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Cardiovascular Pathology
Monday, February 28, 2005 - 7:30 PM
Convention Center, Room 006 C,D
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Moderator:
Jeffrey Saffitz
Washington University School of Medicine
St. Louis, MO
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Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view
Submitted by:
Debra L. Kearney
Texas Children's Hospital
Houston, TX
Prenatal ultrasound of a 19 weeks gestation female fetus revealed a mediastinal mass and pericardial
effusion. The mass was not evident by ultrasound at 14 weeks gestation. Fetal echocardiography
demonstrated a 1.8 x 1.4 cm in maximum dimension, predominantly solid, pericardial tumor attached to the right
side of the aortic root, compressing the right-sided cardiac chambers and displacing the entire heart
into the left hemithorax. The pregnancy was terminated.
Case 1 - Figure 1 - Heart in-situ with large well circumscribed mass overlying right atium. On right a probe elevates the mass exposing the compressed, distorted right atrium
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Case 1 - Figure 2 - A transverse, cross section of the thorax. Right and left lungs are connected by the branch pulmonary arteries with a cross section of the ascending aorta situated near the left lung hilum. The tumor is attached to the anterior and rightwards border of the aorta. The tumor has a fleshy, tan-white cut surface with two central cystic spaces and focal hemorrhage. The section is taken superior to the heart
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Case 1 - Figure 3 - A low power (2x), H & E section through the tumor demonstrating the point of attachment to the root of the aorta (the large vessel in the central-top portion of the image). The tumor has a heterogeneous composition. Myocardium of the right ventricular outflow tract is evident in the right upper corner of the image and is not infiltrated by tumor
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Case 1 - Figure 4 - H & E sections of the tumor demonstrating the heterologous composition with attempted organogenesis. The image to the left shows a cystic space lined by ciliated respiratory epithelium with surrounding mesenchyme and smooth muscle simulating a bronchiole (40x). On the right, the top image shows a nodule of cartilage (20x) and the bottom shows striated muscle (40x). The middle image shows pancreatic tissue with acini and islets (20x)
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Case 1 - Figure 5 - A medium power (10x) H & E section of the tumor demonstrating, on the left, a large cystic space lined by hyperchromatic, immature neuroepithelium simulating the neural tube. The neuroepithelium merges with irregularly shaped tubules lined by columnar and cuboidal epithelium, all dispersed within a moderately cellular, pale staining, immature mesenchyme
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Case 1 - Figure 6 - A low power (2x) H & E section of the tumor demonstrating aggregates of tubules, and solid nests and cords of cells disposed within a stroma that varies in cellularity and density. The very pale, nearly clear, mucinous regions of the stroma should be closely examined for the presence of yolk sac tumor
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Case 1 - Figure 7 - H & E images of the clear, mucinouspale areas of stroma show solid nests (right image 10x), cords and loosely dispersed tumor cells (left image 4x) of yolk sac tumor (left 4x, right 10x)
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Case 1 - Figure 8 - High power, (40x) H & E images of monotonous, tumor cells with a delicate nuclear chromatin pattern, occasional nucleoli, and scant, relatively clear cytoplasm of malignant yolk sac tumor
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Case 1 - Figure 9 - High power (40x) H & E image of hepatic differentiation. The image on the left shows areas of the teratoma with immature fetal liver morphology with congestion/hemorrhage within sinusoids. The image on the right shows clusters of hepatoid pattern of yolk sac tumor surrounded by typical yolk sac tumor morphology
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Case 1 - Figure 10 - Intermediate power (20x) H & E image of primitive endodermal glands representing well differentiated yolk sac tumor. The glands are lined by cells with basal, subnuclear vacuoles and are dispersed within immature stroma
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Submitted by:
Renu Virmani
CV Path
Gaithersburg, Maryland
The patient is a 33-year-old man employed as a roofer with a 20-pack-year history of tobacco use who
presented with chest pain. He was admitted to the hospital at which time an acute myocardial infarction
was ruled out. On physical exam a pericardial friction rub was noted and was subsequently found to have
pericarditis with effusion. He was given Indomethacin, which resulted in marked improvement, but the
chest pain returned. An echocardiogram showed a large left atrial mass with possible mitral valve
involvement. Past medical history was significant for left leg and arm arterial thrombsis, a year prior
to this admission.
The patient underwent surgical removal of the left atrial mass, which measured 5.5 cm in diameter,
gelatinous in appearance and was attached to the interatrial septum.
Case 2 - Figure 1 - Low power view of cardiac myxoma with focal glandular elements
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Case 2 - Figure 2 - A higher magnification of the glandular component; the glands have irregular contours and are lined by cuboidal to columnar cells
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Case 2 - Figure 3 - An area of cardiac myxoma composed of myxoma cells found in a myxoid matrix
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Submitted by:
Jagdish W. Butany
University of Toronto
Toronto, ON, Canada
This 56 year old previously healthy caucasian male presented with severe congestive heart failure. He
had a two-month history of increasing shortness of breath on exertion. He was in florid pulmonary edema
and had to be intubated on admission. He needed large does of inotropes, and was ventilated on 100%
oxygen. A transesophageal echo (TEE) revealed a large tumor mass in the left atrium. A CT scan showed
no lesions in the lungs.
Submitted by:
Henry Tazelaar
Mayo Clinic
Rochester, MN
An 80 year-old man with a history of prostate cancer presented with fatigue and dysuria. He was found
to have a urinary tract infection and was treated with antibiotics. One month later he developed chills,
sweats and cough. He also had been noticing some mild right-sided weakness. A work up revealed another
urinary tract infection and a large vegetation on the atrial side of the anterior leaflet of the mitral
valve, which in addition was moderate to severely regurgitant. Blood cultures grew out Streptococcus
agalactiae. He underwent valve replacement and at the time of surgery was diagnosed with mitral valve
prolapse and vegetations as described above. Two specimens were submitted to surgical pathology: a
myxomatous valve with a focus of subacute endocarditis and separate "yellow to white purulent appearing
"vegetation" measuring 2.5 x 2.0 x 0.2 cm. Sections are from this latter specimen.
Case 4 - Figure 1 - "Vegetation from" mitral valve. Note vacuoles and focus of dense connective tissue (x 20)
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Case 4 - Figure 2 - The "vegetation" is composed predominantly of oval to round cells with abundant pink cytoplasm (x 40)
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Case 4 - Figure 3 - Interspersed among the round cells are clusters and strips of columnar cells, some of which have prominent nucleoli (x 200)
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