Digestive Diseases and Sciences

, Volume 53, Issue 2, pp 405–409 | Cite as

Large Right Atrial Myxoma Containing Gastric Heterotopia Presenting with Dyspnea and Bilateral Leg Edema due to Pulmonary Emboli and Cardiovascular Obstruction: The First Known Report of Gastric Heterotopia in the Cardiovascular System

Original Paper
  • 63 Downloads

Abstract

A 52-year-old male presented with progressive dyspnea, bilateral leg edema, and elevated central venous pressure due to a large right atrial myxoma that caused vascular obstruction and pulmonary emboli. The myxoma contained gastric heterotopia. Other unusual features of this atrial myxoma included its large size, right atrial location, and attachment to the right atrial wall. Although gastric heterotopia has been reported throughout the gastrointestinal tract, and occasionally in other organs, this is the first report of gastric heterotopia in the cardiovascular system. This report confirms and extends previous reports of glandular elements or enteric glands within atrial, or cardiac, myxomas. The clinical presentation of the currently reported patient is explained as follows: the elevated central venous pressure resulted from cardiovascular obstruction and the dyspnea from multiple pulmonary emboli due to the large atrial myxoma. In this case, the clinical presentation was not attributable to the gastric heterotopia. The association of gastric heterotopia with atrial myxoma may, however, be clinically important because of the propensity of gastric heterotopia in the gastrointestinal tract to produce complications. The reported association may provide clues to the histogenesis of these two entities.

Keywords

Atrial myxoma Gastric heterotopia Ectopic gastric tissue Pulmonary emboli Heart Cardiac neoplasms 

References

  1. 1.
    Melato M, Ferlito A (1975) Heterotopic gastric mucosa of the tongue and the oesophagus. J Otorhinolaryngol Relat Spec 37:244–254Google Scholar
  2. 2.
    Johnston C, Benjamin B, Harrison H, Kan A (1989) Gastric heterotopia causing airway obstruction. Int J Pediatr Otorhinolaryngol 18:67–72PubMedCrossRefGoogle Scholar
  3. 3.
    Wang GQ, Dawsey SM, Zhou MH, Lewin KJ (1994) Gastric heterotopia in the upper esophagus (inlet patch) in endoscopic surveys in northern China. J Clin Gastroenterol 19:321–324PubMedCrossRefGoogle Scholar
  4. 4.
    Ward EM, Achem SR (2003) Gastric heterotopia in the proximal esophagus complicated by stricture. Gastrointest Endosc 57:131–133PubMedCrossRefGoogle Scholar
  5. 5.
    Pilette C, Burtin P, Croue A, Ruget O, Boyer J (1995) Mid-esophageal peptic stricture associated with gastric heterotopia and local acid secretion. Endoscopy 27:604–607PubMedGoogle Scholar
  6. 6.
    Cappell MS, Sciales C, Biempica L (1989) Esophageal perforation at a Barrrett’s ulcer. J Clin Gastroenterol 11:663–666PubMedCrossRefGoogle Scholar
  7. 7.
    Haboubi NY, Wilson GE, Martin DF, Faragher EB, Goddard C, Miller JP (1989) Duodenal gastric heterotopia and Camplobacter pylori: an exception to the rule [letter]?. J Clin Pathol 42:1111–1112PubMedCrossRefGoogle Scholar
  8. 8.
    Mann NS, Mann SK, Rachut E (2000) Heterotopic gastric tissue in the duodenal bulb. J Clin Gastroenterol 30:303–306PubMedCrossRefGoogle Scholar
  9. 9.
    Bhattacharya B, Jakate S, Saclarides TJ, Keshavarzian A (2003) Gastric heterotopia presenting as a mass in jejunum. Arch Pathol Lab Med 127:506–507PubMedGoogle Scholar
  10. 10.
    SenGupta SK, Smith F (1983) Gastric heterotopia of the jejunum in a three-week-old baby. J Pediatr Surg 18:302–303PubMedCrossRefGoogle Scholar
  11. 11.
    Chandrakamol B (1978) Gastric heterotopia in the ileum causing hemorrhage. J Pediatr Surg 13:484–487PubMedCrossRefGoogle Scholar
  12. 12.
    Mathis P, Diot J, Hopfner C, Segal S (1975) Gastric heterotopia of the ileum (Meckel’s diverticulum excepted): report of a case. Arch Fr Mal App Dig 64:671–677PubMedGoogle Scholar
  13. 13.
    Chan GS, Yuen ST, Chu KM, Ho JW, Leung SY, Ho JC (1999) Helicobacter pylori in Meckel’s diverticulum with heterotopic gastric mucosa in a population with relatively high H. pylori prevalence rate. J Gastroenterol Hepatol 14:313–316PubMedCrossRefGoogle Scholar
  14. 14.
    Solovei G, Elchardus JF, Favriel JM, Amico S, Petit J, Esso C (1986) Hemorrhagic Meckel’s diverticulum: the place of abdominal scintigraphy with technetium 99 m. Appropos of a case with gastric and pancreatic heterotopia. J Chir 123:570–573Google Scholar
  15. 15.
    Aubrey DA (1970) Gastric heterotopia in the vermiform appendix. Arch Surg 101:628–629PubMedGoogle Scholar
  16. 16.
    Dubilier LD, Caffrey PR, Hyde GL (1969) Multifocal gastric heterotopia in a malformation of the colon presenting as a megacolon. Am J Clin Pathol 51:646–653PubMedGoogle Scholar
  17. 17.
    Cappell MS (1995) Colonic tubulovillous adenoma associated with gastric heterotopia. NJ Med 92:512–515Google Scholar
  18. 18.
    Carlei F, Pietroletti R, Lomanto D, Barsotti P, Crescenzi A, Pistoia MA et al (1989) Heterotopic gastric mucosa of the rectum: characterization of endocrine and mucin-producing cells by immunocytochemistry and lectin histochemistry – report of a case. Dis Colon Rectum 32:159–164PubMedCrossRefGoogle Scholar
  19. 19.
    Antonietta Pistoia M, Guadagni S, Ventura T, Pistoia F, Carboni M (1986) Gastric heterotopia of the rectum [letter]. Endoscopy 18:34PubMedGoogle Scholar
  20. 20.
    Srinivasan R, Loewenstine H, Mayle JE (1999) Sessile polypoid gastric heterotopia of rectum: a report of 2 cases and review of the literature. Arch Pathol Lab Med 123:222–224PubMedGoogle Scholar
  21. 21.
    Hamazaki K, Fujiwara T (2000) Heterotopic gastric mucosa in the gallbladder. J Gastroenterol 35:376–381PubMedCrossRefGoogle Scholar
  22. 22.
    Schimpl G, Schaffler G, Sorantin E, Ratschek M, Klimpfinger M (1994) Polypoid gastric heterotopia in the gallbladder: clinicopathological findings and review of the literature. J Pediatr Gastroenterol Nutr 19:129–131PubMedCrossRefGoogle Scholar
  23. 23.
    Adam R, Fabiani B, Bismuth H (1989) Hematobilia resulting from heterotopic stomach in the gallbladder neck. Surgery 105:564–569PubMedGoogle Scholar
  24. 24.
    Leyman P, Saint-Marc O, Hannoun L, Parc R (1996) Heterotopic gastric mucosa presenting as gallbladder polyps. Acta Chir Belg 96:128–129PubMedGoogle Scholar
  25. 25.
    Evans MM, Nagorney DM, Pernicone PJ, Perrault J (1990) Heterotopic gastric mucosa in the common bile duct. Surgery 108:96–100PubMedGoogle Scholar
  26. 26.
    Grumbach K, Baker DH, Weigert J, Altman RP (1988) Biliary tract duplication cyst with gastric heterotopia. Pediatr Radiol 18:357–359PubMedCrossRefGoogle Scholar
  27. 27.
    Wacrenier A, Fayoux P, Augusto D, Laussel AC, Gosselin B, Leroy X (2002) Gastric heterotopia in the nasopharynx. Int J Pediatr Otorhinolaryngol 64:65–67PubMedCrossRefGoogle Scholar
  28. 28.
    Wolff M, Rankow RM (1980) Heterotopic gastric epithelium in the head and neck region. Ann Plast Surg 4:53–64PubMedCrossRefGoogle Scholar
  29. 29.
    Nawaz K, Graham DY, Fechner RE, Eiband JM (1974) Gastric heterotopia in the ileum with ulceration and chronic bleeding. Gastroenterology 66:113–117PubMedGoogle Scholar
  30. 30.
    Nakagawara M, Kajimura M, Hanai H, Shimizu S, Kobayashi H (2000) Gastroduodenal intussusception secondary to a giant solitary gastric heterotopia: a case report. Gastrointest Endosc 52:568–570PubMedCrossRefGoogle Scholar
  31. 31.
    Santos R, Wills JS (1977) Polypoid gastric heterotopia causing small bowel intussusception. Gastrointest Radiol 2:123–124PubMedCrossRefGoogle Scholar
  32. 32.
    Kalani BP, Vaezzadeh K, Sieber WK (1983) Gastric heterotopia in rectum complicated by rectovesical fistula. Dig Dis Sci 28:378–380PubMedCrossRefGoogle Scholar
  33. 33.
    Lambert MP, Heller DS, Bethel C (2000) Extensive gastric heterotopia of the small intestine resulting in massive gastrointestinal bleeding, bowel perforation, and death: report of a case and review of the literature. Pediatr Dev Pathol 3:277–280PubMedCrossRefGoogle Scholar
  34. 34.
    Goeau-Brissonniere O, Hannoun L, Huguet C (1985) Adenocarcinoma of the cervical esophagus: association with a gastric heterotopia. J Chir 122:101–103Google Scholar
  35. 35.
    McAllister HA, Fenoglio JJ (1978) Tumors of the cardiovascular system. Armed Forces Institute of Pathology, Washington DCGoogle Scholar
  36. 36.
    Fine G, Morales A, Horn RC Jr (1968) Cardiac myxoma: a morphologic and histogenetic appraisal. Cancer 22:1156–1162PubMedCrossRefGoogle Scholar
  37. 37.
    Frishman W, Factor S, Jordan A, Hellman C, Elkayam U, LeJemtel T et al (1979) Right atrial myxoma: unusual clinical presentation and atypical glandular histology. Circulation 59:1070–1075PubMedGoogle Scholar
  38. 38.
    Goldman BI, Frydman C, Harpaz N, Ryan SF, Coiterman D (1987) Glandular cardiac myxomas: histologic immunohistochemical, and ultrastructural evidence of epithelial differentiation. Cancer 59:1767–1775PubMedCrossRefGoogle Scholar
  39. 39.
    Hall RJ, Cooley DA, McAllister HA Jr, Frazier OH, Wilansky S (2001) Neoplastic heart disease. In: Fuster V, Alexander RW, O’Rourke RA, Roberts R, King SB III, Wellens HJJ (eds) Hurst’s the heart, 10th edn. McGraw-Hill, New York, pp 2179–2195Google Scholar
  40. 40.
    St. John Sutton MG, Mercier LA, Giuliani ER, Lie JT (1980) Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Proc 55:371–376PubMedGoogle Scholar
  41. 41.
    Roberts WC (2002) Cardiac neoplasms. In: Topol EJ (ed) Textbook of cardiovascular medicine. Lippincott Williams & Wilkins, Philadelphia, pp 917–933Google Scholar
  42. 42.
    Feldman PS, Horvath E, Kovacs K (1977) An ultrastructural study of seven cardiac myxomas. Cancer 40:2216–2232PubMedCrossRefGoogle Scholar
  43. 43.
    Farrell DJ, Bulmer E, Angus B, Ashcroft T (1996) Immunohistochemical expression of endothelial markers in left atrial myxomas: a study of six cases. Histopathology 28:147–152PubMedCrossRefGoogle Scholar
  44. 44.
    Amano J, Kono T, Wada Y, Zhang T, Koide N, Fujimori M, Ito K (2003) Cardiac myxoma: its origin and tumor characteristics. Ann Thorac Cardiovasc Surg 9:215–221PubMedGoogle Scholar
  45. 45.
    Pucci A, Bartoloni G, Tessitore E, Carney JA, Papotti M (2003) Cytokeratin profile and neuroendocrine cells in the glandular component of cardiac myxoma. Virchows Arch 443:618–624PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Mitchell S. Cappell
    • 1
  • Seth Lapin
    • 2
  • Malcolm Rose
    • 3
  1. 1.Chief, Division of Gastroenterology, MOB 233, Department of MedicineWilliam Beaumont HospitalRoyal OakUSA
  2. 2.Division of GastroenterologyMaimonides Medical CenterBrooklynUSA
  3. 3.Department of MedicineMaimonides Medical CenterBrooklynUSA

Personalised recommendations