Figure 1. (A) . Trans-esophageal echocardiographic image of the
cardiac mass showing the large atrial mass originating from the right
sided atrial septum and protruding through the tricuspid valve and into
the Right Ventricle. (B) . Pulse Wave Doppler showing the
pressure gradient across the tricuspid valve with a mean gradient of 10
mmHg and a peak of 14 mmHg and some obstruction to the outflow tract
(C) . Contrast enhanced CT image demonstrates a pedunculated low
attenuation right atrial mass from the inter-atrial septum extending
through the tricuspid valve in the right ventricle. Axial (D).and sagittal (E) T2 weighted MR images demonstrate same
pedunculated, smooth bordered, right atrial mass arising from the
inter-atrial septum projecting into the right ventricle. Also, moderate
pericardial effusion.
Fig 1 ( F) H&E (40X objective) The tumor shows a moderate
cellularity of pleomorphic cells with mitotic activity (arrow) with
myxoid matrix, prominent dilated capillaries, and areas of necrosis
(left edge, asterisk) accounting for more than 50% of the tumor volume.
The tumor did not show evidence of maturation, being negative for
desmin, S100, myogenin and CD34 and only focally positive for smooth
muscle actin. The tumor shows positive Fig 1(G) MDM2 and Fig
1(H) CDK4 Immunostains Fig 1 (I) The specimen was a
70g, 7.3 X 5.0 X 4.4cm smooth surfaced mass partly surrounded by a thin
pseudo capsule. The cut surface shows hyperemic and myxoid pale yellow
areas.
Figure 2(A) Axial CT image showing the pre-operative gross
tumor volume (GTV) and planning target volumes (PTV) for the different
doses (25.2Gy, 41.4Gy and 54Gy) using IMRT
Figure 2(B) Dose volume histograms for the various tumor target
volumes and normal structures after IMRT 54Gy/30fr was delivered with
concurrent chemotherapy.