Tumors of the heart and pericardium

Abstract

Tumor invasion of the heart and pericardium accounts for a significant degree ofmorbidity in cancer patients. Although present in only 107; of all cancer patients, fully one-third of patients with pericardial or cardiac metastases will die as a direct result ofthis involvement. Malignant tumors of the heart and pericardium can be divided into primary tumors of the heart and pericardium and those arising as metastatic or direct extensions of tumors originating in other organs. Primary tumors are rare and often present with symptoms of cardiac failure or valvular dysfunction without obvious evidence for a malignant etiology. Secondary or metastatic involvement of the heart and pericardium occurs much more commonly. Carcinomas of the lung and breast, because of their high prevalence and proximity to the heart, are the most frequent sources of cardiac involvement followed by melanoma and the hematologic malignancies. Antemortem diagnoses invariably underestimate the presence of cardiac involvement. The discrepancy between antemortem and postmortem diagnoses may be the result of the silent nature of the malignant involvement, simulation by the tumor of primary coronary artery or valvular disease, or obscuring of cardiac disease by the signs and symptoms of widespread metastatic disease. The key to diagnosis is the maintenance of a high index of suspicion in the appropriate clinical setting with the application ofnon-invasive and invasive modalities in pursuit of the diagnosis. Echocardiography (56)) computerized tomography (72), magnetic resonance imaging (3) and cardiac catheterization with endomyocardial biopsy (18) have all led to accurate diagnosis. The early diagnosis and prompt treatment of patients with benign cardiac tumors can