myxoma

粘液腫

　

WordNet

1. a benign tumor of connective tissue containing jellylike material
2. a viral disease (usually fatal) of rabbits

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/03/26 03:16:31」(JST)

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For the atrial subtype, see Atrial myxoma. For the virus, see Myxoma virus.

"Myxomatous" redirects here. It is not to be confused with Myxomatosis.

Myxoma
Micrograph of an atrial myxoma. H&E stain.
Classification and external resources
ICD-10	D21.9
ICD-9	212.7
ICD-O:	M8840/0
OMIM	255960
DiseasesDB	30736
eMedicine	med/186
MeSH	D009232

A myxoma (New Latin from Greek 'muxa' for mucus) is a myxoid tumor of primitive connective tissue. It is the most common primary tumor of the heart in adults, but can also occur in other locations.

Animated image of an MRI of the heart, showing a large myxoma plunging to and fro from atrium to ventricle across the mitral valve.

A Myxoma. A gelatinous tumor can be seen attached by a narrow pedicle to the atrial septum. The myxoma has an irregular surface and nearly fills the left atrium.

Location

• Atrial myxoma
• Cutaneous myxoma
• Odontogenic myxoma

Atrial myxoma

Myxomas are usually located in either the left or right atrium of the heart; about 86 percent occur in the left atrium.

Myxomas are typically pedunculated, with a stalk that is attached to the interatrial septum. The most common location for attachment of the stalk is the fossa ovalis region of the interatrial septum.

An atrial myxoma may create an extra heart sound, audible to auscultation just after S2 It is most seen on echocardiography, as a pedunculated mass that is heterogeneous in appearance. A left atrial myxoma will cause an increase in Pulmonary Capillary Wedge Pressure.

The differential diagnosis include other cardiac tumors such as lipomas and rhabdomyomas (and rarely teratomas). These other tumors of the heart are typically not pedunculated, however, and are more likely to infiltrate the muscle of the heart. Cardiac magnetic resonance imaging (MRI) can help non-invasively diagnose cardiac tumors. However, diagnosis usually requires examination of a tissue sample by a pathologist.

Types

Myxoma	Margin	Vascular pattern	Cellularity	Stroma	Staining characteristics	Recurrence rate	Image (see Histology)
Cutaneous myxoma or Superficial angiomyxoma	Poor to moderately circumscribed, multilobular	Scattered thin-walled vessels	Moderately cellular, bland spindled and stellate cells, variable inflammatory cell infiltrate	Abundant mucin with clefts. Up to 30% have an associated epithelial component	Vimentin; variable staining with CD34, factor XIIIA, SMA, MSA and S-100	20–30%
Intramuscular myxoma	Poorly circumscribed merges with surrounding muscle	Hypovascular variant; hypervascular variant	Hypocellular variant; hypercellular variant; bland spindle cells	Abundant mucin with cystic spaces. Hypercellular variant has strands of collagen	Vimentin; variable staining with actin, desmin, CD34	None
Juxta-articular myxoma	Poorly circumscribed infiltrates surrounding tissue	Focally vascular	Focally hypercellular, peripheral spindle cells with occasional atypical cells and mitoses	Abundant mucin, 89% of cases contain cystic spaces lined by fibrin or collagen	Vimentin; variable staining with actin, desmin, CD34	34%
Aggressive angiomyxoma	Infiltrative	Uniformly distributed medium-sized blood vessels often with prominent hyalinization	Low to moderately cellular, evenly distributed round, spindled or stellate cells	Loose myxoid to focally collagenous	Vimentin, desmin, SMA, MSA, estrogen and progesterone receptor	36–72%
Angiomyofibroblastoma	Well circumscribed	Abundant thin-walled blood vessels	Alternating hypercellular and hypocellular areas, perivascular condensations of spindled to epithelioid stromal cells	Collagenous to edematous with minimal mucin	Vimentin, desmin, CD34, estrogen and progesterone receptor	No recurrences reported, but rare cases of sarcomatous degeneration
Superficial acral fibromyxoma	Pushing to infiltrative	Mild to moderately accentuated vasculature	Moderately cellular, spindle and stellate cells with a storiform to fascicular pattern, variable mast cells	Myxoid to collagenous	CD34, EMA, CD99	Recurrence rare and primarily for incompletely excised lesions
Neurothekeoma (Nerve sheath myxoma)	Well circumscribed, multilobular	Hypovascular	Moderately cellular, spindled cells in fascicles and whorls	Nests of cells separated by collagenous bundles	S-100, EMA	47% if incompletely excised

1.^ SMA, smooth muscle actin. 2.^ MSA, muscle-specific actin. 3.^ EMA, epithelial membrane antigen.

Symptoms

Symptoms associated with cardiac myxomas are typically due to the effect of the mass of the tumor obstructing the normal flow of blood within the chambers of the heart. Because pedunculated myxomas are somewhat mobile, symptoms may only occur when the patient is in a particular position.

Some symptoms of myxoma may be associated with the release of interleukin 6 (IL-6) by the myxoma. High levels of IL-6 may be associated with a higher risk of embolism of the myxoma.

Symptoms of a cardiac myxoma include:

• Dyspnea on exertion
• Paroxysmal nocturnal dyspnea
• Fever
• Weight loss (see cachexia)
• Lightheadedness or syncope (Loss of consciousness)
• Hemoptysis
• Sudden death
• Tachycardia or milder heartrate, i.e. 75 - 100 cycl/min

Treatment

Myxomas are usually removed surgically. The surgeon removes the myxoma, along with at least 5 surrounding millimeters of atrial septum. The septum is then repaired, using material from the pericardium.

See also

• Myxoid tumor
• Cutaneous myxoma
• Carney complex
• Myxomatosis
• Primary tumors of the heart
• Myxomatous degeneration

References

External links

• -435814399 at GPnotebook
• 03-031b. at Merck Manual of Diagnosis and Therapy Home Edition
• Toronto General Hospital Department of Anesthesia VIRTUAL TEE pathology section: Cardiac Myxoma (with video)

UpToDate Contents

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• 1. 心臓腫瘍 cardiac tumors
• 2. 末梢神経腫瘍 peripheral nerve tumors
• 3. 僧帽弁の心エコー評価 echocardiographic evaluation of the mitral valve
• 4. 心雑音の聴診 auscultation of cardiac murmurs
• 5. 心耳の心エコー評価 echocardiographic evaluation of the atria and appendages

English Journal

• A rare cause of severe mitral stenosis and reversible pulmonary hypertension.

• Pujol-López M1, San Antonio R1, Flores-Umanzor EJ1, Guasch E1, Azqueta M1.
• Echocardiography (Mount Kisco, N.Y.).Echocardiography.2017 Jul 3. doi: 10.1111/echo.13586. [Epub ahead of print]
• PMID 28670782

• Acute Reduction of Venous Return in a Patient With a Giant Right Atrial Myxoma.

• Bandyopadhyay S1, Raychaudhuri T.
• Anesthesia and analgesia.Anesth Analg.2017 Jul;125(1):52-55. doi: 10.1213/ANE.0000000000002088.
• PMID 28537980

• Apoptosis-inducing effect of myxoma virus on human neuroglioma cell lines.

• Zhang QS1,2, Zhang M2, Huang XJ2, Liu XJ2, Li WP2.
• Experimental and therapeutic medicine.Exp Ther Med.2017 Jul;14(1):344-348. doi: 10.3892/etm.2017.4487. Epub 2017 May 22.
• PMID 28672936

Japanese Journal

• 症例報告 ペースメーカー埋め込み術に先行し反復性経頭蓋磁気刺激を施行した左房粘液腫由来の脳塞栓症患者

• 佐々木 信幸,角田 亘,安保 雅博
• The Japanese journal of rehabilitation medicine 51(6), 378-382, 2014-06
• NAID 40020142703

• 症例報告 経静脈的および経動脈的に血行再建術をおこなった心臓粘液腫による脳塞栓症の1例

• 神谷 雄己,市川 博雄,水間 啓太 [他]
• 臨床神経学 = Clinical neurology 54(6), 502-506, 2014-06
• NAID 40020121686

• 統合失調症患者に発生した下顎骨歯原性粘液腫の1例

• 石田 純一,今井 裕一郎,柳生 貴裕 [他]
• 日本口腔外科学会雑誌 = Japanese journal of oral and maxillofacial surgery 60(5), 267-271, 2014-05
• NAID 40020108674

Related Links

• Myxoma - Wikipedia, the free encyclopedia

A myxoma (New Latin from Greek 'muxa' for mucus) is a tumor of primitive connective tissue. It is the most common primary tumor of the heart in adults, but can also occur in other locations. Animated image of an MRI of the heart, showing a ...

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★リンクテーブル★

リンク元

「粘液腫」

「粘液腫」

　　[★]

英

myxoma, mucous tumor

同

粘液芽細胞腫 myxoblastoma

関

心臓粘液腫