Cardiac tumours: Difference between revisions

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'''Cardiac tumours''' are rare buggers.
'''[[Heart|Cardiac]] tumours''' are rare buggers.  They provide some work for cardiac surgeons.


==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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In order of frequency:
In order of frequency:
#Myxoma.
#[[Cardiac myxoma|Myxoma]].
#Lipoma.
#[[Lipoma]].
#Papillary fibroelastoma.
#[[Papillary fibroelastoma]].


Notes:
Notes:
*If one is considering only valves - ''papillary fibroelastoma'' is No. 1.
*If one is considering only valves - ''papillary fibroelastoma'' is No. 1.


==Myxoma==
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>
===General===
#Undifferentiated.
*Rare.
#[[Angiosarcoma]].
*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>
#[[Leiomyosarcoma]].
*Diagnosed by imaging.


Most common presentations:<ref name=pmid3188128/>
Note:
*Dyspnea - 45%.
*According to WMSP:<ref name=Ref_WMSP135>{{Ref WMSP|135}}</ref> Most common primary malignant tumour of the heart = angiosarcoma.
*Neurologic symptoms 36%.


===Gross===
=Specific entities=
Location:<ref name=pmid3188128/>
==Cardiac myxoma==
*Usually atrial.
{{Main|Cardiac myxoma}}
*Usually left side.
This includes the common ''atrial myxoma''.


Features:<ref name=pmid12006696>{{cite journal |author=Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR |title=Cardiac myxoma: imaging features in 83 patients |journal=Radiographics |volume=22 |issue=3 |pages=673-89 |year=2002 |pmid=12006696 |doi= |url=http://radiographics.rsna.org/content/22/3/673.long}}</ref>
==Papillary fibroelastoma==
*Lobular surface.
*[[AKA]] ''fibroelastoma''.
*Smooth surface.
**Should '''not''' be confused with ''[[elastofibroma]]''.
*[[AKA]] ''giant Lambl excrescence''.<ref name=pmid9767897>{{Cite journal | last1 = Loire | first1 = R. | last2 = Pinède | first2 = L. | last3 = Donsbeck | first3 = AV. | last4 = Nighoghossian | first4 = N. | last5 = Perinetti | first5 = M. | title = [Papillary fibroelastoma of the heart (giant Lambl excrescence). Clinical-anatomical study on 10 surgically treated patients]. | journal = Presse Med | volume = 27 | issue = 16 | pages = 753-7 | month = Apr | year = 1998 | doi = | PMID = 9767897 }}</ref>


===Histology===
===General===
Features:<ref name=pmid12006696/>
*Usually an incidental finding.
*Myxoid material - extra cellular (???) - '''key feature'''.
*Calcified elastic fibers - ''gamna bodies''.
*Hemorrhage common.
*Often covered by endothelium.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_high_mag.jpg Atrial myxoma (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)].
==Rhabdomyoma==
*Very rare.
*Malignant.
 
 
==Lipoma==
*Like lipomas elsewhere in the body.
 
 
==Metastasis==
*Should be on the list.


===Gross===
*Friable appearing.
*Yellow.
*Typically on free edge.


==Fibroelastoma==
Image:
===General===
*[http://www.e-heart.org/Photos/09_Cardiac_Tumors_Photos/%C2%A9%20Papillary%20fibroelastoma%20-%20Gross.jpg Papillary fibroelastoma (e-heart.org)].<ref>URL: [http://www.e-heart.org/pages/09_Cardiac_Tumors/09_Cardiac_Tumors_Primary_Benign_Cardiac_Papillary%20Fibroelastoma_001.htm http://www.e-heart.org/pages/09_Cardiac_Tumors/09_Cardiac_Tumors_Primary_Benign_Cardiac_Papillary%20Fibroelastoma_001.htm]. 5 March 2013.</ref>
*AKA ''papillary fibroelastoma''.
*Usually an incidental finding.


===Microscopic===
===Microscopic===
Features:<ref>[http://www.pathologyoutlines.com/hearttumor.html http://www.pathologyoutlines.com/hearttumor.html]</ref>
Features:<ref>URL: [http://www.pathologyoutlines.com/hearttumor.html http://www.pathologyoutlines.com/hearttumor.html]. Accessed on: 16 May 2011.</ref>
*Braching papillary fronds which are:
*Braching papillary fronds which are:
**Composed of collagen, and
**Composed of collagen, and
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**Mucopolysaccharide.
**Mucopolysaccharide.


Micrographs:
====Images====
*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma.jpg Papillary fibroelastoma - low magnification (commons.wikimedia.org)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma2.jpg Papillary fibroelastoma - intermediate magnification (commons.wikimedia.org)].
Image:Papillary_fibroelastoma.jpg | Papillary fibroelastoma - low mag. (WC)
Image:Papillary_fibroelastoma2.jpg | Papillary fibroelastoma - intermed. mag. (WC)
</gallery>
 
==Cardiac rhabdomyoma==
{{Main|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 ''[[rhabdomyosarcoma]]''.
 
==Lipoma==
{{Main|Adipocytic tumours}}
*Like lipomas elsewhere in the body.
*Usually location: left ventricle, subendocardial.<ref name=Ref_WMSP135>{{Ref WMSP|135}}</ref>
 
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 tumour of the atrioventricular nodal region==
{{Main|Cystic tumour of the atrioventricular nodal region}}
 
==Angiosarcoma==
[[File: Angiosarc heart 1 sl 1.png| Angiosarcoma of right atrium]]
[[File: Angiosarc heart 1 sl 2.png| Angiosarcoma of right atrium]]
[[File: Angiosarc heart 1 sl 3.png| Angiosarcoma of right atrium]]
[[File: Angiosarc heart 1 sl 4.png| Angiosarcoma of right atrium]]
[[File: Angiosarc heart 1 sl 5.png| Angiosarcoma of right atrium]]
[[File: Angiosarc heart 1 sl 6.png| Angiosarcoma of right atrium]]


===Gross===
Angiosarcoma of right atrium. A. Luminal clot tops tumor with blood filled spaces. B. Tumor replaces myocardium. C. Irregularly branched vessels, sometimes associated with extravasated erythrocytes. D. Irregularly aggregated and oriented spindle cells. E. Cells vary in size and shape much more so than an organizing thrombus or hemangioma. Note luminal tufts (green arrows), clustered large cancer nuclei with nucleoli (blue arrows). F. Cytoplasmic vacuoles, some with erythrocytes (arrows).
*Friable appearing.
*Yellow.
*Typically on free edge.


==See also==
=See also=
*[[Heart]]
*[[Heart]].
*[[Valvular heart disease]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Cardiovascular pathology]]
[[Category:Cardiovascular pathology]]
[[Category:Cardiac tumours]]
Retrieved from "https://librepathology.org/wiki/Cardiac_tumours"