Detection of Herplex Simplex Virus-1 and -2 in Cardiac Myxomas

Abstract

<jats:p>The etiology of sporadic cardiac myxomas remains elusive. The tendency for these lesions to recur following resection, their immunopathological characteristics, along with their histological and molecular profile, may implicate the presence of an infective agent in this type of tumor. In this study, we investigated the presence of herpes simplex virus (HSV) DNA in a cohort of cardiac myxomas in a tertiary referral centre. Twenty-nine formalin-fixed paraffin-embedded (FFPE) sporadic cardiac myxomas were obtained, 17 of which were shown to be informative. These were compared to 19 macroscopically and microscopically normal heart tissue specimens. The detection of HSV-1 and -2 genomic sequences was achieved with the use of a combined nested PCR-Restriction Fragment Length Polymorphism methodology. The presence of HSV-1 and/or -2 DNA was demonstrated in 6 of 17 (35%) informative sporadic cardiac myxomas, whereas no HSV DNA was detected in normal heart tissues (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mi>P</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.01</mml:mn></mml:mrow></mml:math>). The existence of HSV-1/2 DNA in sporadic cardiac myxomas, along with its absence from normal heart tissues, reinforces the possibility that HSV infection might be involved in the development of these lesions. Our findings raise the point of anti-HSV medication postsurgically with a potential benefit in reducing the rate of recurrences.</jats:p>

The tumor microenvironment may trigger lymphoproliferation in cardiac myxoma

“…Viral histogenesis has been postulated in both CM and LPD in cardiac myxomas. The detection of herpesviruses (HSV1 and HSV2) and chronic inflammation in CM suggest a pathogenetic role in the tumor development [14 , 15] . However, other studies have found neither such association nor a detectable HSV viral protein or genomic DNA by both immunohistochemistry and polymerase chain reaction [16 – 18] .…”

“…They are most commonly sporadic, but up to 10% are associated with the Carney complex with a familial inheritance pattern [10] , [11] , [12] – 13] . Viral histogenesis has recently been entertained in some studies [14 , 15] , but refuted by others [16] , [17] – 18] . Lymphoproliferative disorders (LPD) primarily involving the heart (primary cardiac lymphoma/lymphoproliferative disorders PC-LPD) are infrequent [19] , and such tumors arising in CM as composite tumors are unique.…”

The mysterious pathways of cardiac myxomas: a review of histogenesis, pathogenesis and pathology

“…Systemic symptoms appear to be related to IL‐6 production by tumour cells . There are recent reports of herpes simplex virus (HSV)‐1 in some sporadic cases of CM; the presence of plasma cells and T (mainly cytotoxic CD8 + ) cells in such lesions indicates activation of humoral and cellular immune responses, in turn suggesting an origin from a chronic inflammatory lesion of the endocardium . However, immunohistochemical studies of 40 cases revealed no positive signals for HSV‐1 antigens .…”

Recurrent cardiac myxoma in a 25 year old male: a DNA study

“…The authors note that the presence of HSV-1 and/or −2 DNA was detected in 35% of the informative sporadic cardiac myxomas. Furthermore, they consider that the tropism of the virus for myxomatous endocardium and the viral life cycle remain an issue to be addressed concerning the rate of recurrences of the tumor [7]. …”

“…In the literature, the recurrence rate is between 1 to 3% for sporadic cases of cardiac myxomas and is increased significantly for patients with familial and Carney complex myxomas, at 12% and 22% respectively [3]. Some authors suggest that treatment with suppressive anti - HSV drugs such as acyclovir for HSV - positive patients postoperatively is beneficial in reducing the rate of recurrences [7]. We consider that anticoagulation treatment in inoperable patients protects against thromboembolic events.…”