Difference between revisions of "Cardiac tumours"

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=Specific entities=
=Specific entities=
==Cardiac myxoma==
==Cardiac myxoma==
===General===
{{Main|Cardiac myxoma}}
*Uncommon.
This includes the common ''atrial myxoma''.
*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.
*May be familial, i.e. [[Carney complex]] ([[AKA]] NAME syndrome, [[AKA]] LAMB syndrome).<ref>{{Ref WMSP|135}}</ref>
**NAME = Nevi, Atrial myxoma, Myxoid neurofibroma, and Ephelides (freckles<ref>URL: [http://emedicine.medscape.com/article/1119293-overview http://emedicine.medscape.com/article/1119293-overview]. Accessed on: 7 January 2011.</ref>).
**LAMB = Lentigines, Atrial myxomas, Mucocutaneous myxomas, Blue nevi.
 
Most common presentations:<ref name=pmid3188128/>
*Dyspnea - 45%.
*Neurologic symptoms 36%.
 
===Gross===
Location:<ref name=pmid3188128/>
*Usually atrial.
*Usually left side ~60%.<ref name=pmid12006696>{{Cite journal  | last1 = Grebenc | first1 = ML. | last2 = Rosado-de-Christenson | first2 = ML. | last3 = Green | first3 = CE. | last4 = Burke | first4 = AP. | last5 = Galvin | first5 = JR. | title = Cardiac myxoma: imaging features in 83 patients. | journal = Radiographics | volume = 22 | issue = 3 | pages = 673-89 | month =  | year =  | doi =  | PMID = 12006696 }}</ref>
 
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>
*Lobular surface.
*Smooth surface.
 
===Microscopic===
Features:<ref name=pmid12006696/>
*[[myxoid stroma|Myxoid]] material - extra cellular - '''key feature'''.
*Myxoma cells:<ref name=pmid16508920>{{Cite journal  | last1 = Orlandi | first1 = A. | last2 = Ciucci | first2 = A. | last3 = Ferlosio | first3 = A. | last4 = Genta | first4 = R. | last5 = Spagnoli | first5 = LG. | last6 = Gabbiani | first6 = G. | title = Cardiac myxoma cells exhibit embryonic endocardial stem cell features. | journal = J Pathol | volume = 209 | issue = 2 | pages = 231-9 | month = Jun | year = 2006 | doi = 10.1002/path.1959 | PMID = 16508920 }}</ref>
**Stellate, polygonal or spindled morphology.
**+/-Multinucleated.
**Inconspicuous [[nucleoli]].
**Abundant cytoplasm.
*Calcified elastic fibers - ''gamna bodies''.
*Hemorrhage common.
*Often covered by endothelium.
*+/-Ossification.
*+/-Fibrosis.
 
DDx:<ref>{{Ref DCHH|79}}</ref>
*[[Papillary fibroelastoma]] - not really in the histomorphologic [[differential diagnosis]].
*[[Myxofibrosarcoma]] - nuclear pleomorphism.
*[[Myxoid liposarcoma]] - chickenwire vasculature.
 
====Images====
<gallery>
Image:Atrial_myxoma_high_mag.jpg | Atrial myxoma - high mag. (WC)
Image:Atrial_myxoma_edge_high_mag.jpg | Atrial myxoma - endothelial covering - high mag. (WC)
Image:Atrial_myxoma_edge_low_mag.jpg | Atrial myxoma - sharp border - low mag. (WC)
</gallery>
www:
*[http://radiographics.rsna.org/content/22/3/673/F3.expansion.html Atrial myxoma (rsna.org)].<ref name=pmid12006696/>
*[http://radiographics.rsna.org/content/22/3/673/F4.expansion.html Gamna bodies (rsna.org)].<ref name=pmid12006696/>
 
===Sign out===
<pre>
MASS, LEFT ATRIUM, EXCISION:
- MYXOMA.
</pre>
 
====Micro====
The sections show paucicellular myxoid material containing polygonal and spindled cells with eosinophilic myxoid cytoplasm, bland nuclei, inconspicuous nucleoli and focal multinucleation (myxoma cells). Hemosiderin-laden macrophages, calcified elastic fibres (gamna bodies) and scattered inflammatory cells are also present. There is no nuclear atypia. Mitotic activity is not evident. Several sections show fresh hemorrhage.  The edge has a fibrotic rim and appears to be covered by endothelium. No cardiac muscle is identified.


==Papillary fibroelastoma==
==Papillary fibroelastoma==

Revision as of 06:40, 3 October 2013

Cardiac tumours are rare buggers. They provide some work for cardiac surgeons.

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.

Note:

  • According to WMSP:[3] Most common primary malignant tumour of the heart = angiosarcoma.

Specific entities

Cardiac myxoma

Main article: Cardiac myxoma

This includes the common atrial myxoma.

Papillary fibroelastoma

  • AKA fibroelastoma.
  • AKA giant Lambl excrescence.[4]

General

  • Usually an incidental finding.

Gross

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

Image:

Microscopic

Features:[6]

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

Images

  • Papillary fibroelastoma - low mag. (WC)

  • Papillary fibroelastoma - intermed. mag. (WC)

Cardiac rhabdomyoma

Main article: Rhabdomyoma

Rhabdomyosarcoma

See soft tissue tumours.

Lipoma

Main article: Adipocytic tumours
  • Like lipomas elsewhere in the body.
  • Usually location: left ventricle, subendocardial.[3]

DDx:

  • Lipomatous hypertrophy.[8]

Cystic tumour of the atrioventricular nodal region

General

Gross

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

Microscopic

Features:[10]

  • Cystic spaces lined single layer of epithelial cells.
  • +/-Focal mononuclear inflammation.
  • +/-Psammoma bodies.

Images

  • CTAVNR - very low mag. (WC)

  • CTAVNR - high mag. (WC)

IHC

  • CEA +ve.
  • EMA +ve.

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 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 135. ISBN 978-0781765275.
  4. ↑ Loire, R.; Pinède, L.; Donsbeck, AV.; Nighoghossian, N.; Perinetti, M. (Apr 1998). "[Papillary fibroelastoma of the heart (giant Lambl excrescence). Clinical-anatomical study on 10 surgically treated patients].". Presse Med 27 (16): 753-7. PMID 9767897.
  5. ↑ URL: http://www.e-heart.org/pages/09_Cardiac_Tumors/09_Cardiac_Tumors_Primary_Benign_Cardiac_Papillary%20Fibroelastoma_001.htm. 5 March 2013.
  6. ↑ URL: http://www.pathologyoutlines.com/hearttumor.html. Accessed on: 16 May 2011.
  7. ↑ 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.
  8. ↑ Miller, DV.; Tazelaar, HD. (Mar 2010). "Cardiovascular pseudoneoplasms.". Arch Pathol Lab Med 134 (3): 362-8. PMID 20196664.
  9. ↑ Kaminishi, Y.; Watanabe, Y.; Nakata, H.; Shimokama, T.; Jikuya, T. (Jan 2002). "Cystic tumor of the atrioventricular nodal region.". Jpn J Thorac Cardiovasc Surg 50 (1): 37-9. PMID 11855098.
  10. ↑ 10.0 10.1 Paniagua, JR.; Sadaba, JR.; Davidson, LA.; Munsch, CM. (Apr 2000). "Cystic tumour of the atrioventricular nodal region: report of a case successfully treated with surgery.". Heart 83 (4): E6. PMID 10722558.
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