defect (VSD) two years earlier. On physical examination, a grade of 4/6 systolic murmur was heard at the left sternal border. Electrocardiography and a chest X-ray were unremarkable. Two-dimensional transthoracic echocardiography showed an LA cyst (24×23 mm) that was attached to the interatrial septum and detected the trace of blood flow at the margin of the cyst (). The VSD was a small perimembranous type and the pulmonary blood flow to systemic blood flow ratio (Qp/Qs) was 1.2.\nThe patient underwent surgical treatment. The cystic mass attached to the left side of the interatrial septum was white-pink-yellowish and oval in shape. It had a small opening on the surface and was 2.2×1.6 cm (). The cystic mass was widely excised with the atrial septum, leaving the defect in the atrial septum, and the small VSD was closed with two pledgeted sutures without a patch. The defect on the atrial septum was closed with an artificial patch (polytetraflouroethylene, Gore-Tex patch; WL Gore & Assoc, Flagstaff, AZ, USA). The mass was a single cyst and didn't have any content. The diagnosis of myxoma was confirmed by microscopic examination. Histologically, the mass consisted of myxoid cells in abundant loose and myxoid stroma, and the tumor cells were round or polygonal with eosinophilic cytoplasm (). Postoperative echocardiography revealed no VSD shunt and no mass in the left atrium. The patient was discharged 16 days after surgery without any problem.