Benign Cardiac Tumors Research Articles

Aortic Valve Papillary Fibroelastoma: A Sea Anemone in the Heart, A Case Report

Cardiac papillary fibroelastomas are benign primary cardiac tumors usually arising from the normal components of the endocardium. Grossly they have a characteristic short pedicle and multiple papillary fronds similar to sea anemone. Clinically they have varying presentations ranging from asymptomatic to severe ischemic or embolic complications. We hereby present a case of a middle-aged man who presented with exertional dyspnea and palpitations and was discovered to have papillary fibroelastoma involving the aortic valve. The described case illustrates some of the presenting features, the workup and some of the management modalities that need to be implicated in cases of papillary fibroelastomas.

A 20-Year Experience With Resection of Primary Cardiac Tumors and Metastatic Tumors of the Heart

Cardiac tumors are uncommon, occurring in less than 1% of the population, and are comprised of numerous tumor types. Management of certain tumors types such as sarcoma have evolved and improved in the recent era. We evaluate the outcomes of patients who underwent resection of benign or malignant cardiac tumors with a focused review of cardiac sarcomas. Institutional data were reviewed from 1997 to 2017, and 180 patients who underwent tumor resection were identified. Outcomes and survival were examined based on tumor type. Two-thirds of patients (119 of 180) had benign tumors. Of 61 malignant tumors, 23 were sarcomas, 24were cavoatrial tumors, and 8 were T4 lung tumors. Inthe sarcoma group, operative mortality was 2 of 23 (9.1%). Neoadjuvant therapy was administered to 8 of 23patients (34.8%) with R0 resection achieved in 5 of 8 patients (62.5%). R0 resection was successful in 7 of 15 patients (46.7%) without neoadjuvant therapy. Mean survival with neoadjuvant therapy was 2.76 ± 3.85 years versus 1.28 ± 1.31 years without neoadjuvant therapy (p= 0.428). Mean survival with R0 resection was 2.79 ± 4.23 years compared with 1.64 ± 1.63 years without (p= 0.407). In the T4 lung tumor group, operative mortality was zero and R0 resection was achieved in 6 of 8 (75%). The cavoatrial tumors were mostly renal cell carcinoma resected with a mortality of 4.5%. Cardiac tumors are comprised of diverse tumor types. Indications for, and benefits of, resecting benign tumors and many malignant tumor types are clear, and operative outcomes are generally good. Cardiac sarcomas benefit from neoadjuvant therapy, which improves the rate of complete resection, thus improving survival.

Left Atrial Myxoma with Mild Left Ventricular Dysfunction— A Case Report

Atrial Myxoma is the most common primary cardiac tumors accounting for about 50% of benign primary cardiac tumors, with the majority located in the left atrium. This is a case of large left atrial (LA) myxoma presented with features of mitral stenosis associated with moderate left ventricular failure (LVF) and mild pulmonary artery hypertension (PAH) The patient improved markedly after tumor excision.Pulse Vol.10 January-December 2017 p.29-33

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

BackgroundThe purpose of this analysis is to describe the differences in cardiac magnetic resonance characteristics between benign and malignant tumors, which would be helpful for surgical planning. MethodsThis was a prospective cohort study of 130 patients who underwent cardiac magnetic resonance imaging for evaluation of a suspected cardiac mass. After excluding thrombi and tumors without definitive diagnosis, 66 tumors were evaluated for morphologic features and tissue composition. ResultsOf the 66 patients, 39 (59.0%) had malignant tumors and 27 (41.0%) had benign tumors. Patients with malignant tumors were younger when compared with those with benign tumors (age 51 years [42.8-60.0] vs 65 years [60.0-71.0] median). Malignant tumors more often demonstrated tumor invasion (69% vs 0% P < .001) and were more often associated with pericardial effusion (41% vs 7.4% P = .004). Presence of first-pass perfusion (100% vs 33% P < .001) and late gadolinium enhancement (100% vs 59.2%, P < .001) were significantly higher in malignant tumors. In logistic regression modeling, tumor invasion (P < .001) and first-pass perfusion (P < .001) were independently associated with malignancy. Furthermore, using classification and regression tree analysis, we developed a decision tree algorithm to help differentiate benign from malignant tumors (diagnostic accuracy ∼90%). The algorithm-weighted cost of misclassifying a malignant tumor as benign was twice that of classifying a benign tumor as malignant. ConclusionsOur study demonstrates that cardiac magnetic resonance imaging is a useful noninvasive method for differentiating malignant from benign cardiac tumors. Tumor size, invasion, and first-pass perfusion were useful imaging characteristics in differentiating benign from malignant tumors.

Inverted Yoga and Near Syncope: An Unusual Diagnosis of Right Ventricular Myxoma

Primary cardiac tumors are extremely rare and are difficult to diagnose. Although usually benign in nature, myxomas require surgical resection due to their increased risk of embolic and cardiac complications, with the timing of resection dependent on the presentation and size of the tumor. However, if diagnosed early, patients with primary benign cardiac tumors have excellent prognosis following surgery. Therefore, a high index of suspicion and a wide differential diagnosis are very important in detecting rare conditions that can affect otherwise healthy individuals. We present an uncommon case of a right ventricular myxoma that was discovered when the patient was performing inverted yoga and experienced a near syncopal episode. Patient subsequently underwent an echocardiographic evaluation and was found to have a right ventricular myxoma that was excised. Although recurrence is rare, it is important for physicians to remain vigilant and continue careful and consistent follow-up for patients with a history of a cardiac myxoma.

Clinical Outcome of Benign Cardiac Tumors in Infants During A 13 Years’ Experience: Impact of Prenatal Diagnosis

Clinical Outcome of Benign Cardiac Tumors in Infants During A 13 Years’ Experience: Impact of Prenatal Diagnosis

Cardiac myxoma: a contemporary multimodality imaging review.

Cardiac myxoma (CM) is by far the most common primary benign cardiac tumor, typically arising in the left atrium with an attachment point in the fossa ovalis region. Although the etiology of CM remains unclear, we know that this endocardial-based mass originates from undifferentiated mesenchymal cells. Continuous technical improvements in the field of echocardiography since the 1960s has profoundly changed the diagnostic approach by allowing a good tumor detection as well as the preoperative planning by providing crucial information concerning the attachment point location. However, echocardiography has its limitations among which lack of tissue characterization and restricted field of view can arise diagnosis difficulties in atypical presentations. With the widespread and routine use of echocardiography and chest computed tomography (CT), incidental detection of CM is not infrequent. As a consequence, it has become mandatory for cardiologists and radiologists evolving in a multimodality imaging world to be familiar with the wide range of presentations of this tumor. The authors present here a review of the common and less common aspects of CM using the main imaging modalities available: echocardiography, cardiovascular magnetic resonance imaging, CT, positron emission tomography and coronary angiography.

A mobile mass on the tricuspid valve in a young female: The critical distinction between the vegetation and cardiac tumor

Papillary fibroelastomas (PFEs) are benign cardiac tumors with high embolic tendency, and usually originate from the cardiac valve. We report the case of a 34-year-old woman who experienced progressive dyspnea and fatigue. Transthoracic echocardiography revealed a pediculated, homogenous echo-dense, and highly mobile mass attached to the tricuspid valve. The patient was diagnosed with cardiac PFE because of its size and mobility, and surgical resection was scheduled.

Thymic pathology and cardiac myxomas: Coincidence or a closer relationship?

Myxomas are the most common benign cardiac tumors and are located more frequently in the left atrium. In the literature there are cases describing the coexistence of thymic tumors and cardiac myxomas. In the case reported herein, during the resection of a cardiac myxoma, an enlarged thymus gland was encountered and resected. The histological exam revealed a thymic hyperplasia. The aim of this case study is to assess the need of conducting further studies in order to identify a common histological pathway between thymic lesions and cardiac myxomas. The diagnosis of a cardiac myxoma could justify a further workup of the anterior mediastinum in order not to overlook a lesion of thymic origin.

MR Imaging of Cardiac Masses

Cardiac masses present a diagnostic challenge given their relative rarity and the overall difficulty imaging the heart. With the increasing frequency and quality of imaging in general, however, the incidental discovery of cardiac masses is increasing. Cardiac masses seldom produce symptoms, and they are more commonly found during imaging for noncardiac indications. While echocardiography is useful in the initial evaluation of a suspected mass, cardiac magnetic resonance (MR) imaging is the best imaging modality to characterize cardiac tumors due to its superior tissue characterization and its higher contrast resolution. Due to the risk of embolization and arrhythmia, most benign cardiac tumors are removed, and imaging plays an important role in treatment planning. While primary resection remains the mainstay of treatment, new treatment strategies may prolong survival and slow the growth of metastases. A fundamental knowledge of common cardiac masses is vital to all radiologists, and here, we discuss the most pertinent imaging approach to cardiac masses emphasizing MR imaging.

Cardiac Myxomas: A Histodemographic Analysis

Background: Cardiac myxoma is the most common benign cardiac tumour, accounting for more than half of all primary cardiac tumours. Most myxomas are sporadic and the cause is largely unknown. Familial variants with an autosomal dominant inheritance exist. It is localized generally in the left atrium and typically develops in females. Clinical manifestations can mimic cardiac conditions and depend on the natural behaviour of the tumour and its location within the heart, ranging from being completely asymptomatic to causing sudden death. Establishing an early diagnosis is essential, which is confirmed by histopathology.Objective: The aim was to find the relation between cardiac myxomas with age, sex and cardiac sites.Materials and method: This cross sectional study was done in the pathology department of Delta Hospital Limited, Dhaka, Bangladesh, during the period of January 2014 to July 2016. A total of 24 cases were studied irrespective of age, sex along with clinical diagnosis.Results: Among the study subjects females were predominant (70.83%) and highest frequency of cases occurred in between 41-50 years of age (41.67%). Commonest site was left atrium (83.33%).Conclusion: The present study revealed that cardiac myxoma occurs most commonly in the 5th decade with female predominance and the most common site is left atrium.Delta Med Col J. Jan 2018 6(1): 4-8

Giant Papillary Fibroelastoma: A Case Report and Review of the Literature

Papillary fibroelastomas are rare, benign cardiac tumours that originate from cardiac valves or adjacent endocardium. They have a characteristic appearance that resembles sea anemones with frond-like projections. They are usually asymptomatic until they cause an obstruction to flow (especially coronary ostial flow), or they embolise to cause a stroke. Here we present the case of a 55-year-old female who presented with atypical chest pain and was later discovered to have a large, mobile mass in the ascending aorta side of the noncoronary cusp of the aortic valve, measuring 17 × 15 × 14 mm. This was associated with severe aortic regurgitation. She went on to have an excision of the mass and of her native aortic valve and had a mechanical aortic valve replacement. There were no intraoperative complications and along with an overall unremarkable admission was discharged on postoperative day 5. Histopathology confirmed the diagnosis of papillary fibroelastoma. A systematic review of the literature was conducted in PubMed, searching for the largest papillary fibroelastoma on the aortic valve, with the search term ‘aortic valve papillary fibroelastoma’. The largest measured in the literature was 20 × 15 mm, but this was the combined size of three smaller tumours. This case presents the largest solitary aortic valve papillary fibroelastoma with imaging evidence to our knowledge. Tumours of this size present a unique challenge to the cardiac surgeon in their surgical management.

Outcomes After Surgical Resection of Primary Non-Myxoma Cardiac Tumors.

ObjectivePrimary cardiac tumors are rare lesions with different histological type. We reviewed our 17 years of experience in the surgical treatment and clinical results of primary non-myxoma cardiac tumors.MethodsBetween July 2000 and February 2017, 21 patients with primary cardiac tumor were surgically treated in our institution. The tumors were categorized as benign non-myxomas and malignants. Data including the demographic characteristics, details of the tumor histology and grading, cardiac medical and surgical history, surgical procedure of the patients were obtained from the hospital database.ResultsEleven patients were diagnosed with benign non-myxoma tumor (male/female:7/4), ranging in age from 10 days to 74 years (mean age 30.9±26.5 years). Papillary fibroelastoma was the most frequent type (63.6%). There were two early deaths in benign group (all were rhabdomyoma), and mortality rate was 18%. The mean follow-up period was 69.3±58.7 months (range, 3 to 178 months). All survivals in benign group were free of tumor-related symptoms and tumor relapses. Ten patients were diagnosed with malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from 14 years to 73 years (mean age 44.7±18.9 years). Total resection could be done in only three (30%) patients. The mean follow-up period was 18.7±24.8 months (range, 0-78 months). Six patients died in the first 10 months.ConclusionComplete resection of the cardiac tumors, whenever possible, is the main goal of surgery. Surgical resection of benign cardiac tumors is safe, usually curative and provides excellent long-term prognosis. On the contrary, malignant cardiac tumors still remain highly lethal.

Cardiac tumors: About 100 cases

Cases of cardiac tumours including primitives described in the literature remains infrequent compared to metastatic one (secondary tumours). Frequency: 0.001% and 0.28%. The diagnosis becomes increasingly early by dint of modern imaging advent, which facilitated curative surgery and a better prognosis particularly for benign tumours. Bring the experience of our service centre in the management of cardiac tumours, their clinical presentation, treatment modalities, morbidity and mortality and recurrences frequency. During the period of: January 2000–December 2015, 100 patients underwent open heart surgery for cardiac tumour. Thirty-five men and 65 women. The average age: 48.79 years with extremes (5–77 years). The symptomatology is dominated by dyspnea (71% are patients with stage II–III NYHA). Palpitations, fainting/syncope, or embolic complications. The trans-thoracic echocardiographic confirms the diagnosis in all cases. In some cases: a chest CT. Surgical excision with cardiopulmonary bypass (CPB), in 12 patients (without clamping). Surgical expertise specified: the type–nature of the tumour. In total, 92% of benign tumours (70% are myxomas). The preferred seat is the left atrium (67 patients). Pathological forms: – 01 polymorphic poorly differentiated sarcoma; – 02 Fibrosarcoma; – 01 embryonal rhabdomyosarcoma (girl of 05 years); – Kaposi 01; – 01 angiosarcoma; – 02 non-Hodgkin's lymphoma. Total operative mortality: 6% (06 patients). Immediate complications: conduction disorder in 2 patients. The average follow-up: between 1 month to 7 years. Late deaths (03%) due to extra cardiac causes. Three recurrences: 2 for myxoma, one for fibrosarcoma. By cons, there was a very good evolution in the patient with non-Hodgkin lymphoma. Thanks to modern imaging advent, diagnosis can be early before the onset of serious complications; if only one clinically suspicious. The prognosis of benign cardiac tumours depends on the quality of surgical treatment. Surgery gives very good immediate and remote insisting on a periodic and regular monitoring; by cons for malignant tumours, it remains worse and depends on early in the surgical management, which is not hollowing since become symptomatic tumours are not at an advanced stage, in addition requires good protocols codified for these very rare and also very serious tumours ( Fig. 1 ).

Surgical Treatment of Cardiac Tumors: Insights from an 18-Year Single-Center Analysis.

BackgroundThe aim of this study was to investigate the clinical presentation, operative data, and early and late outcomes of a large patient cohort undergoing surgical treatment for cardiac tumors in our institution.Material/MethodsA total of 181 patients underwent surgery because of suspected cardiac tumor in our institution between 1998 and 2016. In 162 cases, the diagnosis was confirmed postoperatively and these patients were included in this study. Preoperative baseline characteristics, operative data, and postoperative early and long-term outcomes were analyzed.ResultsMean age at presentation was 56.6±17.6 years, and 95 (58.6%) patients were female. There were 126 (77.8%) patients with benign cardiac tumors, while the remaining patients had malignant tumors (primary and metastasized). The mean follow-up time was 5.2±4.7 years. The most frequent histologically verified tumor type was myxoma (63%, n=102). In terms of malignant tumors, various types of sarcomas presented most primary malignant cardiac tumors (7.4%, n=12). The mean ICU length of stay was 1.7±2.2 days and overall in-hospital mortality was 3.1% (n=5). Frequent postoperative complications included mediastinal bleeding (5.8%, n=9), wound infection (1.3%, n=2), acute renal failure (5.6%, n=9), and major cerebrovascular events (n=7, 4.6%). The overall cumulative survival after cardiac tumor resection was 94% at 30 days, 85% at 1 year, 72% at 5 years, and 59% at 15 years.ConclusionsSurgical treatment of cardiac tumors is a safe and highly effective strategy associated with good early and long-term outcomes.

Innate immunity in cardiac myxomas and its pathological and clinical correlations.

Cardiac myxomas are the most common benign cardiac tumor. We investigated the immunohistochemical properties of 11 surgically excised cardiac myxomas, in order to analyze the correlation between macrophages and mast cell populations and clinical parameters. CD68+/CD163−/iNOS− (M0) cells represent the most abundant macrophage phenotype; however, CD68+/CD163+ cells (M2) were also frequent. CD68+/iNOS+ (M1) elements were rare. Mast cells, defined as a population of c-kit (CD117)+ and/or tryptase+ cells were also detected. Statistical analysis showed significant correlations between c-kit (CD117)+ and tryptase, CD68 and erythrocyte sedimentation rate (ESR), ESR and red blood cell count (RBC), and prothrombin time and platelet count. The inverse correlation between RBCs in peripheral blood and ESR suggested that anemia associated with chronic inflammatory disease is a noncasual event in patients suffering from cardiac myxoma. Mechanical hemolysis may be only a minor component of anemia, according to the lack of correlation between echographic surface and RBCs. Moreover, tumor size did not correlate with ESR, showing that inflammatory state may depend from both tumor cells population and inflammatory infiltrate. In the future, modulation of macrophage polarization in cardiac myxomas might represent important therapeutic target.

Lipoma of superior vena cava: a rare occurrence

Most benign primary cardiac tumours are myxomas; non-myxomatous tumours are less common but comprise a wide variety. Cardiac lipoma is a rare non-myxomatous variety. A 70-year-old Caucasian woman with right...

Giant Left Atrial Myxoma Masquerading as Cough-Syncope Syndrome.

Left atrial myxomas are the most common type of benign primary cardiac tumor. Patients can present with generalized symptoms, such as fatigue, symptoms from obstruction of the myxoma, or even embolization of the myxoma causing distal thrombosis. We describe a case with several-month duration of syncopal episodes that occurred after coughing and with exertion. Computed tomography of the chest showed a 6.1 cm by 4.5 cm mass in the left atrium, later evaluated with an echocardiogram. Cardiothoracic surgery removed the mass, and it was determined to be an atrial myxoma. It is important for an internist to be able to diagnose an atrial myxoma because of the risks associated with embolization and even sudden death as myxoma can block blood supply from atrium to ventricle.

Śluzak lewej komory serca powikłany zatorowością obwodową

Left ventricular myxoma is a very rare, benign primary cardiac tumor. Due to its localization, size and mobility, it may be a source of peripheral embolism. The recurrence of myxoma after surgical removal is rare, ranging from 0% to 3% in solitary tumors and 12–22% in the familial type. We report two cases of left ventricular myxomas complicated by arterial embolism. In the first case of a 19-years old male, apart from systemic embolisation, a very fast tumor growth, suggesting thrombus formation, was observed. In the second case of a 42-years old male, the recurrence of myxoma in left ventricle apex was found 2 months after surgical excision, together with de novo development of two additional tumors in the right atrium. Clinical features of cardiac myxoma, both in terms of complications and recurrences, necessitate careful follow up with an echocardiographic control in all patients after tumor removal surgery.

Cardiac Magnetic Resonance Imaging in Oncology.

Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. Advances in imaging techniques have enhanced the detection and evaluation of cardiac masses; meanwhile, innovative applications have created a growing role for cardiac MRI for the management of cardiotoxicity caused by cancer therapies. An overview is provided of the clinical indications and technical considerations of cardiac MRI. Its role in the evaluation of cardiac masses and cardiac function is reviewed, and novel sequences are discussed that are giving rise to future directions in cardio-oncology research. A review of the literature was also performed, focusing on cardiac MRI findings associated with cardiac dysfunction related to cancer treatment. Cardiac MRI can be used to differentiate benign and malignant primary cardiac tumors, metastatic disease, and pseudotumors with high spatial and temporal resolution. Cardiac MRI can also be used to detect the early and long-term effects of cardiotoxicity related to cancer therapy. This is accomplished through a multiparametric approach that uses conventional bright blood, dark blood, and postcontrast sequences while also considering the applicability of newer T1 and T2 mapping sequences and other emerging techniques. Cardio-oncology programs have an expanding presence in the multidisciplinary approach of cancer care. Consequently, knowledge of cardiac MRI and its potential applications is critical to the success of contemporary cancer diagnostics and cancer management.