Cardiac tumors

CARDIAC TUMORSCARDIAC TUMORS

Primary Cardiac tumorsPrimary Cardiac tumors BenignBenign MalignantMalignant

Secondary Cardiac TumorsSecondary Cardiac Tumors BenignBenign MalignantMalignant

GeneralGeneral

NeoplasiaNeoplasia of the heart or of the heart or pericardium pericardium : :

Secondary more common thanSecondary more common than PrimaryPrimary

GeneralGeneral

Primary tumorsPrimary tumors• <3/10,000 autopsies<3/10,000 autopsies• Over ¾ are benignOver ¾ are benign

Secondary Secondary • 20-40 x more common20-40 x more common• Present in 20% of patients dying of malignancyPresent in 20% of patients dying of malignancy

Prevalence:

OutlineOutline

GeneralGeneral Primary Cardiac tumorsPrimary Cardiac tumors

BenignBenign

Primary Cardiac TumorsPrimary Cardiac Tumors

BenignBenign MyxomaMyxoma Papillary fibroelastomaPapillary fibroelastoma FibromaFibroma LipomaLipoma RhabdomyomasRhabdomyomas

Benign Benign Primary Cardiac TumorsPrimary Cardiac Tumors

The most common primary cardiac tumor in The most common primary cardiac tumor in the Age > 35 the Age > 35

75% in the Lt. Atrium near fossa ovalis75% in the Lt. Atrium near fossa ovalis 15% Rt. Atrium15% Rt. Atrium 5-10% Lt. Ventricle5-10% Lt. Ventricle 5% multiple sites5% multiple sites

Myxomas

Benign Primary Cardiac TumorsBenign Primary Cardiac Tumors

GrosslyGrossly• Typically pedunculatedTypically pedunculated• Gelatinous consistencyGelatinous consistency• FriableFriable

HistologicallyHistologically• Copious mucopolysaccharide stromaCopious mucopolysaccharide stroma• Scattered solitary or clustered polygonal cells.Scattered solitary or clustered polygonal cells.

Myxomas

MICROSCOPYMICROSCOPY

ManangementManangement

High propensity for embolizationHigh propensity for embolization Surgical results excellentSurgical results excellent

BenignBenign Primary Cardiac TumorsPrimary Cardiac Tumors

Familial pattern of Myxomas with autosomal Familial pattern of Myxomas with autosomal dominant featuresdominant features

Age < 30Age < 30

Carney Complex

Papillary FibroelastomaPapillary Fibroelastoma

The most common The most common valvularvalvular tumor, followed by tumor, followed by• SarcomaSarcoma• MelanomaMelanoma

Present in all age groups, but most commonly Present in all age groups, but most commonly in Age>60in Age>60


Small tumors (<1cm) with homogeneous speckeled Small tumors (<1cm) with homogeneous speckeled patternpattern

Commonly pedunculated with multiple frondsCommonly pedunculated with multiple fronds Affect the Lt and Rt sides with same frequencyAffect the Lt and Rt sides with same frequency Attach to Attach to

• Atrial surface of AV valves, andAtrial surface of AV valves, and• Ventricular surface of semilunar valvesVentricular surface of semilunar valves


Adults Adults Aortic valve Aortic valve Children Children Tricuspid valve Tricuspid valve Rarely on endocardial surfacesRarely on endocardial surfaces Symptomatic only in the aortic position (other than Symptomatic only in the aortic position (other than

embolic Sx)embolic Sx)• Ostial occlusion Ostial occlusion angina, sudden death angina, sudden death• Rarely valvular dysfunctionRarely valvular dysfunction

Source of embolization in up to 30% of patientsSource of embolization in up to 30% of patients

FibromasFibromas

Encapsulated, solitary tumorsEncapsulated, solitary tumors Frequently in the septal myocardiumFrequently in the septal myocardium Often encroach on the conduction Often encroach on the conduction

system as they growsystem as they grow

FibromasFibromas

With septal involvement V.Fib is often the With septal involvement V.Fib is often the first presentationfirst presentation

Indications for surgical resection:Indications for surgical resection:• Mechanical problems due to sizeMechanical problems due to size• Arrhythmogenic nidusArrhythmogenic nidus

Resection of septal fibromas is Resection of septal fibromas is not always not always possible possible

LipomasLipomas

Affect both myocardium and pericardiumAffect both myocardium and pericardium Can reach several centimeters in sizeCan reach several centimeters in size

Rhabdomyoma:Rhabdomyoma:

Most common tumor of the heart for Age < Most common tumor of the heart for Age < 30 yr30 yr

Almost exclusively in childrenAlmost exclusively in children Associated with tuberous sclerosisAssociated with tuberous sclerosis Regression of tumor in infancy has been Regression of tumor in infancy has been

reportedreported

A large firm, white tumor mass was A large firm, white tumor mass was found filling the left ventricle. This is found filling the left ventricle. This is

a cardiac rhabdomyoma.a cardiac rhabdomyoma.

MalignantMalignant Primary Cardiac Tumors Primary Cardiac Tumors

AngiosarcomasAngiosarcomas

RhabdomyosarcomasRhabdomyosarcomas

MesotheliomasMesotheliomas

LymphomaLymphoma

Intrapericardial PheochromocytomasIntrapericardial Pheochromocytomas


Most common primary malignancy of the heartMost common primary malignancy of the heart Malignant cells that form vascular channelsMalignant cells that form vascular channels Most commonly affect theMost commonly affect the

• Rt. Heart Rt. Heart Rt. AtriumRt. Atrium

• PericardiumPericardium Hemorrhagic effusionHemorrhagic effusion ThrombusThrombus


Diffuse, irregularly shapedDiffuse, irregularly shaped Mean survival one yearMean survival one year Successful Rx with Chemo and XRT followed Successful Rx with Chemo and XRT followed

by transplant reportedby transplant reported

RhabdomyosarcomasRhabdomyosarcomas

Most commonly seen in adultsMost commonly seen in adults No chamber selectivityNo chamber selectivity No pericardial involvementNo pericardial involvement Multiple sites of cardiac involvement is commonMultiple sites of cardiac involvement is common Poor prognosisPoor prognosis Limited success with resection and adjuvant Rx.Limited success with resection and adjuvant Rx.


Diffuse pericardial tumorDiffuse pericardial tumor Involve both parietal and visceral pericardiumInvolve both parietal and visceral pericardium Superficially invade the myocardiumSuperficially invade the myocardium Rarely invade the cardiac chambersRarely invade the cardiac chambers


Sx of pericarditis or tamponadeSx of pericarditis or tamponade Poor prognosisPoor prognosis XTR or chemo only offer temporary XTR or chemo only offer temporary

improvementimprovement

LymphomaLymphoma

MalignantMalignant Secondary Cardiac Secondary Cardiac TumorsTumors

Solid Tumors involving the heart:Solid Tumors involving the heart: LungLung BreastBreast Soft tissue sarcomasSoft tissue sarcomas Renal carcinomaRenal carcinoma MelanomaMelanoma

Leukemia and Lymphomas also common Leukemia and Lymphomas also common culpritsculprits

MalignantMalignant Secondary Cardiac Secondary Cardiac TumorsTumors

IVC tumors in GeneralIVC tumors in General Renal carcinomaRenal carcinoma

• 80% 5 year survival for surgical resection of 80% 5 year survival for surgical resection of tumors migrating up the IVCtumors migrating up the IVC

HepatomaHepatoma Ovarian CAOvarian CA

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Cardiac tumors

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