Hamartoma of mature cardiomyocytes presenting with atypical angina, 18F-fluorodeoxyglucose positron emission tomography uptake, and myocardial bridging: a case report

Abstract

Background Hamartoma of mature cardiomyocytes is a rare tumor and the present case shows a complex diagnostic pathway to understand its nature and treatment options in a young patient. The myocardial bridge was also part of the clinical evaluation discovered during the diagnostic workout. Case summary A 27-year-old woman with atypical chest pain and diffuse electrocardiographic changes received the diagnosis of neoformation of the interventricular septum with 18F-FDG uptake, and evidence of myocardial bridging on coronary angiography. On suspicion of malignancy, coronary unroofing and surgical biopsy was performed. The final diagnosis was hamartoma of mature cardiomyocytes. Discussion This case offers great insight into medical reasoning and decision-making process. Given the history of chest pain, the patient was evaluated for possible ischemic, embolic, or vascular causes. Given a left ventricular wall thickness ≥15 mm, HCM should always be suspected; nuclear magnetic resonance imaging is essential to distinguish between HCM. The MRI is also critical in distinguishing HCM itself from tumoral phenocopies. To rule out a neoplastic process, 18F-FDG-PET was used. A surgical biopsy was performed, and the final diagnosis was completed after the immune-histochemistry study. A myocardial bridge was found during preoperative coronagraphy and was treated accordingly.

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“…Globally, these findings imply that population diversity and inclusion in analyses always matter, as numbers keep varying both on autopsy [14][15][16][17] and angiogram. [18][19][20][21] MBs tend to be localized more in the left system, and Loukas et al 15 found it to be coronary artery dominance-dependent in their sample; however, MBs over the right coronary artery are also described, 22 while concomitant presence with a quadricuspid aortic valve, 23 transposition of great arteries, 24 hamartoma, 25 Takotsubo and spontaneous coronary artery dissection 26,27 have recently been reported.…”

“… 14 - 17 quanto na angiografia. 18 - 21 As PMs tendem a se localizar mais no sistema esquerdo, e Loukas et al, 15 descobriram que é dependente da dominância da artéria coronária em sua amostra; no entanto, PMs sobre a artéria coronária direita também são descritas, 22 enquanto presença concomitante com valva aórtica quadricúspide, 23 transposição de grandes artérias, 24 hamartoma, 25 Takotsubo e dissecção espontânea da artéria coronária 26 , 27 foram recentemente relatados.…”