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. 1992 Jan;67(1):89–91. doi: 10.1136/hrt.67.1.89

Atrial myxoma: a tumour in search of its origins.

D M Krikler 1, J Rode 1, M J Davies 1, N Woolf 1, E Moss 1
PMCID: PMC1024709  PMID: 1531423

Abstract

OBJECTIVE--To determine whether atrial myxomas express antigens suggesting a neural origin. DESIGN--A retrospective analysis based on immunohistochemical examination of myxoma tissue. SETTING--Atrial myxomas excised by two tertiary referral cardiothoracic surgical units. SUBJECTS--24 excised atrial myxomas. Three were from known cases of familial myxoma syndrome. METHODS--Immunohistochemical identifications of three neuroendocrine markers (protein gene product (PGP) 9.5, neurone specific enolase (NSE), synaptophysin) and S100 antigen; CD34 and von Willebrand factor; and chi smooth muscle actin to identify possible Schwann cell differentiation, endothelial cells, and smooth muscle cells respectively. RESULTS--The myxoma cells were PGP 9.5 positive in 18, S100 positive in 16, and NSE positive in 12. Of the 12 NSE positive myxomas seven were synaptophysin positive. All tumours that were NSE positive were also S100 and PGP 9.5 positive. The tumour surface was partially covered by myxoma cells, partly by endothelial cells. CONCLUSION--The histological appearances of myxomas with stellate cells embedded within a loose connective tissue stroma, abundant basophil cell infiltration, and the presence of pericellular type IV collagen are similar to nerve sheath tumours (neurofibromas) at other sites. A significant proportion of myxomas also express Schwann cell and neuroendocrine differentiation markers. These features cannot prove the origin of myxomas because tumours may develop aberrant phenotype expression but they do accord with the view that myxomas originate from endocardial sensory nerve tissue.

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Selected References

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  1. Boxer M. E. Cardiac myxoma: an immunoperoxidase study of histogenesis. Histopathology. 1984 Sep;8(5):861–872. doi: 10.1111/j.1365-2559.1984.tb02401.x. [DOI] [PubMed] [Google Scholar]
  2. Chejfec G., Falkmer S., Grimelius L., Jacobsson B., Rodensjö M., Wiedenmann B., Franke W. W., Lee I., Gould V. E. Synaptophysin. A new marker for pancreatic neuroendocrine tumors. Am J Surg Pathol. 1987 Apr;11(4):241–247. [PubMed] [Google Scholar]
  3. Cordell J. L., Falini B., Erber W. N., Ghosh A. K., Abdulaziz Z., MacDonald S., Pulford K. A., Stein H., Mason D. Y. Immunoenzymatic labeling of monoclonal antibodies using immune complexes of alkaline phosphatase and monoclonal anti-alkaline phosphatase (APAAP complexes). J Histochem Cytochem. 1984 Feb;32(2):219–229. doi: 10.1177/32.2.6198355. [DOI] [PubMed] [Google Scholar]
  4. Dewald G. W., Dahl R. J., Spurbeck J. L., Carney J. A., Gordon H. Chromosomally abnormal clones and nonrandom telomeric translocations in cardiac myxomas. Mayo Clin Proc. 1987 Jul;62(7):558–567. doi: 10.1016/s0025-6196(12)62293-9. [DOI] [PubMed] [Google Scholar]
  5. Dhillon A. P., Rode J., Leathem A. Neurone specific enolase: an aid to the diagnosis of melanoma and neuroblastoma. Histopathology. 1982 Jan;6(1):81–92. doi: 10.1111/j.1365-2559.1982.tb02704.x. [DOI] [PubMed] [Google Scholar]
  6. Feldman P. S., Horvath E., Kovacs K. An ultrastructural study of seven cardiac myxomas. Cancer. 1977 Nov;40(5):2216–2232. doi: 10.1002/1097-0142(197711)40:5<2216::aid-cncr2820400532>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  7. Ferrans V. J., Roberts W. C. Structural features of cardiac myxomas. Histology, histochemistry, and electron microscopy. Hum Pathol. 1973 Mar;4(1):111–146. doi: 10.1016/s0046-8177(73)80051-6. [DOI] [PubMed] [Google Scholar]
  8. Gould V. E. Histogenesis and differentiation: a re-evaluation of these concepts as criteria for the classification of tumors. Hum Pathol. 1986 Mar;17(3):212–215. doi: 10.1016/s0046-8177(83)80213-5. [DOI] [PubMed] [Google Scholar]
  9. Gould V. E., Lee I., Wiedenmann B., Moll R., Chejfec G., Franke W. W. Synaptophysin: a novel marker for neurons, certain neuroendocrine cells, and their neoplasms. Hum Pathol. 1986 Oct;17(10):979–983. doi: 10.1016/s0046-8177(86)80080-6. [DOI] [PubMed] [Google Scholar]
  10. Kahn H. J., Marks A., Thom H., Baumal R. Role of antibody to S100 protein in diagnostic pathology. Am J Clin Pathol. 1983 Mar;79(3):341–347. doi: 10.1093/ajcp/79.3.341. [DOI] [PubMed] [Google Scholar]
  11. McComb R. D. Heterogeneous expression of factor VIII/von Willebrand factor by cardiac myxoma cells. Am J Surg Pathol. 1984 Jul;8(7):539–544. doi: 10.1097/00000478-198407000-00006. [DOI] [PubMed] [Google Scholar]
  12. Morales A. R., Fine G., Castro A., Nadji M. Cardiac myxoma (endocardioma). An immunocytochemical assessment of histogenesis. Hum Pathol. 1981 Oct;12(10):896–899. doi: 10.1016/s0046-8177(81)80194-3. [DOI] [PubMed] [Google Scholar]
  14. Peltonen J., Jaakkola S., Lebwohl M., Renvall S., Risteli L., Virtanen I., Uitto J. Cellular differentiation and expression of matrix genes in type 1 neurofibromatosis. Lab Invest. 1988 Dec;59(6):760–771. [PubMed] [Google Scholar]
  15. Riccardi V. M. Mast-cell stabilization to decrease neurofibroma growth. Preliminary experience with ketotifen. Arch Dermatol. 1987 Aug;123(8):1011–1016. [PubMed] [Google Scholar]
  16. Rode J., Dhillon A. P., Doran J. F., Jackson P., Thompson R. J. PGP 9.5, a new marker for human neuroendocrine tumours. Histopathology. 1985 Feb;9(2):147–158. doi: 10.1111/j.1365-2559.1985.tb02431.x. [DOI] [PubMed] [Google Scholar]
  17. Schmechel D. E. Gamma-subunit of the glycolytic enzyme enolase: nonspecific or neuron specific? Lab Invest. 1985 Mar;52(3):239–242. [PubMed] [Google Scholar]
  18. Schmechel D., Marangos P. J., Brightman M. Neurone-specific enolase is a molecular marker for peripheral and central neuroendocrine cells. Nature. 1978 Dec 21;276(5690):834–836. doi: 10.1038/276834a0. [DOI] [PubMed] [Google Scholar]
  19. Sehested M., Hou-Jensen K. Factor VII related antigen as an endothelial cell marker in benign and malignant diseases. Virchows Arch A Pathol Anat Histol. 1981;391(2):217–225. doi: 10.1007/BF00437598. [DOI] [PubMed] [Google Scholar]
  20. Skalli O., Ropraz P., Trzeciak A., Benzonana G., Gillessen D., Gabbiani G. A monoclonal antibody against alpha-smooth muscle actin: a new probe for smooth muscle differentiation. J Cell Biol. 1986 Dec;103(6 Pt 2):2787–2796. doi: 10.1083/jcb.103.6.2787. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Vidaillet H. J., Jr, Seward J. B., Fyke F. E., 3rd, Su W. P., Tajik A. J. "Syndrome myxoma": a subset of patients with cardiac myxoma associated with pigmented skin lesions and peripheral and endocrine neoplasms. Br Heart J. 1987 Mar;57(3):247–255. doi: 10.1136/hrt.57.3.247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Wang J. H., Dhillon A. P., Sankey E. A., Wightman A. K., Lewin J. F., Scheuer P. J. 'Neuroendocrine' differentiation in primary neoplasms of the liver. J Pathol. 1991 Jan;163(1):61–67. doi: 10.1002/path.1711630111. [DOI] [PubMed] [Google Scholar]
  23. Wilson P. O., Barber P. C., Hamid Q. A., Power B. F., Dhillon A. P., Rode J., Day I. N., Thompson R. J., Polak J. M. The immunolocalization of protein gene product 9.5 using rabbit polyclonal and mouse monoclonal antibodies. Br J Exp Pathol. 1988 Feb;69(1):91–104. [PMC free article] [PubMed] [Google Scholar]
  24. Wold L. E., Lie J. T. Cardiac myxomas: a clinicopathologic profile. Am J Pathol. 1980 Oct;101(1):219–240. [PMC free article] [PubMed] [Google Scholar]
  25. Zhang P. F., Jones J. W., Anderson W. R. Cardiac myxomas correlative study by light, transmission, and scanning electron microscopy. Am J Cardiovasc Pathol. 1989;2(4):295–300. [PubMed] [Google Scholar]

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