Benign Cardiac Tumors Research Articles

Carney Complex with Biatrial Cardiac Myxoma

Cardiac myxomas make up approximately 50% of all benign cardiac tumors and represented 86% of all surgically treated cardiac tumors. Most of them originated from the left atrium, in some cases from both of atria. We report a case of male patient with biatrial myxomas and other extra-cardiac involvement: hypophyseal adenoma, enlargement of thyroid gland, tubular adenoma polyp of colon and bilateral large cell calcifying Sertoli cell tumor (LCCSCT) of testis. These findings led to the diagnosis of Carney's complex, which is a syndrome with multiple neoplasias, cardiac myxomas, lentigines, and endocrine abnormalities. A genetic test confirm this diagnosis.

Primary Cardiac Tumours: Our Experience

Introduction Primary cardiac tumours are rare with autopsy incidence of less than 0.1 percent. We present our experience on surgical treatment of such tumours. Methods Since 2001, fifteen patients underwent surgical intervention for primary cardiac tumour at our centre. Mean age was 46.5 ± 17.5 years (range 20 to 73 years). There were eight female patients. Thirteen patients had atrial myxoma and the remaining two had primary malignant tumours. Surgical excision of the tumour was done under cardiopulmonary bypass and cardioplegic cardiac arrest. Results Complete excision was possible in all benign cardiac tumours where as excision was possible in only one of the two malignant tumours. One patient with suspected angiosarcoma had biopsy taken from the heart. There was no operative mortality. All the patients with atrial myxoma were symptom free and free of recurrence on follow-up echocardiography. The patient with suspected angiosarcoma (histopathology was reported as hemangioma only) presented with disseminated disease and metastasis to thoracic spine with paraplegia three months postoperatively. The other patient with rhabdomyosarcoma who had complete excision of tumour followed by repair of the defect is currently on adjuvant chemotherapy. Conclusion Surgical excision of primary benign cardiac tumours is possible with excellent surgical outcome where as outcome is guarded in primary malignant cardiac tumours. DOI: http://dx.doi.org/10.3126/njh.v8i1.8329 Nepalese Heart Journal Vol.8(1) 2011 pp.8-11

Left ventricular hemangioma

A young Saudi woman presented with symptoms of palpitation, near syncope, anxiety, and fatigue. Transthoracic echocardiography showed a left ventricular mass. Under cardiopulmonary bypass, brief cardioplegic arrest, and the aid of a thoracoscope, the mass was resected. Histologic examination showed a rare benign cardiac tumor: mixed cavernous-capillary hemangioma.

Giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava

Cardiac myxomas are the most common type of benign cardiac tumors and most of them occur in the left atrium but the biatrial myxoma is uncommon. We present a rare case of giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava. A 58-year old woman presented with exertional dyspnea and intermittent chest discomfort. The non-pedunculated tumor involved most of the interatrial septum and extended from the orifice of the inferior vena cava to the displaced mitral annulus and the lower left pulmonary vein. The resected specimen weighed 76 gram and measured 80 × 40 × 30 mm. She did not complain of dyspnea or show any sign of recurrence by echocardiography during the 2-year follow-up period.

A case of giant left ventricular lipoma: unusual presentation

Primary cardiac tumors are rare and usually benign. The incidence of cardiac lipomas is 8 % of benign cardiac tumors [1]. Several surgical options have been reported to obtain an appropriate operative view because of their poor visualization when the tumors are located in the Left Ventricle (LV). We report a rare case of massive left ventricular lipoma occupying pericardial space. A 23-year-old female had back pain since 6 months. She visited a local orthopedician, who ordered for computed tomography scan of chest and back. Computed tomography showed a large epicardial mass located along the anterior surface of the heart, from the diaphragm level through the aortic arch level. The mass showed an attenuation value identical with that of subcutaneous adipose tissue and contained some areas with high density. The mass was not enhanced by contrast media. Percutaneous biopsy was done, histologic examination of the specimen demonstrated mature adipose tissue. An encapsulated adipose mass weighing 865 g, which originated from the left ventricle anteriorolateral surface without any invasion to the pericardium, was near completely excised, except for a small portion which was encasing obtuse marginal artery. Microscopic examination revealed mature adipose tissue with partial necrosis, confirming the diagnosis of lipoma.

Fibroelastoma or atheromatous plaque: a case report

Cardiologia CROATICA Cardiac fibroelastoma is a rare, benign cardiac tumor. Usually, they arise from valvular endocardium and non-valvular location is rare. Although transthoracic echocardiography is sufficient for diagnosis of most cardiac tumors, small tumors may be missed. We describe an adult female patient who was clinically asymptomatic, but was submitted for the echocardiocraphic evaluation because of the high blood pressure. Transthoracic echocardiography showed a small lesion that was attached to the aortic wall near the aortic valve. In such a case, differential diagnosis consists of tumor, thrombus or atheromatous plaque and usually relies on localization of the structure and clinical presentation. In conclusion, echocardiography represents an invaluable diagnostic tool for the detection of intracardiac masses while it simultaneously provides information about their size, location, mobility and attachment site as well as the presence and extent of any consequent hemodynamic effects. However, it is almoust impossible to define tissue character using echocardiography alone, as in our case. Magnetic resonance imaging excels at making a differential diagnosis of various soft tissues and organs becuse of its high revolving power. According to the proper diagnosis the adequate treatment including conservative or surgical approach could be provided.

Left Atrial Huge Myxoma with Positional Presyncope and Completely Prolapsed Into the Left Ventricle

Kardiyak miksomalar nadir görülmektedir. Benign kardiyak tümörler olmasına rağmen, lokalizasyonu nedeniyle malign potansiyeli olabilmektedir. Yetmiş dokuz yaşında kadın hasta altı ay önce başlayan pozisyonel baş dönmesi şikayetiyle başvurdu. Detaylı fizik muayeneden sonra, yapılan ekokardiyografide sol atriyumdan köken olan ve sol ventrikül girişinde obstrüksiyona neden olan büyük miksoma gösterildi. Bu yüzden, pozisyonel baş dönmesi şikayetiyle başvuran olguların ayırıcı tanısında miksoma akılda tutulmalı ve ekokardiyografik incelemeleri yapılmalıdır

23-year experience on diagnosis and surgical treatment of benign and malignant cardiac tumors

IntroductionAlthough myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors.Material and methodsFrom 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic.ResultsMyxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter.ConclusionsShort and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.

Multimodality Imaging of a Giant Aortic Valve Papillary Fibroelastoma

Papillary fibroelastomas (PFEs) are benign cardiac tumors arising from endocardium. They are commonly found on valvular surfaces and average 1.0–1.5 cm in size. Though often asymptomatic, PFEs can lead to potentially severe complications, primarily due to their embolic potential. Surgical resection is recommended for all symptomatic or large PFEs. We report the case of a patient presenting with cardiovascular symptoms who was found to have a very large aortic valve PFE, as diagnosed by histopathologic examination following surgical resection. Multimodality cardiovascular imaging demonstrates the classic morphologic findings, including a pedunculated appearance and oscillating “frond-like” surface projections.

An echogenic mass on the aortic valve.

An asymptomatic 64-year-old patient came for a routine check-up following inferior wall myocardial infarction (MI) and stent insertion in France 6 months previously. He had no cardiovascular risk factors or significant past medical history. Systemic examination was normal as were his haematological and biochemical parameters. A routine echocardiogram (TTE) revealed a mass on the non-coronary leaflet of the aortic valve (AV) with normal left ventricular function and no other valvular abnormalities. Subsequent transoesophageal echocardiography confirmed a pedunculated echogenic mobile mass 0.5–1 cm in diameter attached to the aortic side of AV (Fig. 1a and online video files). Further imaging with cardiac MR described the hypointense mobile mass as possible fibroelastoma. The patient underwent excision of the tumour (Fig. 1b) and AV replacement. Histopathology revealed a central fibrous core surrounded by a layer of loose connective tissue with variable elastic tissue with the surface covered by endothelial cells, consistent with papillary fibroelastoma (Fig. 2). His post-operative recovery was uneventful and was later discharged. Papillary fibroelastoma is a rare, benign cardiac tumour accounting for 10 % of all cardiac tumours [1]. They are generally found on aortic and mitral valves. Patients may present with neurological events, stroke, angina, myocardial infarction, sudden death or as incidental findings on autopsy or at surgery. TTE is useful in making the diagnosis. Treatment in asymptomatic patients is controversial. However, left-sided tumours may be considered for surgery as they can embolise causing strokes, MI, peripheral ischaemia and even vascular obstruction. Though rightsided tumours follow a more benign course, they can interfere with cardiac output if bulky enough.

Giant intrapericardial lipoma: An unusual cause of dyspnoea

The pericardial lipomas are rare benign cardiac tumors. The clinical presentation of these cardiac neoplasms varies according to the site of growth. We describe here a case of massive intrapericardial lipoma leading to severe dyspnea, its diagnostic work up and briefly review the existing literature of this uncommon disorder. The patient underwent successful surgical resection of the tumor with complete alleviation of the symptoms.

Life-Threatening Tumors of the Heart in Fetal and Postnatal Age

To evaluate the role of histology in diagnosis and management of biologically benign heart tumors causing life-threatening symptoms and even death in children and fetuses. The clinical impact of a multidisciplinary approach including 2-D echocardiography, histology, genetics, and cardiac surgery has not yet been fully elucidated. Forty-one consecutive antenatal (n = 17) or postnatal (n = 24) detected cardiac masses were evaluated by 2-D echocardiography (in alive patients) or at autopsy, and 12/41 cases with definite histologic diagnosis of primary and benign cardiac tumor were entered in this study. Rhabdomyomas (n = 6), hemangiomas (n = 3), central fibrous body chondroma (n = 1), fibroma (n = 1), or left atrial myxoma (n = 1) were histologically diagnosed in 4 fetuses and in 8 children. Death occurred in 6 patients showing diffuse or infiltrative tumors, 2/6 experiencing intrauterine death or sudden and unexpected infant death. Seven patients underwent surgery, 4/7 are alive and well at >5 years follow-up, whereas 3 deaths followed partial tumor resection. Two fetuses with extensive tumor/s were aborted. Tuberous sclerosis complex gene mutations were seen in patients with rhabdomyomas. Histology represents the best diagnostic approach in life-threatening pediatric cardiac tumors allowing definite diagnosis in cases other than rhabdomyoma and in sudden deaths, influencing clinical management and counselling. 2-D echocardiography remains the main tool for early clinical diagnosis and follow-up. A multidisciplinary approach is advisable because of rarity, difficult management, and possible associations with inheritable diseases.

Sudden death as presenting symptom caused by cardiac primary multicentric left ventricle rhabdomyoma, in an 11-month-old baby. An immunohistochemical study

This case report describes a sudden cardiac death in an apparent healthy 11-month-old infant caused by a multifocal cardiac rhabdomyoma. Parents reported that a few days before the child had fallen to the ground getting a little superficial injury to the scalp. The authors hypothesize that it may have been a transient loss of consciousness episode caused by the cardiac tumour. After the gross examination, histological investigation supported by immunohistochemical analysis using antibody anti- Myoglobin, Actin, Vimentin, Desmin, CD34, S-100, Ki-67 was carried out for the diagnosis. Death was attributed to a multifocal cardiac rhabdomyoma, a benign tumour of striated muscle, which has been completely asymptomatic. In particular, one mass filled the entire posterior wall of the left ventricle. The insidious development of benign cardiac tumours also in infants and children is outlined, focusing on the responsible mechanisms of sudden death in such cases and providing a reference for additional study on these subjects.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/7163626988365078

Giant left atrial myxoma presenting as acute myocardial infarction

Myxomas are the most common type of benign cardiac tumor. The most frequent clinical presentations are symptoms resulting from atrioventricular valve obstruction or systemic embolization. Coronary embolization is a rare, although real and potentially fatal, complication of cardiac myxomas. We present a case report and review of the literature on this disease association. A 57-year-old woman was admitted to our coronary care unit with a diagnosis of non-ST elevation acute myocardial infarction. Transthoracic echocardiography showed a large left atrial mass attached to the interatrial septum, coral-like and with a friable appearance, suggestive of myxoma. Coronary angiography revealed no significant lesions and the patient underwent surgical excision of the mass, which histological study showed to be compatible with myxoma. The postoperative period was uneventful and the patient is doing well, with no recurrence of myxoma.

Enfarte agudo do miocárdio como forma de apresentação de mixoma gigante da aurícula esquerda

Myxomas are the most common type of benign cardiac tumor. The most frequent clinical presentations are symptoms resulting from atrioventricular valve obstruction or systemic embolization. Coronary embolization is a rare, although real and potentially fatal, complication of cardiac myxomas. We present a case report and review of the literature on this disease association. A 57-year-old woman was admitted to our coronary care unit with a diagnosis of non-ST elevation acute myocardial infarction. Transthoracic echocardiography showed a large left atrial mass attached to the interatrial septum, coral-like and with a friable appearance, suggestive of myxoma. Coronary angiography revealed no significant lesions and the patient underwent surgical excision of the mass, which histological study showed to be compatible with myxoma. The postoperative period was uneventful and the patient is doing well, with no recurrence of myxoma.

Mediastinal diffuse large B-cell lymphoma invading the left atrium mimicking coronary artery disease with a mural thrombus

A left atrial mass associated with coronary artery disease is often diagnosed as a mural thrombus rather than other possible etiologies such as benign primary cardiac tumor (myxoma, lipoma), a malignant primary cardiac tumor (sarcoma, lymphoma), or secondary involvement for extracardiac tumors. Malignant lymphoma initially presenting as intracardiac masses is very rare. Chest computed tomography with contrast enhancement and cardiac magnetic resonance may be the best methods for distinguishing primary cardiac tumors from direct extension from adjacent mediastinal structures. We report the case of a 59-year-old man with incidentally found mediastinal diffuse large B-cell lymphoma invading the left atrium, which presented with coronary artery disease and a left atrial mass. Improvement in cardiac ventricular function heart after coronary artery bypass grafting may provide the patient with a better chance of receiving an adequate dose of chemotherapy.

The Value of 18F-FDG PET/CT in the Assessment of Cardiac Malignancy Remains to Be Defined

TO THE EDITOR: We read with great interest the recent article by Rahbar et al. titled “Differentiation of Malignant and Benign Cardiac Tumors Using 18F-FDG PET/CT” ([1][1]). The paper is interesting because diagnosis of cardiac malignancy is difficult and poorly defined. For example, it has been

Left Atrial Papillary Fibroelastoma Accidentally Diagnosed with Gastric Cancer

Papillary fibroelastoma is a rare but benign cardiac tumor and usually originates from the cardiac valve. We describe a 78-year-old woman who was initially diagnosed with gastric cancer, and was incidentally found to have a mass in the free wall of her left atrium between the left atrial appendage and the left superior pulmonary vein. An excision was performed through the left atrial appendage under cardiopulmonary bypass. The histopathologic examination of the resected tissue revealed a papillary fibroelastoma. The unusual localization of this papillary fibroelastoma was discussed.

The Heart of the Matter

b l PRESENTATION In this case, a man with multiple cardiac symptoms suffers cardiac arrest during his medical evaluation, is revived, and is then treated for a very unusual tumor. The patient was a 46-year-old, previously healthy man who presented with complaints of shortness of breath and chest heaviness. Further inquiry revealed generalized fatigue and numerous episodes of profuse sweating over the preceding 2 months. A review of systems was otherwise negative.

Surgery for Primary Cardiac Tumors in Children

Background— To evaluate indications and results of surgery for primary cardiac tumors in children. Methods and Results— Eighty-nine patients aged ≤18 years undergoing surgery for cardiac tumor between 1990 and 2005 from 16 centers were included retrospectively (M/F=41/48; median age 4.3 months, range 1 day to 18 years). Sixty-three patients (68.5%) presented with symptoms. Surgery consisted of complete resection in 62 (69.7%) patients, partial resection in 21 (23.6%), and cardiac transplant in 4 (4.5%). Most frequent histotypes (93.2%) were benign (rhabdomyoma, myxoma, teratoma, fibroma, and hemangioma). Postoperative complications occurred in 29.9%. Early and late mortality were 4.5% each (mean follow-up, 6.3±4.4 years); major adverse events occurred in 28.2% of the patients; 90.7% of patients are in New York Heart Association class I. There were no statistically significant differences in survival, postoperative complications, or adverse events after complete and partial resection in benign tumors other than myxomas. Cardiac transplant was associated significantly with higher mortality rate ( P= 0.006). Overall mortality was associated to malignancy ( P =0.0008), and adverse events during follow-up ( P =0.005). Conclusions— Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most frequent surgical histotypes. Malignant tumors negatively affect early and late survival. Heart transplant is indicated when conservative surgery is not feasible. Lack of recurrence after partial resection of benign cardiac tumors indicates that a less risky tumor debulking is effective for a subset of histotypes such as rhabdomyomas and fibromas.