Familial recurrent atrial myxoma: Carney's complex

Abstract

We report on a family of 4 members, all of whom have had multifocal, recurrent atrial myxomas associated with skin pigmentation, melanotic schwannomas, mucocutaneous myxomas, and tumors of the ovary and pituitary, adrenal, and thyroid glands. Immunochemistry of the myxoma cells is positive for calretinin, confirming their neuroendocrine origin. Genetic studies confirmed mutations in the gene coding protein kinase A, regulatory subunit 1-α (PRKAR1α). This is Carney's complex, characterized by multiple, mucocutaneous myxomas; pigmented lesions over the lips, conjunctiva, and genitalia; adenomas of the breast and thyroid; schwannomas; and endocrinal abnormalities including Cushing syndrome and acromegaly. Members of the family require vigorous screening, including urinary free cortisol, plasma transforming growth factor-β(1) and thyrotropin-releasing hormone, testicular ultrasound, routine echocardiographic screening, searches for cardiac and mucocutaneous myxomas in multiple locations, and genetic studies for the PRKAR1α gene sequence.

Figure 1

Echocardiographic image of left atrial myxoma.

Figure 2

Echocardiographic image of right and left atrial myxoma.

Figure 3

Gadolinium‐enhanced MRI image. Abbreviations: MRI, magnetic resonance imaging.

Figure 4

H&E histology of myxoma cells. Abbreviations: H&E: Hematoxylin and eosin.

Figure 5

Immunochemistry of calretinin‐positive myxoma cells.