case_images: PMC3568891_01
case_images: Two-dimensional (a) and magnified three-dimensional (b) transesophageal echocardiogram (TEE) of the left atrium (LA), mitral valve, and left ventricle. A 4.4 x 3.5 cm mass (asterisk) is seen attached to the posterolateral aspect of the LA.
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case_images: PMC3568891_01_CRIM.MEDICINE2013-461815.001.jpg
case_images: fig1
case_images: Mean and peak gradients across the mitral inflow were 4 and 12 mmHg, respectively (Figure 1).
case_images: Axial (a) MRI T1- and (b) T2-weighted and (c) CT contrast enhanced imaging and 4-chamber MRI (d) first pass perfusion and (e) late gadolinium enhancement (TI = 350 ms) imaging. MRI T1- and T2-weighted black blood images demonstrate a lobulated mass (asterisk) with central signal drop-out suggestive of punctuate calcification confirmed by CT. CT imaging also suggests that this mass is contiguous with the posterior leaflet of the mitral valve. Dynamic contrast-enhanced MRI demonstrates very minimal first pass perfusion and heterogenous late enhancement consistent with surface thrombus overlying a tumour. (RA) right atrium, (LA) left atrium, (RV) right ventricle, and (LV) left ventricle.
case_images: CRIM.MEDICINE2013-461815.002.jpg
case_images: PMC3568891_01_CRIM.MEDICINE2013-461815.002.jpg
case_images: fig2
case_images: Cardiac CT and MRI corroborated the TEE findings (Figure 2).
case_images: Macroscopic image shows the left atrial mass attached to the posterior wall of the left atrium and the entire posterior mitral leaflet, except for its free margin.
case_images: CRIM.MEDICINE2013-461815.003.jpg
case_images: PMC3568891_01_CRIM.MEDICINE2013-461815.003.jpg
case_images: fig3
case_images: The mass involved the atrial wall posteriorly and the entire posterior mitral leaflet, except for its free margin (Figure 3).
case_images: Section shows sheets of densely packed spindle cells infiltrating the myocardium, as well as the overlying epicardial adipose tissue (Stain: H&E, x5).
case_images: CRIM.MEDICINE2013-461815.004.jpg
case_images: PMC3568891_01_CRIM.MEDICINE2013-461815.004.jpg
case_images: fig4
case_images: The tumour cells had large, pleomorphic nuclei with prominent nucleoli (Figure 4).
case_images: The tumour cells show large, pleomorphic nuclei with prominent nucleoli. An abnormal mitotic figure is identified (Stain: H&E, x40).
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case_images: PMC3568891_01_CRIM.MEDICINE2013-461815.005.jpg
case_images: fig5
case_images: Frequent abnormal mitotic figures were identified (Figure 5).
case_images: Focal areas of the tumour showed malignant cartilaginous change (a), osteoid and bone formation ((a) Stain: H&E, x10, (b) Stain: H&E, x20).
case_images: CRIM.MEDICINE2013-461815.006.jpg
case_images: PMC3568891_01_CRIM.MEDICINE2013-461815.006.jpg
case_images: fig6
case_images: In some areas, the tumour showed malignant cartilaginous and osteoid differentiation (Figure 6).
case_images: Immunohistochemistry profile shows mild focal positivity for S100.
case_images: CRIM.MEDICINE2013-461815.007.jpg
case_images: PMC3568891_01_CRIM.MEDICINE2013-461815.007.jpg
case_images: fig7
case_images: S100 (Figure 7), and negative staining for smooth muscle actin, CD117, CD34, and O13 (CD99). Staining with MDM2 and platelet-derived growth factor (PDGF) was not performed.