Cardiac tumours

Cardiac tumours are rare buggers.

Common heart tumours

• Approximately 10% of resected (primary) cardiac tumours are malignant.
  • 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.

Myxoma

General

• Rare.
• Clinical: may lead to cerebral infarction.
• Diagnosed by imaging.

Most common presentations:

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

Gross

Location:

• Usually atrial.
• Usually left side.

Features:

• Lobular surface.
• Smooth surface.

Histology

Features:

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

Images:

• Atrial myxoma (wikimedia.org).
• Atrial myxoma - endothelial covering (wikimedia.org).
• Atrial myxoma - sharp border (wikimedia.org).

Rhabdomyoma

• Very rare.
• Benign.
• Associated with tuberous sclerosis.

Rhabdomyosarcoma

See soft tissue tumours.

Lipoma

• Like lipomas elsewhere in the body.

Metastasis

• Most common cardiac tumour; 1:~100 primary tumours:secondary tumours.
• Usually from lung. (???)

Malignant heart tumours:

1. Undifferentiated.
2. Angiosarcomas.
3. Leiomyosarcomas.

Fibroelastoma

General

• AKA papillary fibroelastoma.
• Usually an incidental finding.

Microscopic

Features:

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

Micrographs:

• Papillary fibroelastoma - low magnification (commons.wikimedia.org).
• Papillary fibroelastoma - intermediate magnification (commons.wikimedia.org).

Gross

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

See also

• Heart.
• Valvular heart disease.