Asymptomatic Myxoma Originating from the Right Ventricular Outflow Tract
A 42-year-old female presented with general weakness occurring over 3 months. She was a hepatitis B carrier and had undergone prior surgeries for benign breast nodules and a parotid gland tumor. She had also been recently diagnosed with uterine myoma. On admission, she had a normal temperature of 36.5°C, blood pressure of 120/80 mmHg, pulse rate of 100 beats/min, and respiratory rate of 16 breaths/min. There was no history of fever or weight loss. Thoracic auscultation revealed clear lung sounds without crackles and regular heart beat without murmur, but she had pale conjunctiva. Electrocardiogram and chest radiograph were unremarkable. Laboratory data were within normal range for white blood cell count, erythrocyte sediment rate and C-reactive protein level, but there was evidence of microcytic anemia (hemoglobin 6.3 g/dL, mean corpuscular volume of 65.6 fL, serum iron 10 mcg/dL, total iron binding capacity 474 mcg/dL, serum ferritin 1.73 ng/mL). Serologic tests for autoimmune markers were also negative. Although uterine myoma was thought to be the main cause of anemia, abdominal computed tomography (CT) was performed to identify any other possible causes of bleeding, and a large mass in the pulmonary outflow tract was found incidentally. Pulmonary angio CT showed a contrast-enhancing mass in the RVOT (). Transthoracic Doppler echocardiography (TTE) was performed for further evaluation of the RVOT mass and revealed a large, mobile, ovoid mass measuring 24 × 17 mm in diameter, which was prolapsing into the pulmonary trunk during the systolic phase (). Although we were not able to obtain a pulse wave Doppler measurement across the obstruction owing to a non-favorable interception angle, there was no definite flow acceleration around the tumor by color flow Doppler. The right ventricle (RV) chamber was mildly dilated, but there was no significant tricuspid regurgitation or right ventricular hypertrophy, and the estimated RV systolic pressure was 36 mmHg. Transesophageal echocardiography was performed to confirm the size and location of the mass, showing the stalk of the mass originating from the subvalvular infundibulum ().\nThe patient underwent surgery and the mass was completely removed via right atrial approach under cardiopulmonary bypass (). The mass was yellowish, soft and had a wide stalk. Microscopic examination showed stellate and globular cells that were arranged in a cord-like pattern with an abundant myxoid background, consistent with a benign myxoma (). The patient's postoperative course was uneventful and she was discharged 10 days after surgery.