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\begin{document}

\title{Left Atrial Paraganglioma}



\author[1]{Esra Guner}%
\author[1]{Busra Guvendi Şengör}%
\author[1]{CETIN GECMEN}%
\author[1]{Fuat Büyükbayrak}%
\author[1]{Regayip Zehir}%
\affil[1]{Kartal Kosuyolu Yuksek Ihtisas Egitim ve Arastirma Hastanesi}%


\vspace{-1em}



  
  \date{June 17, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
A previously healthy 68-year-old woman presented to the outpatient
clinic with a 2-month history of palpitation. Physical examination and
laboratory findings were unremarkable. Her electrocardiogram showed
sinus tachycardia with a heart rate of 115 beats/m. Transthoracic
echocardiography (TTE) showed a normal ejection fraction with a huge
mass in the left atrium (Figure 1a). Transesophageal echocardiography
(TEE) and cardiac magnetic resonance imaging (MRI) were performed for
further evaluation. TEE revealed a hyperechogenic, well-demarcated mass
in the left atrium, that was attached to the interatrial septum and
adjacent to the left pulmonary veins (Figure 1b, 1c,1d). Cardiac MRI
revealed a heterogeneous left atrial mass located on the fossa ovalis,
58x52x54 mm in size and markedly hyperintense on a STIR sequence (Figure
1e). These findings were suggestive of a benign cardiac tumour such as
myxoma or hemangioma. A decision for surgery was made and coronary
angiography was performed which showed that the branch of the circumflex
artery supplied and surrounded the mass in the form of a net (Figure
1e). The patient underwent complete excision of the mass (Figure 2a,
2b). Histopathological examination revealed a nested architecture of
epitelioid cells, the nests are round or oval in shape and invested by
an fibrovascular stroma. Tumor cells had centrally and eccentrically
located round nuclei and cytoplasm ranging from finely granular to
eosiniphilic. At immunohistochemical staining, the nests were positive
for chromogranin A, negative for cytokeratin (Figure 2c, 2d, 2e, 2f). A
diagnosis of paraganglioma was made. After an uneventful postoperative
course, she was discharged home on postoperative day 6. Cardiac
paraganglioma is a very rare neuroendocrine tumour and accounts for less
than 1\% of primary cardiac tumours (1,2). Approximately 10\% of
paragangliomas may be malignant, complete surgical resection remains the
first-line treatment (3).%
\end{abstract}%



\sloppy


\textbf{Title Page}

Left Atrial Paraganglioma

Keywords: Paraganglioma, cardiac tumor,left atrium

\textbf{Total word count:} 289 words.

\begin{enumerate}
\tightlist
\item
  Zeynep Esra G\selectlanguage{ngerman}üner: Güner Z.E
  MD\textsuperscript{1}drzesraguner@gmail.com
\item
  Bü\selectlanguage{polish}ş\selectlanguage{english}ra G\selectlanguage{ngerman}üvendi \selectlanguage{polish}Ş\selectlanguage{english}eng\selectlanguage{ngerman}ör: \selectlanguage{polish}Ş\selectlanguage{english}eng\selectlanguage{ngerman}ör B.G
  MD\textsuperscript{1}guvendi2861@hotmail.com
\item
  Çetin Geçmen: Geçmen Ç MD\textsuperscript{1} koronerr@hotmail.com
\item
  Fuat Büyükbayrak: Büyükbayrak F
  MD\textsuperscript{1}fuat.buyukbayrak@sbu.edu.tr
\item
  Regayip Zehir: Zehir R Associate Professor,
  MD\textsuperscript{1}zehirregayip@yahoo.com
\end{enumerate}

\textsuperscript{1}Department of Cardiology, Kartal Ko\selectlanguage{polish}ş\selectlanguage{english}uyolu Education
and Research Hospital, \selectlanguage{polish}İ\selectlanguage{english}stanbul, Turkey

\textbf{Correspondence Author:} Zeynep Esra G\selectlanguage{ngerman}üner, MD

\textbf{Adress:} Kartal Ko\selectlanguage{polish}ş\selectlanguage{english}uyolu Y\selectlanguage{ngerman}üksek \selectlanguage{polish}İ\selectlanguage{english}htisas E\selectlanguage{polish}ğ\selectlanguage{english}itim ve Ara\selectlanguage{polish}ş\selectlanguage{english}t\selectlanguage{polish}ı\selectlanguage{english}rma
hastanesi

Denizer caddesi Cevizli Kav\selectlanguage{polish}ş\selectlanguage{english}a\selectlanguage{polish}ğı \selectlanguage{english}No: 2

Kartal, \selectlanguage{polish}İ\selectlanguage{english}stanbul, Turkey

\textbf{e- Mail:} drzesraguner@gmail.com

\textbf{Phone:} +905542095696

Declaration of conflicting interests: No conflict of interest to declare

Funding (Financial Disclosure): No

Ethical Approval: Non-applicable

Left Atrial Paraganglioma

Zeynep Esra G\selectlanguage{ngerman}üner MD, Bü\selectlanguage{polish}ş\selectlanguage{english}ra G\selectlanguage{ngerman}üvendi \selectlanguage{polish}Ş\selectlanguage{english}eng\selectlanguage{ngerman}ör MD, Çetin Geçmen MD, Fuat
Büyükbayrak MD,Regayip Zehir MD

A previously healthy 68-year-old woman presented to the outpatient
clinic with a 2-month history of palpitation. Physical examination and
laboratory findings were unremarkable. Her electrocardiogram showed
sinus tachycardia with a heart rate of 115 beats/m. Transthoracic
echocardiography (TTE) showed a normal ejection fraction with a huge
mass in the left atrium (Figure 1a). Transesophageal echocardiography
(TEE) and cardiac magnetic resonance imaging (MRI) were performed for
further evaluation. TEE revealed a hyperechogenic, well-demarcated mass
in the left atrium, that was attached to the interatrial septum and
adjacent to the left pulmonary veins (Figure 1b, 1c,1d). Cardiac MRI
revealed a heterogeneous left atrial mass located on the fossa ovalis,
58x52x54 mm in size and markedly hyperintense on a STIR sequence (Figure
1e). These findings were suggestive of a benign cardiac tumour such as
myxoma or hemangioma. A decision for surgery was made and coronary
angiography was performed which showed that the branch of the circumflex
artery supplied and surrounded the mass in the form of a net (Figure
1e). The patient underwent complete excision of the mass (Figure 2a,
2b). Histopathological examination revealed a nested architecture of
epitelioid cells, the nests are round or oval in shape and invested by
an fibrovascular stroma. Tumor cells had centrally and eccentrically
located round nuclei and cytoplasm ranging from finely granular to
eosiniphilic. At immunohistochemical staining, the nests were positive
for chromogranin A, negative for cytokeratin (Figure 2c, 2d, 2e, 2f). A
diagnosis of paraganglioma was made. After an uneventful postoperative
course, she was discharged home on postoperative day 6.

Cardiac paraganglioma is a very rare neuroendocrine tumour and accounts
for less than 1\% of primary cardiac tumours (1,2). Approximately 10\%
of paragangliomas may be malignant, complete surgical resection remains
the first-line treatment (3).

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Hai Z, Guangrui S. Cardiac paraganglioma.~Eur Heart J.
  2018;39(23):2219. doi:10.1093/eurheartj/ehu241.
\item
  Yadav PK, Baquero GA, Malysz J, Kelleman J, Gilchrist IC. Cardiac
  paraganglioma.~Circ Cardiovasc Interv. 2014;7(6):851-856.
  doi:10.1161/CIRCINTERVENTIONS.114.001856.
\item
  Joynt KE, Moslehi JJ, Baughman KL. Paragangliomas: etiology,
  presentation, and management.~Cardiol Rev. 2009;17(4):159-164.
  doi:10.1097/CRD.0b013e3181a6de40.
\end{enumerate}

\textbf{Figure Legends}

\textbf{Figure 1a.} Transthoracic echocardiography (TTE) showed a huge
mass in the left atrium, that was attached to the interatrial septum.

\textbf{Figure 1b.} Transesophageal echocardiography (TTE) revealed a
hyperechogenic, well-demarcated mass in the left atrium, that was
attached to the interatrial septum.

\textbf{Figure 1c.} TEE showed a mass, adjacent to the left pulmonary
veins.

\textbf{Figure 1d.} 3D TEE image of the mass was seen.

\textbf{Figure 1e.} Cardiac MRI revealed a heterogeneous left atrial
mass located on the fossa ovalis.

\textbf{Figure 1f.} Coronary angiography showed that the branch of the
circumflex artery surrounded the mass in the form of a net.

\textbf{Figure 2a.} Intraoperative image of the mass was noted.

\textbf{Figure 2b.} Resected mass was seen.

\textbf{Figure 2c.} Histological examination revealed a nested
architecture of epitelioid cells, the nests are round or oval in shape
and invested by an fibrovascular stroma. Tumor cells had centrally and
eccentrically located round nuclei and cytoplasm ranging from finely
granular to eosiniphilic (hematoxylin and eosin stain) (the
magnification of the image was 10x).

\textbf{Figure 2d.} Tumor had clear cell pattern (hematoxylin and eosin
stain) (the magnification of the image was 40x).

\textbf{Figure 2e.} At immunohistochemical staining, the nests were
positive for chromogranin A (the magnification of the image was 40x).

\textbf{Figure 2f.} The tumor cell nests are surrounded by supporting
sustentacular cells that highlighted by S100 immunohistochemical
staining (the magnification of the image was 40x). Staining for
cytokeratin and TTF1 was negative (not pictured).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/figure-1/figure-1}

\end{center}
\end{figure}\selectlanguage{english}
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\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/figure-2/figure-2}

\end{center}
\end{figure}

\selectlanguage{english}
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\end{document}

