case_images: PMC11148456_01
case_images: (A) Sternal fat left ventricular long-axis view: a hypoechoic mass is seen in the left atrium, and some of this hypoechoic mass is seen entering the left ventricle during diastole through the mitral orifice. (B) No obvious blood flow is seen in the mass. (C) Pulsed Doppler flow spectra at the mitral valve orifice: mild mitral regurgitation.
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case_images: Notably, TTE showed that the left ventricular ejection fraction (LVEF) was preserved at 68% ( Figure 1 ), and the patient did not present any symptoms regarding the cardiovascular system.
case_images: (A) Initial admission preoperative enhanced CT scan of the chest and abdomen: arrows indicate a homogeneous low-density mass almost entirely occupying the left atrium, extending into the left auricle and pulmonary artery opening. (B) Readmission CT tomography scan of the chest at 4 months postoperatively: tumor recurrence is seen at the arrows.
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case_images: An enhanced computed tomography (CT) scan of the chest, abdomen, and coronary arteries on admission showed a filling defect in the left atrium, which was likewise considered to be atrial tethering ( Figure 2 ). TTE revealed a solid left atrial space causing mitral orifice obstruction, tricuspid regurgitation (moderate-to-severe), severe pulmonary hypertension, and a chest CT scan revealed a hypodense shadow in the left atrium and a large amount of pleural effusion. ( Figure 2 ), We considered tumor recurrence and started urgent anti-heart failure therapy. The patient's oxygen saturation level was extremely low, and we performed ventilator-assisted ventilation.
case_images: (A) Surgical resection of the cardiac mass. Postpathological histology and immunohistochemistry. (B-E) Under the microscope, the tumor was composed of dense and sparse cells, the tumor cells were spindle-shaped, with poorly defined cell boundaries, pale cytoplasm, long oval nuclei, obvious anisotropy, easy-to-see nuclear schizophrenia, and mucus-like stroma in the sparse cell area. Some of the cells are rich in cytoplasm and reddish stained, and the nuclei were biased to one side.
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case_images: The mass had a solid, greyish-yellow, translucent section with focal necrosis ( Figure 3 ). MyoD1, and myogenin all showed focal positive expression, although 10% of the samples had Ki67. MDM2, S-100, beta-catenin, STAT6, EMA, H3K27M, H3K27Me3, P16, GFAP and CD57 all yielded negative results ( Figure 3 ).
case_images: Complete timeline, including diagnosis (surgery) and treatment.
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case_images: However, on the second day after admission, the patient's shortness of breath worsened, her consciousness appeared fuzzy, and she passed away after resuscitation ( Figure 4 ).