Background

The most prevalent primary heart tumor is a myxoma.  It is estimated that more than 75% of myxomas develop in the left atrium, either at the mitral annulus or the fossa ovalis boundary of the interatrial septum, about 20% originate from the right atrium, and 5% originate from both atria and ventricles. Common issues associated with atrial myxomas include emboli, cardiovascular obstructions and symptoms such as weight loss and fever.

Epidemiology

Atrial myxomas are most common in females between the age of 40 and 60. Some research indicates that men are around 25% more like to develop right atrial myxomas and women are more than twice likely to develop left atrial myxoma. There are very few instances of children developing atrial myxomas.

Anatomy

Pathophysiology

Macroscopically, atrial myxomas are typically pedunculated and are of a soft consistency. Myxomas range in size from 1cm-15cm in circumference and 15g-180 g in weight. The surface of the tumor may be smooth, villous, or fragile.

Myxomas which are connected with embolic events typically have a villous or fragile surface, but myxomas with smooth surface are typically large and more obstructive. Atrial myxomas frequently produce vascular endothelial growth factor, which induces angiogenesis, as well as diverse cytokines and growth factors.

These factors lead to physical symptoms such as:

• Weight loss
• Fever
• Malaise
• Anorexia
• High sedimentation rate

Etiology

Immunohistochemical investigations reveal that myxoma cells derive from neural and endothelial-differentiable mesenchymal cells. Carney’s complex, a hereditary autosomal dominant condition, accounts for 10% of myxomas, whereas the rest appear to be sporadic. The precise cause of atrial myxoma is still being investigated.

Genetics

Prognostic Factors

Patients who undergo a surgical route for atrial myxomas generally have a favorable prognosis. Mortality rate following surgical resection is below 5% and postoperative recovery is quick.

Given below are the recurrence rates following surgery:

• Sporadic cases: 1%-3%
• Familial cases: 12%
• Complex cases: 24%

One study suggests that limited treatment of tumors, excision with proper margins, and meticulous evaluation of all heart chambers are crucial factors for preventing tumor recurrence.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Future Trends

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References

https://www.ncbi.nlm.nih.gov/books/NBK556040/