Cardiac Tumors Research Articles

Gastric and cardiac inflammatory myofibroblastic tumor: an extremely rare case

BackgroundInflammatory myofibroblastic tumor (IMT) is a unique, rarely metastatic tumor composed of myofibroblasts and fibrous spindle cells with inflammatory cell infiltration that can affect any organ in the human body. By reviewing the relevant literature on PubMed, we found that this is the first case report of IMT with both gastric and cardiac involvement.Case presentationA 57-year-old male patient was admitted to the hospital with complaints of malaise, poor appetite, and epigastric pain with black stools. We found a mass in the patient’s stomach and left atrium by contrast-enhanced computed tomography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and other tests. The patient underwent laparoscopic Billroth II subtotal gastrectomy and Braun’s gastrointestinal reconstruction under general anesthesia. On the 46th day following stomach surgery, the cardiac tumor was removed under general anesthesia. The patient has treated with doxorubicin 70 mg of D1 chemotherapy two months after cardiac surgery. Postoperative pathological immunohistochemistry of the mass confirmed the diagnosis of an IMT. His review three months after the cardiac surgery suggested the progression of the left atrial mass, but he declined further treatment and finally died one month after the review.ConclusionsAs a unique class of tumors that rarely metastasize, IMTs have an unknown etiology and pathogenesis, and distant metastasis is primarily observed in patients with negative activin receptor-like kinase (ALK) expression. The preferred treatment for IMT is complete surgical resection, and the effectiveness of adjuvant therapy for patients with distant metastases is still being determined. The clinical presentation of IMT lacks specificity and is often related to the location of tumor growth, which poses a diagnostic challenge. Pathological immunohistochemistry is the only way to confirm the diagnosis at present. Our case report reminds clinicians that a category of ALK-negative IMT with a tendency toward distant metastasis should not be ignored.

Mitral valve leaflet blood cyst treated with minimally invasive approach: a case report and review of literature

IntroductionCardiac blood cyst is a very rare benign tumor of the heart in adults. Though it is very common in the first half year of life, it regresses with time and its occurrence is very rare in children older than six months and in adults. Until now less than 100 valvular blood cyst cases have been reported in adults.Case presentationWe present a case of a 66-year-old male who presented to us with exertional chest tightness, shortness of breath, and right leg weakness for two weeks. He was diagnosed with a cardiac mass two months ago in another hospital. The physical examination was unremarkable. Abdominal ultrasound showed a cyst in the liver and left kidney. Echocardiography showed a mass-occupying lesion of a cystic nature in the mitral valve with moderate mitral regurgitation. Based on echocardiography findings and computed tomography report, the preliminary diagnosis of mitral valve cystic tumor was made. The patient underwent minimally invasive resection of the cyst. The posterior mitral cusp was repaired and a mitral annuloplasty ring was placed. The postoperative recovery was uneventful. The histopathology report confirmed the diagnosis of a cardiac blood cyst. The patient was followed up for six months without any complications. This case is presented to enrich the medical literature on the cardiac blood cyst.ConclusionAlthough a cardiac blood cyst is a rare entity in adults, it still should be considered in the differential diagnosis of cardiac tumors. Because the natural history and hemodynamic effects are very diverse, large symptomatic cardiac blood cysts, especially in the left heart should be resected to avoid complications.

A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve.

Introduction: Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification, a chronic and degenerative mitral valve fibrous ring process. It usually carries a benign prognosis. The prevalence of CCMA is about 0.06%-0.07% of the population. CCMA is generally diagnosed incidentally and can be confused with other intracardiac masses such as cardiac tumors, abscesses, vegetation, or calcified thrombi. Multimodality imaging, including TEE, cardiac computed tomography, and cardiac magnetic nuclear resonance, can easily differentiate CCMA from other masses and help avoid unnecessary surgery. CCMA is typically located in the basal area of the posterior mitral valve, and the calcification seems like a round, large, soft mass with a central echo-dense location. CCMA may have a benign course, but it may sometimes be complicated with mitral valvular dysfunction, systemic embolization, or conduction abnormalities in the scenarios mentioned above, as well as when the diagnosis is unclear, surgery is indicated. Mitral valve replacement should be preferred compared to mitral valve repair.
 Conclusions: It is important to note that the decision for mitral valve replacement, including CAC cases, should be individualized based on various factors, including the patient's clinical condition, symptoms, severity of valve disease, and associated comorbidities.
 As scientific understanding and research progress, there may be ongoing developments and refinements in the conservative and surgical management of CCMA.

Thymoma unveiled by right atrium cavity mass: A rare clinical image

Cardiac tumors are rare, and metastatic deposits are more common than primary cardiac tumors [1,2]. We present a rare case of a 52-year-old, without significant past medical history, initially reported intermittent right shoulder pain six years ago.

A Very Rare Case of Primary Mural Endocarditis of the Right Atrium due to Candida Albicans

Right-sided infective endocarditis accounts for 5-10% of all infective endocarditis cases. Fungal endocarditis represents 1-3% of all of infective endocarditis cases, with Candida spp. being the most common microbiological cause. Primary mural endocarditis is defined by the absence of valvular vegetations together with the presence of vegetations on the endocardial free wall that are not associated with myocardial abscesses, cardiac structural abnormalities, devices, prosthetic material, thrombi or tumors. It constitutes a very rare entity and only 63 cases have been published the literature. C. albicans is the microbiological cause in only nine of these cases, none of which involves the right atrium. We report the case of a frail 84-year-old female patient with a pacemaker presenting with fever. In the transthoracic and three-dimensional transesophageal echocardiograms, a mobile mass was found attached on the free wall of the right atrial base. Blood cultures were positive for C. albicans and the modified Duke criteria were fulfilled for a definite diagnosis of infective endocarditis. After evaluation from a heart team the patient was managed with transvenous lead extraction and intravenous high-dose caspofungin, according to the 2023 Guidelines of the European Society of Cardiology for the management of endocarditis. Pacemaker lead cultures were negative leading to the diagnosis of primary mural endocarditis. The patient responded well to treatment with significant clinical and laboratory improvement. Long-term oral fluconazole was initiated after hospital discharge with a close follow-up plan. To our knowledge this is the first case of primary mural endocarditis of the right atrium due to C. albicans.

Progress in the Use of Echocardiography in Patients with Tumors.

Advances in cancer treatment have increased patient survival rates, shifting clinical focus towards minimizing treatment-related morbidity, including cardiovascular issues. Since echocardiography allows for a comprehensive non-invasive assessment at all cancer stages, it is well suited to monitor cardiovascular disease secondary to oncology treatment. This has earned it significant attention in the study of cardiac tumors and treatment-induced cardiac alterations. Ultrasound methods-ranging from transthoracic and transesophageal echocardiography to ultrasound diagnostic techniques including myocardial strain imaging, myocardial work indices, three-dimensional cardiac imaging-offer a holistic view of both the tumor and its treatment impact cardiac function. Stress echocardiography, myocardial contrast echocardiography, and myocardial acoustic angiography further augment this capability. Together, these echocardiographic techniques provide clinicians with early detection opportunities for cardiac damage, enabling timely interventions. As such, echocardiography continues to be instrumental in monitoring and managing the cardiovascular health of oncology patients, complementing efforts to optimize their overall treatment and survival outcomes.

The usefulness of contrast echocardiography in the evaluation of cardiac masses: a multicenter study

BackgroundCardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE.MethodsBetween April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2).ResultsThe final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively.ConclusionsCombined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.

Cerebral Embolism and MINOCA Secondary to Left Atrial Myxoma after Occlusion of Atrial Septal Defect by Amplatzer Occluder: A Case Report.

Primary heart tumors are rare, with atrial myxomas being the most common type. Atrial myxomas can lead to embolisms, heart obstruction, and systemic symptoms. Herein, we report a case of 72-year-old woman who presented with a left atrial myxoma at the atrial septal defect occluder, a new acute cerebral infarction, and MINOCA (myocardial infarction with no obstructive coronary atherosclerosis). Left atrial myxoma is a common primary cardiac tumor; however, left atrial myxomas arising after percutaneous atrial septal defect occlusion are rare. Additionally, the patient presented with a new case of multiple systemic emboli. The patient underwent surgical resection of a left atrial myxoma, occluder, and left atrium, and atrial septal repair, and was discharged with good recovery for outpatient follow-up. The possibility of a cardiac tumor, especially an atrial myxoma, which can lead to a series of complications, should be considered at the closure site after percutaneous atrial septal closure. Therefore, active surgical treatment and long-term follow-up are warranted in such cases.

Use of fine-needle puncture under endosonographic control in the diagnosis of left atrium sarcoma – case report

Background. Over the past 30 years, with the development of endoscopic technologies and the advent endoscopic ultrasound-guided fine-needle aspiration (EuS-FnA) it has become possible to diagnose with preliminary verification of cardiac tumors, which in turn is an undoubted advantage in detecting cardiac pathology. A rare clinical case is presented: the detection of a tumor of the left atrium using high-tech endoscopic techniques, in particular a EuS-FnA. when studying the surgical material using immunohistochemistry and FISH hybridization, the final diagnosis sounded like intimal sarcoma. Diagnosis of intimal sarcoma is a complex clinical task, and difficulties in making a diagnosis delay the duration of treatment. Our experience demonstrates the modern role of endoscopy as a minimally invasive method of diagnosing intracardiac tumors.

Hepatocellular Carcinoma with Right Atrial Metastasis

Cardiac tumours may be primary or secondary-metastatic (malignant). Secondary cardiac tumours are much more common than primary cardiac tumours. Their frequency on large anatomical studies varies between 3.4% and 13.9%. Though cardiac metastases may originate from any malignant tumor, melanomas have the greatest propensity for cardiac involvement, and also carcinomas of the thorax, including breast, lung, and esophageal [12,13]. The routes of metastasis include direct invasion, hematogenous, lymphatic, or transvenous, especially through the inferior vena cava [9,10]. Cardiac involvement should be suspected or sought in any patient with a known malignancy who develops new cardiovascular signs or symptoms. Imaging methods - echocardiography, computed tomography (CT) and MRI, are essential in establishing the diagnosis and the invasion of the tumour in the cardiac cavity. The severe evolution of secondary cardiac tumors depends on the extension of the primary tumour, but also on the severity of the clinical cardiac manifestations. Generally, the treatment is surgical. A correct diagnosis is important in the clinical setting since cardiac metastases are able to induce sudden cardiac death1. Primary hepatocellular carcinoma (HCC) is the sixth cause of cancer in the world and the second cause of cancer mortality worldwide, with more than 830,000 deaths recorded annually2. We present a case of HCC growth into the vena cava inferior (VCI) and invasion into the right atrium (RA).

A Rare Case Series: Cardiac Myxoma and their Versatile Presentation

Background: Although rare, cardiac myxomas are the most common primary cardiac tumor with an incidence of 0.5 per million per year. Clinical presentation is variable and ranges from intracardiac obstruction, embolization to the pulmonary and systemic circulation, heart failure or constitutional symptoms. Surgical resection is the only effective treatment to prevent its debilitating and catastrophic complication. Case summary: Here, three atypical presentations as well as three different locations of cardiac myxomas were reported. First one is a rare case of ST-elevated myocardial infarction due to myxoma that originated from the left ventricle. One case involved right sided myxomas with pulmonary embolism. The third case involved huge left atrial myxoma combined with recurrent syncope. All three cases were almost misdiagnosed due to their atypical presentation. Echocardiography was the primary tool for detecting and diagnosing these cases. Subsequently all three patients underwent successful resection of myxoma. We also review clinical presentations and diagnostic characteristics of cardiac myxomas. Conclusion: Rare cardiac myxomas may have various clinical and imaging features. Physicians especially other non-cardiologist must increase their awareness of this disease and engage in the early diagnosis. Echocardiography is the diagnostic procedure of choice. The long-term survival after surgical resection is excellent and recurrence is rare. Bangladesh Heart Journal 2024; 39(1): 63-68

Precision diagnostics in cardiac tumours: Integrating echocardiography and pathology with advanced machine learning on limited data

This study pioneers the integration of echocardiography and pathology data with advanced machine learning (ML) techniques to significantly enhance the diagnostic accuracy of cardiac tumours, a critical yet challenging aspect of cardiology. Despite advancements in diagnostic methods, cardiac tumours' nuanced complexity and rarity necessitate more precise, non-invasive, and efficient diagnostic solutions. Our research aims to bridge this gap by developing and validating ML models—Support Vector Machines (SVM), Random Forest (RF), and Gradient Boosting Machines (GBM)—optimized for limited datasets prevalent in specialized medical fields. Utilizing a dataset comprising clinical features from 399 patients at the Heart Hospital, our study meticulously evaluated the performance of these models against traditional diagnostic metrics. The RF model emerged superior, achieving a groundbreaking accuracy of 96.25 % and a perfect ROC AUC score of 0.99, significantly outperforming existing diagnostic approaches. Key predictors identified include age, echo malignancy, and echo position, underscoring the value of integrating diverse data types. Clinical validation conducted at the Heart Hospital further confirmed the models' applicability and reliability, with the RF model demonstrating a diagnostic accuracy of 94 % in a real-world setting. These findings advocate for the potential of ML in revolutionizing cardiac tumour diagnostics, offering pathways to more accurate, non-invasive, and patient-centric diagnostic processes. This research not only highlights the capabilities of ML to enhance diagnostic precision in the realm of cardiac tumours but also sets a foundation for future explorations into its broader applicability across various domains of medical diagnostics, emphasizing the need for expanded datasets and external validation.

A Rare Case of Simultaneous Cardiac Papillary Fibroelastoma and Cardiac Myxoma

A 55-year-old female was seen for a cardiac workup due to anxiety and a cardiac tumor was subsequently found on an echocardiogram. The tumor measured 3x2cm in the left atrium and was thought to be cardiac myxoma. Gross and histological findings revealed simultaneous cardiac myxoma and papillary fibroelastoma. The latter caused a decreased ejection fraction with excision requiring a mitral valve replacement. Primary cardiac tumors are rare, and most are benign with over 50% being cardiac myxomas. We experienced an exceptionally rare case of two separate simultaneous cardiac tumors in a patient.

Cardiac solitary fibrous tumor - an extremely rare but potentially fatal diagnosis.

The background of this review is a description of the case of a 28-year-old man with an extremely rare cardiac solitary fibrous tumor (SFT). Although this tumor was removed surgically and in the 6-month follow-up examination no relapse was noted, recurrence was observed and confirmed in the magnetic resonance imaging 4 months later. SFT prevalence, symptoms and signs, treatment options and prognosis are reviewed.

Infarto com Supra-ST em Adulto Jovem: Rara Apresentação de Mixoma Atrial Gigante

Abstract Cardiac tumors are rare entities, among which atrial myxoma (AM) stands as the most frequent, accounting for approximately half of all reported cases. The incidence of AM is estimated to range from 0.001% to 0.3% within the general population, yet only about 0.06% of these cases present with coronary embolic events. We report on a 33-year-old male smoker who experienced acute, severe precordial pain radiating to the left upper limb, lasting for one hour. The electrocardiographic evaluation demonstrated ST-segment elevation in leads D2, D3, and aVF, alongside significantly elevated serum troponin levels, confirming a diagnosis of ST-segment elevation myocardial infarction (STEMI). Subsequent coronary angiography revealed proximal occlusion of the right coronary artery due to thrombus. An initial attempt of thrombus aspiration was unsuccessful, followed by primary angioplasty with balloon inflation without stent placement. Further diagnostic exploration through transthoracic echocardiography identified a homogenous, smooth-surfaced mass measuring 5.2 cm x 2.3 cm attached to the interatrial septum. This mass, characterized by lobulations, prolapsed into the mitral valve and left ventricle during diastole, consistent with AM. Surgical resection of the mass was successfully performed, with the patient being discharged asymptomatic. In the reported case, the patient's profile, notably his age, and gender, diverges from the typical epidemiological characteristics associated with AM. This case adds to the limited number of reports where the inferior wall is affected by the right coronary artery being occluded. This report emphasizes the significance of differential diagnoses in younger patients presenting with STEMI.

MRI and CT Appearances in Various Cardiac Tumours.

While primary cardiac malignancies are infrequent, the heart often serves as a site for metastases. Myxomas are recognized as among the most prevalent primary benign tumours globally, while sarcomas represent the most common malignant primary tumours. The diverse range of potential clinical presentations depends on factors such as location, size, and the aggressiveness of the disease. The majority of diagnoses rely on medical imaging, making it crucial to familiarize oneself with their distinctive characteristics. When a cardiac mass is suspected, MRIof the heart has emerged as the preferred diagnostic method, surpassing previous techniques. CTis a valuable tool for assessing cardiac morphology and improving electrocardiography gating by providing enhanced details. This article conducts a comprehensive review of the MRI and CT characteristics of both primary and secondary cardiac malignancies, emphasizing crucial distinctions and common diagnostic pitfalls. Despite their rarity, cardiac masses continue to hold significance in the realm of cardio-oncology. Furthermore, this article explores conditions such as thrombus, Lambl's excrescences, and pericardial cysts, which can mimic tumours. Multimodal imaging has played a pivotal role in identifying the origin of cardiac masses in numerous cases, particularly when combined with the clinical context. This article offers an in-depth examination of the frequency, clinical indicators, imaging, diagnostic procedures, available treatments, and prognoses related to cardiac masses.

Cardiac Tumor in the Left Atrium

Cardiac Tumor in the Left Atrium

Primary Cardiac Tumours: A Series of Four Cases

Primary cardiac tumours are uncommon, and approximately 90% of them, in both children and adults, are benign. Primary tumours are less prevalent than secondary malignancies that spread to the heart. The subtle and non specific nature of the clinical signs could cause a delay in diagnosis, as well as surgical treatment. Although epidemiology and multimodality imaging approaches are helpful, the definitive diagnosis often necessitates histologic evaluation, and histological characterisation continues to be the gold standard in diagnostics. Herein the authors described four (two males and two females) cases of intriguing primary cardiac tumours. All the cases were diagnosed to have a cardiac mass/clot by Echocardiography (Echo), and the cases underwent tumour excision. Histopathological analysis revealed three benign cases diagnosed as atrial myomas, and one malignant case diagnosed as high-grade spindle cell sarcoma, specifically rhabdomyosarcoma. Immunohistochemistry (IHC) was required for the definitive diagnosis of the malignant patient. All the patients were followed-up for a period of one year. All benign cases were symptom- free, while the patient who had rhabdomyosarcoma expired. The aim of the present case series was to highlight the importance of histopathological examination, as well as the prognosis of cardiac tumours.

Kiosk 3Q-TA-01 - A Case of a Cardiac Calcified Amorphous Tumor Mimicking a Left Atrial Myxoma

Kiosk 3Q-TA-01 - A Case of a Cardiac Calcified Amorphous Tumor Mimicking a Left Atrial Myxoma

Kiosk 5R-TA-08 - Cardiac Tumor Assessment by Cardiovascular Magnetic Resonance Imaging: Diagnostic Accuracy and Clinical Outcomes

Kiosk 5R-TA-08 - Cardiac Tumor Assessment by Cardiovascular Magnetic Resonance Imaging: Diagnostic Accuracy and Clinical Outcomes