Occam's razor versus Hickam's dictum: two very rare tumours in one single patient

Abstract

Occam's razor, the principle that a single explanation is the most likely in medicine, assumes that when a patient has multiple symptoms the clinician seeks a single diagnosis rather than diagnosing multiple and different ones. However, as proposed by Hickam's dictum, sometimes rare different diseases occurred in only one patient. We present a patient with a simultaneous diagnosis of two rare tumours, a cardiac hemangioma (primary cardiac tumour, often misdiagnosed as myxoma) and an appendiceal mucocele (a lesion of the appendix that can be neoplastic or not). A 71-year-old male presented with anorexia, asthenia, fever and weight loss for about one month. During the etiological investigation, a cardiac mass and an appendiceal lesion were detected and both lesions required surgical intervention. Cardiac and abdominal surgeries were uneventful and full recovery was achieved. The histological examination showed a cardiac hemangioma and a neoplastic appendiceal mucocele.

Figure 1

(A–C): Thoraco-abdomino-pelvic CT. Mass in the distal IVC (panels A and B) and a very enlarged mucinoid appendix (panel C).

Figure 2

Abdominal US (panel A) and colonoscopy (panel B).

Figure 3

Transesophageal echocardiography (panel A) and cardiac magnetic resonance (panels B and C).

Figure 4

Histological findings. Microscopic viewing of the atrial tumour (panel A) and appendiceal mucocele (B).