Survivin expression in cardiac myxoma.

Background: Cardiac myxoma, the most common primary tumor of the heart, has variable clinical presentations and an immunohistochemical profile. Survivin, an antiapoptosis protein, may play an important role in the causes of cardiac myxoma. This investigation will report the expression pattern of survivin in cardiac myxomas.

Methods: This study included 40 patients with cardiac myxoma, who were treated with surgical excision of the lesion. Detailed clinical parameters were reported and the expression of survivin was studied by immunohistochemical staining.

Results: The patient population was comprised of 24 (60%) women and 16 (40%) men. The mean age of the patients was 42 years, with an age range of 30 to 63 years. All study cases were sporadic myxomas rather than familial myxoma. Patients were asymptomatic (20%), or had dyspnea (40%), stroke (15%), chest pain (12%), and fever (12%) on presentation. All lesions were located in the left atrium. The location of the myxoma and clinical events did not differ in terms of pathological changes, such as vascular proliferation, inflammation, cellularity, hyaline, calcification and thrombosis. Cardiac myxoma was characterized by a survivin dependent pathway with 100% immunohistochemical staining in the cytoplasm and the distribution in scoring system of survivin expression were 1 case (2.5%) in score 1; 12 cases (30%) in score 2; 12 cases (30%) in score 3 and 15 (37.5%) in score 4.

Conclusion: Cardiac myxomas demonstrate strong expression of survivin in the cytoplasm. This implies survivin may play an important role in the apoptosis pathway in cardiac myxomas.