Clinicopathologic study and DNA analysis of 37 cardiac myxomas: a 28-year experience.
OBJECTIVE
This study was performed to identify morphologic features of cardiac myxomas related to embolism and to provide a better understanding of the biology of these tumors, mainly in relation to their interleukin (IL)-6 expression and DNA content.


METHODS
A total of 37 cardiac myxomas were reviewed retrospectively in a clinicopathologic study that included the correlation of echocardiographic and pathologic findings in 25 cases, together with immunohistochemical evaluation of IL-6 expression and flow cytometric DNA analysis of 35 tumors.


RESULTS
There were 24 female patients and 13 male patients. The mean (+/- SD) age was 52 +/- 15 years. Fifty-four percent of patients presented with dyspnea, 51% presented with increased erythrocyte sedimentation rate (ESR), and 27% presented with embolic episodes, which were significantly associated with villous surface tumors. Atrial fibrillation was registered in 19% of patients and was significantly associated with large left atrial myxomas. Echocardiography proved to be a reliable method for preoperative diagnosis and for predicting tumor size and morphology. There was no perioperative mortality or long-term recurrences. The frequency of early surgical complications was associated with a longer mean ischemic time. Seventeen percent of tumors had abnormal DNA content, and 74% of tumors showed immunohistochemical expression of IL-6. Neither of these factors showed a significant association with embolism or constitutional illness.


CONCLUSIONS
Villous surface myxomas are related to embolism, and large left atrial tumors are related to atrial fibrillation. Echocardiography is a reliable method with which to predict tumor size and morphology. Myxoma cells usually express IL-6, and some tumors have abnormal cellular DNA content. Surgical excision of the tumor is a safe and effective treatment.
Acebo
Elvira
E
Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain.
Val-Bernal
J Fernando
JF
Gómez-Román
J Javier
JJ
Revuelta
J Manuel
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000782:Aneuploidy; D002648:Child; D004273:DNA, Neoplasm / Q000235:genetics*; D004452:Echocardiography; D005260:Female; D005434:Flow Cytometry; D006338:Heart Neoplasms / Q000235:genetics* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000235:genetics* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D009360:Neoplastic Cells, Circulating; D012189:Retrospective Studies
D004273:DNA, Neoplasm; D015850:Interleukin-6