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Virtual Case of the Month
Unusual cardiac mass presenting as humeral artery embolisation
  1. Isabella Evangelista1,
  2. Gaetano Ruocco1,
  3. Linda Ricci2,
  4. Alberto Palazzuoli1
  1. 1 Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte Hospital, University of Siena, Siena, Italy
  2. 2 Department of Medical Biotechnologies, Le Scotte Hospital, University of Siena, Siena, Italy
  1. Correspondence to Professor Alberto Palazzuoli, Cardiovascualr Diseases Unit, Department of Internal Medicine, Le Scotte Hospital, University of Siena, Siena 53100, Italy; palazzuoli2{at}unisi.it

https://doi.org/10.1136/jclinpath-2018-205671

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    Clinical question

    A 73-year-old man presents acute ischaemia of the left humeral artery in the upper limb. He had a recent cerebral haemorrhage in combination with multiple cerebral ischaemic lesions. A transthoracic echocardiography showed an isoechogen, polylobate and mobile mass protruding into the left atrium (area size: 5 cm2), attached with a pedicle to the atrial slope of the anterior mitral leaflet (figure 1). A histological analysis of the upper limb material was performed (figure 2).

    Figure 1

    Echocardiographic appearance of mobile mass protruding into the left atrium.

    Figure 2

    In a background of necrosis and haemorrhage, there is an admixture of mononucleated intermediate cells and larger syncytiotrophoblast cells; H&E, ×200/×100 (A). Some tumour cells stain with anti-human chorionic gonadotropin; ×200 (B). Antibodies to CK7 mark …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Contributors IE wrote the case and collected the data. GR performed echocardiography and contributed to data collection. LR performed immunohistochemical analysis. AP performed echocardiography and reviewed the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.