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2015 Annual Meeting
Evening Specialty Conference - Cardiovascular Pathology
Tuesday, March 24, 2015 - 7:30pm to 9:30pm
CC 311
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Case title: Case 1A- 1B- 1C
Clinical Summary:

case 1A.

A 67 year old woman  with a history of dyslipidemia, systemic hypertension,  peripheral vessel atherosclerotic disease (50% bilateral internal carotid arteries), ovaric cysts

After dinner, she went to bed but had suddenly dyspnea, cough, cold sweats.

At the emergency room: ECG, sinus tachycardia (130 bpm); Xray, increased cardio-thoracic ratio, pulmonary edema.

Lab tests: Neutrophil leukocytosis (13,91 x 10^9/l), CRP 1,41 mg/dl; hepatic and renal function indexes, K, Na, Calcium, CPK and TnI: normal limits

Case 1B.

A 65 year old woman, with a history of dyslipidemia (statins), systemic hypertension (amlodipin), bilateral internal carotid arteries stenosis (50-60%),  family history of ischemic heart disease.

She was first admitted to the hospital for chest pain in 2004 with a diagnosis of double vessel coronary artery disease (LAD: 80% ostial stenosis; dominant RCA with 90% stenosis I

II tract). At that time, stenting of the LAD and PTCA+ stenting of the RCA was successfully performed.  

In 2007, due to recurrence of chest pain and dypnea, she underwent coronary angiography

With evidence of three-vessel coronary artery disease  (Left main trunk 60% ostial; LAD moderate stenosis 50% distal to previous stent; LCx critical stenosis 75% I tract).

She thus underwent to coronary artery bass-pass with left internal mammary artery  to the LAD  and saphenous vein to the obtuse margin branch.

Case 1C.

A 58 year old woman, no CV risk factors.

In 2006, onset of supraventricular premature complexes :  antiarrhythmic therapy

In 2008, TT and TE echocardiographic check-up: huge right atrial mass, occupying two-thirds of the atrial chamber, without any relationship with the atrial septum and the tricuspid valve, partially obstructing the inferior caval vein flow.

Pre-operative CT scan: huge RA mass, 9x15 cm in size,  dense and with calcar appearance... no lymphonodes or hepatic lesions…

Surgical operation: partially calcified RA mass removal, with attachment between the coronary sinus and the inferior vena cava orifices.

Gross features of the resected mass
Gross features of the resected mass
Panoramic histologic sections
Panoramic histologic sections
CD31 immunohistochemistry
CD31 immunohistochemistry
Gross and panoramic histology features of the resected mass
Gross and panoramic histology features of the resected mass
Hematoxylin eosin histologic sections
Hematoxylin eosin histologic sections
First surgical resection A- Hematoxylin eosin histologic sections
First surgical resection A- Hematoxylin eosin histologic sections
First surgical resection B- Hematoxylin eosin histologic sections
First surgical resection B- Hematoxylin eosin histologic sections
First surgical resection C- Hematoxylin eosin histologic sections
First surgical resection C- Hematoxylin eosin histologic sections
Second surgical resection (recurrence) A- Hematoxylin eosin histologic sections
Second surgical resection (recurrence) A- Hematoxylin eosin histologic sections
Second surgical resection (recurrence) B- Hematoxylin eosin histologic sections
Second surgical resection (recurrence) B- Hematoxylin eosin histologic sections
Third surgical resection (recurrence) A- Hematoxylin eosin histologic sections
Third surgical resection (recurrence) A- Hematoxylin eosin histologic sections
Third surgical resection (recurrence) B- Hematoxylin eosin histologic sections
Third surgical resection (recurrence) B- Hematoxylin eosin histologic sections
Case title: Unusual Case of Exertional Dyspnea in a Young Man
Clinical Summary:

A 25-year-old male presented to the emergency department with a month history of palpitations, exertional angina, diminished exercise capacity, and lightheadedness with positional changes. He also noted significant weight loss of more than 10 kg over several weeks.

Objective examination was revealed a persistent precordial thrill, a grade 2/6 systolic ejection murmur, and a palpable and audible systolic “plop”.

An electrocardiogram showed a normal sinus rhythm.

A transthoracic (TTE) followed by a transesophageal echocardiogram (TEE) demonstrated a cystic, multi-lobated, and pedunculated mass attached to the apex of the left ventricle.  The tumor prolapsed across the aortic valve and into the aortic root during systole to produce an almost complete obstruction.  The mitral and aortic valves were normal.

A coronary angiogram showed normal coronary arteries and an intraventricular mass without evidence of neovascularization.

A computed tomography (CT) of the thorax corroborated the echocardiographic findings.

A cardiac magnetic resonance imaging (MRI) study confirmed the presence of an extremely mobile, multilobated, left intraventricular mass that prolapsed across the aortic valve and measured 2.5 cm in lateral diameter x 6 cm in height, filling almost completely the left ventricular cavity.  It was closely related to the posteromedial papillary muscle of the left ventricle and appeared isointense as cardiac muscle on T1 with slight enhancement on T2 and after gadolinium infusion, suggesting a moderately vascular tumor.

An abdominal ultrasound (US) was unremarkable.

Biochemical and hematologic parameters were within normal limits.

The patient underwent a resection of the mass via a transmitral approach using a left auriculotomy.  The mass was comprised of 3 polypoid tumors directly attached to the posteromedial papillary muscle, one of which was noted to be protruding into the anterior leaflet of the mitral valve.  The tumors were resected as close to the papillary muscle as possible, but a clean resection margin was impossible to obtain.  Once they were removed, a wedge resection of the papillary muscle was performed, while attempting to preserve the chordae tendineae of the anterior and posterior leaflets of the mitral valve.











Case title: An Unusual Cause For Ventricular Tachycardia in A Young Adult
Clinical Summary:

A 23-year-old man was referred by his family physician to a cardiology clinic with a several-month history of progressive dyspnea and palpitations.

 

Cardiac and physical examination were non-contributory.

 

The initial 12-lead ECG was within normal limits. A Holter recording revealed frequent premature ventricular contractions and sustained monomorphic ventricular tachycardia.

 

Transthoracic echocardiography detected a large intracardiac mass, near the apex of the left ventricle that was estimated to be similar in size to the left ventricle. Left and right ventricular size and function were normal, and no significant pericardial effusion or valvular abnormalities were noticed.

 

 The cardiac MRI confirmed the presence of a large mass located in the left ventricular myocardium toward the apex, measuring 7.4 x 6.1 x 5.0 cm. It displayed intermediate T1-weighted signal intensity and high T2-weighted signal intensity. The mass had smooth outer borders and was intramyocardial, with a thin rim of what appeared to be myocardial tissue surrounding the mass. This rim of tissue separated the lesion from the left ventricular cavity on the inside and a small pericardial effusion on the outside.

 




Case title: 77 year old man with sudden death
Clinical Summary:

The patient was a 77 year old retired country club golf pro from Bullhead City, Arizona who was in Boston to see a Red Sox game. After the game, he walked into a bar across Landsdowne Street from Fenway Park and died suddenly. The microscopic images provided are from the autopsy.

Microscopic Image 1
Microscopic Image 1
Microscopic Image 2
Microscopic Image 2
Microscopic Image 3
Microscopic Image 3