Unique Calcification in Atrial Myxomas: Diagnostic Challenges Unveiled

In the realm of cardiac pathology, atrial myxomas stand out as the most prevalent primary cardiac tumors in adults. These tumors often originate from the left atrium, particularly from the interatrial septum. Despite their benign nature, cardiac myxomas can lead to severe complications such as embolism, valve obstruction, and heart failure, emphasizing the importance of prompt diagnosis and treatment to enhance patient outcomes and quality of life. The variability in the features of cardiac myxomas, including their location, shape, composition, and vascularization, can pose challenges in their differentiation from other cardiac lesions.

Furthermore, cardiac myxomas can exhibit rare occurrences of calcification or ossification, adding complexity to their diagnosis. These calcifications or ossifications can mimic the characteristics of malignant tumors on echocardiography, complicating the interpretation of imaging findings. The presence of such features can mislead clinicians and necessitate a thorough analysis to distinguish them accurately.

In a recent report, two compelling cases shed light on these diagnostic challenges. A 47-year-old woman and a 35-year-old man presented with varying symptoms, leading to the discovery of atrial myxomas with unique calcification or ossification patterns. Imaging studies, including transthoracic and transesophageal echocardiography, revealed distinct echogenic masses in the atria with suspicious features suggestive of malignancy. Subsequent contrast-enhanced echocardiography provided additional insights into the blood supply within the lesions, aiding in the surgical planning for mass resection.

The surgical interventions unveiled intriguing findings within the atrial masses. The first case unveiled a solid myxoma with partial ossification, showcasing a rare pathological manifestation. In contrast, the second case exhibited a solid myxoma with massive calcification, underscoring the diverse presentations of these cardiac tumors. The detailed pathological analyses confirmed these unique subtypes of atrial myxomas, emphasizing the importance of precise characterization for tailored management strategies.

Histologically, myxomas display a heterogeneous composition, encompassing fibrosis, hemorrhage, and occasionally, calcification or ossification. While these features are atypical, they underscore the diverse nature of cardiac myxomas and the challenges they pose in diagnostic imaging. The differentiation between calcification and ossification in myxomas versus malignant tumors remains a critical aspect of accurate diagnosis, necessitating further research to elucidate their distinct imaging characteristics.

In conclusion, the cases of atrial myxomas with calcification or ossification offer valuable insights into the complexities of cardiac tumor diagnosis and management. Advanced imaging modalities, such as transesophageal echocardiography and contrast-enhanced techniques, play a pivotal role in enhancing diagnostic accuracy and guiding treatment decisions. As the field continues to evolve, a deeper understanding of the pathogenesis and imaging features of these myxoma variants is essential to refine diagnostic approaches and improve patient outcomes in the realm of cardiac pathology.