Large left atrial myxoma with synchronous laryngeal squamous cell carcinoma: A case report

Figure 1 Imaging findings. A-D: Neck computed tomography (CT) showed a malignant tumor (arrowhead) involving the supraglottic larynx. Positron emission tomography (PET)/CT showed high (18)F-fluorodeoxyglucose (FDG) uptake by the laryngeal tumor; E and F: Chest CT showed a 3.8 cm × 2.2 cm hypodensity (arrow) in the left atrium, which had faint (18)FDG uptake on PET/CT; G and H: Transthoracic echocardiogram showed a large, well circumscribed heterogenous lesion (arrow) in the left atrium, protruding through the mitral valve opening causing mitral inflow obstruction, transmitral peak pressure gradient and mean pressure gradient measured 17 mmHg and 6 mmHg, respectively.

Figure 2 Laryngoscopy findings. A and B: Bedside laryngoscopy showed a craggy tumor at the base of the tongue (arrow), affecting bilateral vallecula, involving the entire epiglottis, but the laryngeal inlet was seen (arrowhead); C and D: The patient was intubated using a video laryngoscope with bougie guidance.

Figure 3 Intraoperative findings. A: An encapsulated solid myxoma (arrow) in the left atrium was attached to the atrial wall adjacent to the left atrial appendage by a broad base (arrowhead); B: Gross specimen of the resected myxoma with the broad attachment (arrowhead) measuring 4 cm in length. LA: Left atrium; RA: Right atrium; RV: Right ventricle.

Figure 4 Histopathological findings of the left atrial tumor. A: On macroscopic examination, cut sections show a predominantly hemorrhagic appearance with some pale yellow myxoid areas. No fleshy areas are identified (scale included at the bottom of the image); B: Low power microscopic examination shows stellate, ovoid, and plump spindle cells set in a vascularized myxoid stroma [hematoxylin and eosin-stained slide (HE) 50 × magnification]; C: The cells are singly dispersed, and arranged in perivascular rings around small blood vessels (HE-stained slide, 200 × magnification); D: There is no high-grade cytological atypia. There is prominent intratumoral hemorrhage and hemosiderin deposition. Mixed inflammatory infiltrate is noted (HE-stained slide, 400 × magnification).