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Case Reports
. 2020 Jan 15;2(1):51-54.
doi: 10.1016/j.jaccas.2019.12.004. eCollection 2020 Jan.

Suspicious Right Heart Mass: A Rare Case of Benign Metastasizing Leiomyoma of the Tricuspid Valve

Mohamed M Gad  1 , Mihnea-Alexandru Găman  2 , Najdat Bazarbashi  1 , Kenneth A Friedman  3 , Amit Gupta  3
Affiliations
Case Reports

Suspicious Right Heart Mass: A Rare Case of Benign Metastasizing Leiomyoma of the Tricuspid Valve

Mohamed M Gad et al. JACC Case Rep. .

Abstract

Benign metastasizing leiomyoma is a rare condition usually affecting women of reproductive age with a history of uterine leiomyoma and characterized by soft tissue masses in various extrauterine sites. We report a case of a 46-year-old woman with previously resected uterine leiomyoma with subsequent pulmonary and tricuspid valve lesions. (Level of Difficulty: Intermediate.).

Keywords: BML, benign metastasizing leiomyoma; CT, computed tomography; benign metastasizing leiomyoma; hysterectomy; metastasis; tricuspid valve.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Right Heart Mass on Echocardiography (A) Four-chamber transthoracic echo image demonstrating a pedunculated multilobulated mobile lesion in the basal right ventricle (yellow arrow). (B) Subsequent transesophageal echocardiography shows the lesion to be attached to the tricuspid valve leaflet (yellow arrow).
Figure 2
Figure 2
Pelvic Mass and Pulmonary Metastases on CT Imaging (A) Axial computed tomography (CT) chest in lung window settings demonstrates multiple rounded lower lobe predominant pulmonary nodules (yellow arrows), concerning for metastatic disease. (B) Abdominopelvic CT scan shows a large complex pelvic mass (yellow arrows) compressing on bilateral ureters with biopsy consistent with leiomyoma.
Figure 3
Figure 3
Right Heart Mass on Cardiac Magnetic Resonance Imaging A 4-chamber delayed contrast-enhanced magnetic resonance image reveals the lobulated hypodense lesion with basal right ventricle (yellow arrow) without discernible contrast enhancement, a thrombus/vegetation was favored over a hypoperfused neoplasm.
Figure 4
Figure 4
Gross Specimen and Pathological Appearance of Right Heart Mass (A) Gross specimen of the tricuspid valve mass: a smooth, tan-white, firm, and lobulated mass measuring 4.8 × 2.5 × 1.3 cm with an attached portion of chordae tendinae. (B) Pathological examination (hematoxylin and eosin staining with ×20 magnification) revealed spindle-shaped cells mostly arranged in a parallel fashion and containing pink (eosinophilic) cytoplasm with oval or diamond-shaped nuclei and no atypia or mitoses, consistent with low-grade smooth muscle neoplasm/benign metastasizing leiomyoma.
See this image and copyright information in PMC

References

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