Difference between revisions of "Cardiac tumours"

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'''Cardiac tumours''' are rare buggers.
'''Cardiac tumours''' are rare buggers.


==Common heart tumours==
==Most common (malignant)==
*Metastases - most common cardiac tumour; 1:~100 primary tumours:secondary tumours.<ref name=pmid20472615>{{Cite journal  | last1 = Castillo | first1 = JG. | last2 = Silvay | first2 = G. | title = Characterization and management of cardiac tumors. | journal = Semin Cardiothorac Vasc Anesth | volume = 14 | issue = 1 | pages = 6-20 | month = Mar | year = 2010 | doi = 10.1177/1089253210362596 | PMID = 20472615 }}</ref>
 
==Primary heart tumours==
*Approximately 10% of resected (primary) cardiac tumours are malignant.<ref name=pmid18350921>{{cite journal |author=Burke A |title=Primary malignant cardiac tumors |journal=Semin Diagn Pathol |volume=25 |issue=1 |pages=39-46 |year=2008 |month=February |pmid=18350921 |doi= |url=}}</ref>
*Approximately 10% of resected (primary) cardiac tumours are malignant.<ref name=pmid18350921>{{cite journal |author=Burke A |title=Primary malignant cardiac tumors |journal=Semin Diagn Pathol |volume=25 |issue=1 |pages=39-46 |year=2008 |month=February |pmid=18350921 |doi= |url=}}</ref>
**90% are sarcomas.
**90% are sarcomas.
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Notes:
Notes:
*If one is considering only valves - ''papillary fibroelastoma'' is No. 1.
*If one is considering only valves - ''papillary fibroelastoma'' is No. 1.
Malignant heart tumours (in order of frequency):<ref name=pmid20472615>{{Cite journal  | last1 = Castillo | first1 = JG. | last2 = Silvay | first2 = G. | title = Characterization and management of cardiac tumors. | journal = Semin Cardiothorac Vasc Anesth | volume = 14 | issue = 1 | pages = 6-20 | month = Mar | year = 2010 | doi = 10.1177/1089253210362596 | PMID = 20472615 }}</ref>
#Undifferentiated.
#Angiosarcoma.
#Leiomyosarcoma.


==Myxoma==
==Myxoma==
===General===
===General===
*Rare.
*Uncommon.
*Clinical: may lead to cerebral infarction.<ref name=pmid3188128>{{cite journal |author=Knepper LE, Biller J, Adams HP, Bruno A |title=Neurologic manifestations of atrial myxoma. A 12-year experience and review |journal=Stroke |volume=19 |issue=11 |pages=1435-40 |year=1988 |month=November |pmid=3188128 |doi= |url=http://stroke.ahajournals.org/cgi/reprint/19/11/1435}}</ref>
*Clinical: may lead to cerebral infarction.<ref name=pmid3188128>{{cite journal |author=Knepper LE, Biller J, Adams HP, Bruno A |title=Neurologic manifestations of atrial myxoma. A 12-year experience and review |journal=Stroke |volume=19 |issue=11 |pages=1435-40 |year=1988 |month=November |pmid=3188128 |doi= |url=http://stroke.ahajournals.org/cgi/reprint/19/11/1435}}</ref>
*Diagnosed by imaging.
*Diagnosed by imaging.
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*Smooth surface.
*Smooth surface.


===Histology===
===Microscopic===
Features:<ref name=pmid12006696/>
Features:<ref name=pmid12006696/>
*Myxoid material - extra cellular (???) - '''key feature'''.
*Myxoid material - extra cellular (???) - '''key feature'''.
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*[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_edge_high_mag.jpg Atrial myxoma - endothelial covering (wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_edge_high_mag.jpg Atrial myxoma - endothelial covering (wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_edge_low_mag.jpg Atrial myxoma - sharp border (wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_edge_low_mag.jpg Atrial myxoma - sharp border (wikimedia.org)].
==Rhabdomyoma==
*Very rare.
*Benign.
*Associated with [[tuberous sclerosis]].<ref name=pmid20721876>{{Cite journal  | last1 = Yinon | first1 = Y. | last2 = Chitayat | first2 = D. | last3 = Blaser | first3 = S. | last4 = Seed | first4 = M. | last5 = Amsalem | first5 = H. | last6 = Yoo | first6 = SJ. | last7 = Jaeggi | first7 = ET. | title = Fetal cardiac tumors: a single-center experience of 40 cases. | journal = Prenat Diagn | volume =  | issue =  | pages =  | month = Aug | year = 2010 | doi = 10.1002/pd.2590 | PMID = 20721876 }}</ref>
==Rhabdomyosarcoma==
See ''[[soft tissue tumours]]''.
==Lipoma==
*Like lipomas elsewhere in the body.
==Metastasis==
*Most common cardiac tumour; 1:~100 primary tumours:secondary tumours.<ref name=pmid20472615>{{Cite journal  | last1 = Castillo | first1 = JG. | last2 = Silvay | first2 = G. | title = Characterization and management of cardiac tumors. | journal = Semin Cardiothorac Vasc Anesth | volume = 14 | issue = 1 | pages = 6-20 | month = Mar | year = 2010 | doi = 10.1177/1089253210362596 | PMID = 20472615 }}</ref>
*Usually from lung. (???)
Malignant heart tumours:<ref name=pmid20472615>{{Cite journal  | last1 = Castillo | first1 = JG. | last2 = Silvay | first2 = G. | title = Characterization and management of cardiac tumors. | journal = Semin Cardiothorac Vasc Anesth | volume = 14 | issue = 1 | pages = 6-20 | month = Mar | year = 2010 | doi = 10.1177/1089253210362596 | PMID = 20472615 }}</ref>
#Undifferentiated.
#Angiosarcomas.
#Leiomyosarcomas.


==Fibroelastoma==
==Fibroelastoma==
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*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma.jpg Papillary fibroelastoma - low magnification (commons.wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma.jpg Papillary fibroelastoma - low magnification (commons.wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma2.jpg Papillary fibroelastoma - intermediate magnification (commons.wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma2.jpg Papillary fibroelastoma - intermediate magnification (commons.wikimedia.org)].
==Rhabdomyoma==
*Very rare.
*Benign.
*Associated with [[tuberous sclerosis]].<ref name=pmid20721876>{{Cite journal  | last1 = Yinon | first1 = Y. | last2 = Chitayat | first2 = D. | last3 = Blaser | first3 = S. | last4 = Seed | first4 = M. | last5 = Amsalem | first5 = H. | last6 = Yoo | first6 = SJ. | last7 = Jaeggi | first7 = ET. | title = Fetal cardiac tumors: a single-center experience of 40 cases. | journal = Prenat Diagn | volume =  | issue =  | pages =  | month = Aug | year = 2010 | doi = 10.1002/pd.2590 | PMID = 20721876 }}</ref>
==Rhabdomyosarcoma==
See ''[[soft tissue tumours]]''.
==Lipoma==
*Like lipomas elsewhere in the body.
DDx:
*Lipomatous hypertrophy.<ref name=pmid20196664>{{Cite journal  | last1 = Miller | first1 = DV. | last2 = Tazelaar | first2 = HD. | title = Cardiovascular pseudoneoplasms. | journal = Arch Pathol Lab Med | volume = 134 | issue = 3 | pages = 362-8 | month = Mar | year = 2010 | doi =  | PMID = 20196664 }}</ref>
==Cystic AV node tumour==
===General===
*Super rare.
*Usually 1-2 mm.
===Gross===
*"Bump" in the ''triangle of Koch''.
*Cystic spaces.
===Microscopic===
Features:
*Cystic spaces lined by epithelial cells.
*+/-Psammoma bodies. (???)
===IHC===
*CEA +ve.
*EMA +ve.


===Gross===
===Gross===

Revision as of 13:07, 29 September 2010

Cardiac tumours are rare buggers.

Most common (malignant)

  • Metastases - most common cardiac tumour; 1:~100 primary tumours:secondary tumours.[1]

Primary heart tumours

  • Approximately 10% of resected (primary) cardiac tumours are malignant.[2]
    • 90% are sarcomas.
    • 10% are lymphomas.

In order of frequency:

  1. Myxoma.
  2. Lipoma.
  3. Papillary fibroelastoma.

Notes:

  • If one is considering only valves - papillary fibroelastoma is No. 1.

Malignant heart tumours (in order of frequency):[1]

  1. Undifferentiated.
  2. Angiosarcoma.
  3. Leiomyosarcoma.

Myxoma

General

  • Uncommon.
  • Clinical: may lead to cerebral infarction.[3]
  • Diagnosed by imaging.

Most common presentations:[3]

  • Dyspnea - 45%.
  • Neurologic symptoms 36%.

Gross

Location:[3]

  • Usually atrial.
  • Usually left side.

Features:[4]

  • Lobular surface.
  • Smooth surface.

Microscopic

Features:[4]

  • Myxoid material - extra cellular (???) - key feature.
  • Calcified elastic fibers - gamna bodies.
  • Hemorrhage common.
  • Often covered by endothelium.

Images:

Fibroelastoma

General

  • AKA papillary fibroelastoma.
  • Usually an incidental finding.

Microscopic

Features:[5]

  • Braching papillary fronds which are:
    • Composed of collagen, and
    • Avascular.
  • +/-Elastic tissue.
  • Surrounded by:
    • Endothelium, and
    • Mucopolysaccharide.

Micrographs:

Rhabdomyoma

Rhabdomyosarcoma

See soft tissue tumours.

Lipoma

  • Like lipomas elsewhere in the body.

DDx:

  • Lipomatous hypertrophy.[7]

Cystic AV node tumour

General

  • Super rare.
  • Usually 1-2 mm.

Gross

  • "Bump" in the triangle of Koch.
  • Cystic spaces.

Microscopic

Features:

  • Cystic spaces lined by epithelial cells.
  • +/-Psammoma bodies. (???)

IHC

  • CEA +ve.
  • EMA +ve.

Gross

  • Friable appearing.
  • Yellow.
  • Typically on free edge.

See also

References

  1. ↑ 1.0 1.1 Castillo, JG.; Silvay, G. (Mar 2010). "Characterization and management of cardiac tumors.". Semin Cardiothorac Vasc Anesth 14 (1): 6-20. doi:10.1177/1089253210362596. PMID 20472615.
  2. ↑ Burke A (February 2008). "Primary malignant cardiac tumors". Semin Diagn Pathol 25 (1): 39-46. PMID 18350921.
  3. ↑ 3.0 3.1 3.2 Knepper LE, Biller J, Adams HP, Bruno A (November 1988). "Neurologic manifestations of atrial myxoma. A 12-year experience and review". Stroke 19 (11): 1435-40. PMID 3188128. http://stroke.ahajournals.org/cgi/reprint/19/11/1435.
  4. ↑ 4.0 4.1 Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR (2002). "Cardiac myxoma: imaging features in 83 patients". Radiographics 22 (3): 673-89. PMID 12006696. http://radiographics.rsna.org/content/22/3/673.long.
  5. ↑ http://www.pathologyoutlines.com/hearttumor.html
  6. ↑ Yinon, Y.; Chitayat, D.; Blaser, S.; Seed, M.; Amsalem, H.; Yoo, SJ.; Jaeggi, ET. (Aug 2010). "Fetal cardiac tumors: a single-center experience of 40 cases.". Prenat Diagn. doi:10.1002/pd.2590. PMID 20721876.
  7. ↑ Miller, DV.; Tazelaar, HD. (Mar 2010). "Cardiovascular pseudoneoplasms.". Arch Pathol Lab Med 134 (3): 362-8. PMID 20196664.
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