Benign Metastasizing Leiomyoma of the Heart

Abstract

This is a rare case of a 53-year-old woman with history of oophorectomy and hysterectomy 3 years prior to presentation admitted for gait abnormality and found to have a basal ganglia stroke. Transthoracic echocardiogram for stroke work up revealed a cardiac mass in the right atrium emanating from Inferior Vena Cava (IVC). Computed Tomography imaging of abdomen and pelvis ruled out malignancy. The mass was surgically removed due to high risk of embolization. Intraoperative, transesophageal echocardiogram was negative for inter-atrial shunt. Pathology report revealed Benign Metastasizing Leiomyoma that was estrogen and progesterone hormone positive. CASe RepoRt abetes mellitus, and an abdominal hysterectomy with bilateral salpingo-oophorectomy which was performed three years prior for symptomatic uterine leiomyoma. There was also a history of chronic pulmonary nodules dating back 8 years; prior biopsy of one of the nodules revealed a benign hamartoma. On her initial presentation, the physical exam was notable for a mild gait disturbance. Otherwise, there were no other abnormalities. Laboratory studies were normal. The electrocardiogram revealed sinus rhythm with 1 st degree AV Block. Chest x-ray showed unchanged pulmonary nodules. A magnetic resonance imaging (MRI) of the brain showed a left basal ganglia infarct with extension to the periventricular white matter (Figure 1). Chest computed tomography angiography (CTA) ruled out pulmonary embolism as a cause for the dyspnea. The CTA also demonstrated multiple pulmonary nodules in the right upper and left upper lobes that had Check for updates