title: A novel approach for a novel combination: a trans-septal biopsy of left atrial mass in recurrent phyllodes tumour.
abstract: A 69-year-old female with a previous hemisternectomy for recurrent phyllodes tumour was referred for echocardiography because of progressive dyspnoea, orthopnea, and a diastolic mitral rumble on auscultation. Transthoracic echocardiography revealed a large left atrial mass. Although a diagnosis of myxoma was likely, there was concern that this was a cardiac metastasis. A tissue diagnosis was mandatory before further thoracic surgery could be considered. This was obtained via a trans-septal puncture using transoesophageal echocardiographic guidance. Histology confirmed a diagnosis of myxoma, and our patient underwent successful surgery. This case highlights the importance of obtaining accurate tissue diagnosis and of excluding metastatic disease in patients with a cardiac mass and a history of tumour, prior to deciding whether surgical excision is warranted.
authors.affiliation: Department of Cardiology, Queen Elizabeth Building, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK. colettejackson@doctors.org.uk
authors.forename: Colette E
authors.initials: CE
authors.lastname: Jackson
authors.forename: Roy S
authors.initials: RS
authors.lastname: Gardner
authors.forename: Derek T
authors.initials: DT
authors.lastname: Connelly
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D009232:Myxoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003557:Phyllodes Tumor / Q000473:pathology* / Q000601:surgery; D018570:Risk Assessment; D013249:Sternum; D013526:Surgical Mesh; D016896:Treatment Outcome