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目的分析左心房原发性黏液瘤的临床特征、病理学特点,探讨其组织来源、诊断及鉴别诊断。方法收集14例心脏黏液瘤患者的临床资料,对组织病理学表现和免疫组化结果进行分析,并结合文献复习。结果 14例心脏黏液瘤患者,男性3例,女性11例,年龄20～64岁,平均年龄50.2岁;黏液瘤均位于左心房。除1例没有临床症状外其余均有胸闷、心悸、气促。镜下大量黏液样基质中可见散在或灶状分布的肿瘤细胞,细胞呈星芒状、梭形、圆形或卵圆形,核深染,局部可见多核瘤细胞。免疫组化:14例vimentin均(+),SMA灶性(+),Ki-67(-);6例calretinin灶性(+)。结论左心房黏液瘤可能起源于原始多潜能间叶细胞,可向平滑肌分化;但部分细胞calretinin(+)。组织病理结合超声心动图可明确诊断。该瘤复发率较低,预后较好。
Objective To analyze the clinical features and pathological features of primary atrial myxoma of the left atrium, and to explore its source of tissue, diagnosis and differential diagnosis. Methods The clinical data of 14 patients with cardiac myxoma were collected, and the histopathological findings and immunohistochemical results were analyzed. Combined with the literature review. Results 14 patients with cardiac myxoma, 3 males and 11 females, aged 20 to 64 years, mean age 50.2 years; myxoma were located in the left atrium. In addition to 1 case without clinical symptoms, the rest are chest tightness, heart palpitations, shortness of breath. A large number of mucus-like matrix showed scattered or focal distribution of tumor cells, cells were star-shaped, fusiform, round or oval, nuclear stained, locally visible polycythemia tumor cells. Immunohistochemistry: 14 cases of vimentin (+), SMA (+), Ki-67 (-); 6 cases of calretinin foci (+). Conclusions Left atrial myxoma may originate from primitive pluripotent mesenchymal cells and may differentiate into smooth muscle; however, some cells may have calretinin (+). Histopathology combined echocardiography can confirm the diagnosis. The tumor recurrence rate is low, the prognosis is good.