Myxoid Emboli

Abstract

Emboli are common clinicopathologic findings. Recognition of the type of arterial emboli could be the first clue to the original source. Emboli with myxomatous changes are rare. Myxoma-like features in mural organizing thrombi have been reported. The most challenging differential diagnosis is between embolic cardiac myxomas and myxomatous thromboemboli. Emboli from sarcomas and arteriosclerotic plaques with myxoid features are also potential pitfalls. There is scarcity of studies focusing on myxoid emboli and their clinical and pathologic importance. We performed a retrospective study over 12 years. We retrieved all of the embolectomy specimens. We histologically screened the emboli for myxoid stroma, myxomatous changes, and mucinous degeneration. We retrieved 12 cases (3%) of myxoid emboli out of 391 embolectomy specimens. We found 4 cases of thromboemboli, 5 cases of atrial myxomas, 2 cases of atheromatous plaques, and a myxoid liposarcoma. The age range was between 35 and 71 years, with a mean age of 51 years. The male-to-female ratio was 3:2. Myxoid thromboemboli and myxomas were large, while atheromatous plaque emboli were small. Myxoid emboli arising from organizing mural thrombi can be histologically confused with cardiac myxomas and vice versa. Myxoid emboli from atheromatous plaque and myxoid sarcomas can mimic embolizing myxomas. Certain histologic features are helpful hints to differentiate between myxoid emboli. In doubtful cases, immunohistochemistry is helpful. Correct histologic recognition of the different types of myxoid emboli helps guide the clinicians to the most likely etiology and appropriate management in occlusive peripheral vascular diseases with clinically unrecognized lesions.