Quiz WHAT IS YOUR DIAGNOSIS?

We report two patients with primary cardiac atrial neoplasms.

Case 1.

The first patient was 34-year-old female admitted do the cardiac surgery clinic for an urgent procedure. An intraoperative TEE (transesophageal echocardiography) study revealed well circumscribed structure filling almost the entire left atrium of the heart. Radical surgery was performed and histological examination showed a tumor mostly composed of spindle cells (Fig. 1 AB) that were diffusely positive for vimentin and presented focal SMA reactivity. Epithelioid component (Fig. 1C) showed positive reaction to vimentin, CD31 and EMA. There was no reaction to pancytokearatins, S100 protein, melan A, desmin, miogenin, ERG, SOX10, ALK1, CD30, and PLAP.

Case 2

A 30-year-old man complained of exercise dyspnea, heart arrythmia and weakness. The diagnosis of right atrium tumor compressing right and left ventricle with pulmonary and pericardial effusion was set after obtaining magnetic resonance imaging (MRI) and positron emission tomography (PET). The patient was underwent emergency surgery, but the operation was not radical (R1). Histopathological study revealed biphasic neoplasm (Fig 2. A-C) characterized by the following immunophenotype: pancytokeratins (+), CK5/6 (+), calretinin (+), desmin (–), SMA(–) S100 protein (–), and CD31(–).