Difference between revisions of "Cardiac tumours"

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Cardiac tumours (view source)

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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.
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_high_mag.jpg Atrial myxoma - high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_edge_high_mag.jpg Atrial myxoma - endothelial covering - high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Atrial_myxoma_edge_low_mag.jpg Atrial myxoma - sharp border - low mag. (WC)].
*www:
**[http://radiographics.rsna.org/content/22/3/673/F3.expansion.html Atrial myxoma (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==
*[[AKA]] ''fibroelastoma''.
*[[AKA]] ''fibroelastoma''.
**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>
===General===
===General===
*Usually an incidental finding.
*Usually an incidental finding.
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*Yellow.
*Yellow.
*Typically on free edge.
*Typically on free edge.
Image:
*[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>


===Microscopic===
===Microscopic===
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**Mucopolysaccharide.
**Mucopolysaccharide.


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma.jpg Papillary fibroelastoma - low mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Papillary_fibroelastoma2.jpg Papillary fibroelastoma - intermed. mag. (WC)].
Image:Papillary_fibroelastoma.jpg | Papillary fibroelastoma - low mag. (WC)
Image:Papillary_fibroelastoma2.jpg | Papillary fibroelastoma - intermed. mag. (WC)
</gallery>


==Cardiac rhabdomyoma==
==Cardiac rhabdomyoma==
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==Rhabdomyosarcoma==
==Rhabdomyosarcoma==
See ''[[soft tissue tumours]]''.
See ''[[rhabdomyosarcoma]]''.


==Lipoma==
==Lipoma==
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==Cystic tumour of the atrioventricular nodal region==
==Cystic tumour of the atrioventricular nodal region==
===General===
{{Main|Cystic tumour of the atrioventricular nodal region}}
*Super rare.<ref name=pmid11855098>{{Cite journal  | last1 = Kaminishi | first1 = Y. | last2 = Watanabe | first2 = Y. | last3 = Nakata | first3 = H. | last4 = Shimokama | first4 = T. | last5 = Jikuya | first5 = T. | title = Cystic tumor of the atrioventricular nodal region. | journal = Jpn J Thorac Cardiovasc Surg | volume = 50 | issue = 1 | pages = 37-9 | month = Jan | year = 2002 | doi =  | PMID = 11855098 }}</ref>
*Usually 1-2 mm.
*May cause [[Sudden_natural_death|sudden cardiac death]].<ref name=pmid10722558/>
 
===Gross===
*"Bump" in the ''triangle of Koch''.
*Cystic spaces.
 
===Microscopic===
Features:<ref name=pmid10722558>{{Cite journal  | last1 = Paniagua | first1 = JR. | last2 = Sadaba | first2 = JR. | last3 = Davidson | first3 = LA. | last4 = Munsch | first4 = CM. | title = Cystic tumour of the atrioventricular nodal region: report of a case successfully treated with surgery. | journal = Heart | volume = 83 | issue = 4 | pages = E6 | month = Apr | year = 2000 | doi =  | PMID = 10722558 }}</ref>
*Cystic spaces lined single layer of epithelial cells.
*+/-Focal mononuclear inflammation.
*+/-[[Psammoma bodies]].


Images:
==Angiosarcoma==
*[http://commons.wikimedia.org/wiki/File:Cystic_tumour_of_the_atrioventricular_nodal_region_-_very_low_mag.jpg CTAVNR - very low mag. (WC)].
[[File: Angiosarc heart 1 sl 1.png| Angiosarcoma of right atrium]]
*[http://commons.wikimedia.org/wiki/File:Cystic_tumour_of_the_atrioventricular_nodal_region_-_high_mag.jpg CTAVNR - high mag. (WC)].
[[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]]


===IHC===
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).
*CEA +ve.
*EMA +ve.


=See also=
=See also=
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[[Category:Cardiovascular pathology]]
[[Category:Cardiovascular pathology]]
[[Category:Cardiac tumours]]
Michael
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