Primary Cardiac Tumors Research Articles

AORTIC VALVE PAPILLARY FIBROELASTOMA IN A CAT: CASE REPORT

Cardiac tumors are rare in cats. Usually the diagnosis can be made on echocardiographic examination. Papillary fibroelastoma in this case is a primary cardiac tumor and is histopathologically defined as benign. However, these types of tumors carry the risk of thromboembolism and may cause complications such as stroke or infarction. In these types of the cases the symptoms are not specific and may vary depending on the size or structure of the mass. In the report a case of papillary fibroelastoma identified echocardiographically in a male tabby cat is discussed.

Cardiac Myxomas Resembling Malignant Neoplasia: Incidentally Diagnosed vs. Cerebral Embolized Myxomas.

Simple SummaryCardiac tumors are relatively rare. Cardiac Myxomas (CM) are considered one of the most common benign cardiac tumors. They are usually distinct from soft tissue myxoma, most often occurring as a solitary, sporadic, pedunculated mass in the left atrium, and approximately 10% are associated with Carney syndrome with a high recurrence rate. They may cause sudden death, usually due to mitral valve obstruction or congestive heart failure. Malignant changes are known to occur but are extremely rare. They may mimic malignant neoplasia because of frequent embolism and can cause neurological deficits before theirsurgical removal. The current study analyzed the outcomes after operative myxoma excision in patients with or without cerebral embolic events prior to excision.Background: Cardiac myxomas (CM) are the most common primary cardiac tumors in adults. They are usually benign; however, malignant changes are known to occur but are extremely rare. Embolization is a common complication of cardiac myxomas and can cause neurological deficits before their surgical removal. The current study analyzed the outcomes after operative myxoma excision in patients, with and without cerebral embolic events prior to excision. Methods: All 66 consecutive patients who underwent a surgical excision of CM between 2005 and 2019 at our department were analyzed retrospectively. Patients with (n = 14) and without (n = 52) preoperative strokes caused by cerebral tumor embolization were compared. Results: The mean age was 58.4 ± 12.7 years in the stroke group (SG) and 62.8 ± 11.7 years in the non-stroke group (N-SG) (p = 0.226). Gender (35.7% vs. 61.5% female; p = 0.084) did not differ significantly, and comorbidities were comparable in both groups. The left hemisphere in the territory of the middle cerebral artery was affected by preoperative cerebral infarction most commonly (28.6%). The time from diagnosis to cardiac surgery procedure was 7 (3–24) days in the SG and 23 (5–55) days in the N-SG (p = 0.120). Cardiac myxomas were localized in the left atrium in both groups more frequently (SG: 92.9% vs. N-SG: 78.8%; p = 0.436). In the SG, 57.1% of CM had a non-solid surface, were localized in the left heart, and had a pedunculated attachment away from the fossa ovalis. In the N-SG, 92.3% of CM did not meet all these criteria (p < 0.001). The maximal diameters of CM were comparable (SG: 3.4 ± 1.5 cm vs. N-SG: 3.8 ± 2.1 cm; p = 0.538). The operation times (192.5 (139.3–244.5) min vs. 215.5 (184.5–273.3) min; p = 0.046) and the cross-clamp times (54.5 (33.3–86.5) min vs. 78.5 (55–106.8) min; p = 0.035) were significantly shorter in the SG. Only in the N-SG were reconstructions of the endocardium with bovine pericardium required after resection (51.9% vs 0%; p < 0.001). In the N-SG, CM were explored via the right atrium more often (57.7% vs. 14.3%; p = 0.007). Patients in the N-SG required significantly shorter ICU care after surgery (p = 0.020). Other postoperative courses did not differ significantly. After tumor removal, 1.9% of the N-SG suffered their first stroke and 14.3% of the SG had a cerebral re-infarction (p = 0.111). The 30-day mortality rates were 1.9% in the N-SG and 7.1% in the SG (p = 0.382). In one case in the N-SG, a tumor recurrence was diagnosed. The Kaplan–Meiercurves showed a significantly better long-term prognosis for patients in the N-SG (p = 0.043). Conclusions: After the surgical removal of CM, the outcome is compromised if preoperative cerebral embolization occurs. Surgical treatment is therefore indicated as soon as possible, especially when CM have a non-solid surface, are localized in the left heart, and have a pedunculated attachment away from the fossa ovalis.

Primary malignant cardiac tumors: Sex-related therapy and multidisciplinary approach as a new challenge for the future.

Primary malignant cardiac tumors represent (PMCTs) a very rare disease with an incidence of 0.009%1 (up to 10% of primary cardiac neoplasms) and are related to a very poor prognosis. The study by Mohamed Rahouma tries to give us information on sex differences in PMCTs, their incidence, behavior, and outcomes. Females were significantly older and had a lower stage of cancer. Males are known to have a more aggressive course and present at an earlier age. Sarcoma is the most common type of PMCTs in both males and females. There was no gender disparity in late mortality and patients who underwent surgery had a better prognosis than those who did not undergo surgery. Significant predictors of late mortality were found to be patients' high comorbidity index, angiosarcoma histology, and Stage III/IV. A challenge for cardiac surgeons is to improve survival in patients with cardiac malignancies, involving a multidisciplinary approach with oncologists, cardiologists, and radiologists. To pave the way for a significant improvement in survival in the future, more advanced sex-specific medical therapies for cancer such as novel chemotherapy agents, targeted immune therapies, genetic engineering need to be standardized to PMCTs and combined with radiological therapies such as gamma-knife and very advanced surgery to effectively treat even very aggressive forms of malignant tumors, with a significant impact on the patient's quality of life and survival.

MULTIPLE CEREBRAL ANEURYSMS ORIGINATING FROM PREVIOUSLY RESECTED CARDIAC MYXOMA

Primary cardiac tumors are very rare, accounting for 0,001 – 0,03% in autopsy series, cardiac myxoma (CM) account for approximately 50% of them. Association between CM and cerebral aneurism is well documented in this condition but the occurrence of cerebral aneurism after resection of CM is very rare there is only 40 reports in medical literature. We present a case of 45 years old female patient with multiple cerebral aneurysms 2 years after a successful resection of cardiac myxoma, submitted to radiosurgery for 2 bigger aneurisms with good result. This report ads to literature new clinical findings and a hypothesis of radiosurgery as an effective option of treatment for cerebral aneurisms with origin in CM.

Cardiac masses and contrast echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. Introduction echocardiography may be the first imaging modality detecting a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast echocardiography may aid in the differential diagnosis. Methods: we describe five cardiac masses in which echo-contrast helped to assess the presence or not of vascularization. Panel A shows a left atrial mass attached to the fossa ovalis with a large stalk prolapsing to the mitral inflow. Contrast echocardiography showed late but homogeneous opacification of the mass. Gross pathology confirmed an atrial mixoma. Panel B shows two masses in a patient with non-small cell lung cancer one embedded in the inferior left ventricular wall and the other floating in the left atrium. Administration of echo-contrast showed late and inhomogeneous enhancement of the myocardial mass and absent opacification of the atrial mass suggesting a metastatic infiltration of the myocardium together with an avascular neoplastic thrombus in the left atrium. Panel C shows a multi-lobulated and mobile mass in the right atrium straddling the tricuspid valve. Contrast echocardiography highlighted an inhomogeneous diffusion of the contrast within the mass with a rapid opacification only of its atrial portion. Gross pathology confirmed a recurrent thymoma. Panel D shows an intraventricular mass arising from the interventricular septum with multiple hypoechoic areas in a patient with metastatic carcinoid. Contrast administration showed a very late and mild degree of inhomogeneous enhancement. Conclusion: the echo-contrast allows a good differentiation between vascularized and non-vascularized cardiac masses, providing an important indication to differentiate thrombus from tumor. In those hypervascularized masses the homogeneous or inhomogeneous distribution of the contrast could be an interesting clue that orientates between primary or secondary cardiac tumors. Abstract Figure.

Surgical Treatment of Primary Cardiac Tumors in Children Systematic Review and Meta-analysis.

This systematic review sought to investigate the current evidence regarding surgical management of primary cardiac tumors in children. Twenty-four studies were deemed eligible, reporting on 713 pediatric patients. Cumulative 30-day mortality rate was 5.5% and 7.5% after surgery. It was revealed a statistically lower mortality rate in the group of patients below 1 year of age, justifying a more aggressive surgical approach for primary cardiac tumors, except for rhabdomyoma that can regress spontaneously.

DIFFUSE LARGE B-CELL LYMPHOMA OF THE HEART

Diffuse large B-cell lymphoma (DLBCL) of the heart accounts for only 1% of primary cardiac tumors. Histopathologic examination becomes the primary key for diagnosis and immunohistochemical evaluation for non-Hodgkin lymphoma (NHL) subtype determination is able to predict disease progression and therapeutical modality. Case description: 70-year-old man complained of shortness of breath. Echocardiographic examination revealed mass occupied the left atrium measured 5.9 x 2.9 cm inherent with interatrial septum and mass with a stem in the right atrium measured 4.6 x 2.4 cm. Intraoperative, considerable amount of extracardiac mass was found, mass extension was unable to be determined. Thoracic surgeon decided to sample the extracardiac mass without performing cardiac surgery. The histopathologic features showed round blue cell tumor resembling a NHL. Immunohistochemical staining were consistent with diffuse NHL, large cell, high grade lymphoma, suitable for DLBCL. Round blue cell tumor of extracardiac mass with positive expression of LCA and CD 20 is suitable for B-cell non-Hodgkin lymphoma. Ki-67 immunohistochemical staining revealed a 70-80% proliferation index which indicates a high-grade lymphoma and defining diagnosis and treatment of DLBCL.

Oncotic (Myxomatous) Aneurysms: A Review of Management

AbstractAtrial myxomas are the most common primary cardiac tumors and may manifest with neurological symptoms in ∼ 30% of cases. Cerebral ischemia, aneurysmal formation, and extravascular metastases are mechanisms that lead to these neurological manifestations. Perilesional changes on computed tomography (CT) and magnetic resonance imaging (MRI) may help in the diagnosis of myxomatous aneurysms, which are usually located in the distal middle cerebral artery (MCA) and in the posterior cerebral artery (PCA) circulation territories. Careful resection of the cardiac lesion is essential for preventing embolism. However, treatment of myxomatous aneurysms is controversial due to the limited understanding of the natural history of this condition. Treatment may include clinical observation in asymptomatic patients, surgical resection, endovascular approaches, adjuvant chemotherapy, and low-dose radiation therapy. We present one case of a female patient with myxomatous aneurysm secondary to an atrial myxoma who presented with neurological symptoms and another case of a female patient who developed neurological symptoms after initial surgical treatment of the primary lesion. Lesion growth rate, topography, morphology, and the patient's clinical condition must be considered when choosing a therapeutical method. Further clinical studies are needed to achieve a better understanding and treatment of this disease.

Primary and secondary cardiac tumors: clinical presentation, diagnosis, surgical treatment, and results.

Cardiac tumours are some of the rarest primary tumours, while cardiac metastasis are more common yet still relatively rare. Seventy five percent of primary cardiac tumours are benign tumours. Cardiac tumours present with a range of obstructive, embolic, arrhythmic or systemic symptoms, and in many cases may present asymptomatically. The clinical presentation depends largely on the size and location of the mass. With advances in cardiac imagining and the introduction of cardiopulmonary bypass, the diagnosis and surgical treatment of these rare tumours has improved the prognosis and outlook for benign and malignant tumours. Management depends on tumour histology, size and location as well as the clinical presentation. Conservative management is reserved for small, benign tumours that can undergo regular echocardiographic follow-up. Symptomatic benign tumours are treated with surgical resection and the results are excellent. Malignant primary cardiac tumours have a poor prognosis with high rates of relapse and a median survival of 10-24months.

Fibroma Cardíaco: Seguimento a Longo Prazo por Ressonância Magnética Cardíaca

Background: Primary cardiac neoplasms are rare, and a correct diagnosis is essential to planning the most appropriate treatment. Objective: To demonstrate the role of cardiac magnetic resonance imaging (CMR) in the assessment, diagnosis, and follow-up of cardiac fibroma. Case report: Female 21-year-old patient with a myocardial mass detected on echocardiogram. CMR confirmed a diagnosis of cardiac fibroma. The patient chose to be followed up, and her condition remained stable after six years. Discussion: Cardiac fibromas are the second most common neoplasm in children and young people. On CMR, it is characterized by intense and homogeneous delayed enhancement. CMR plays an important role in the assessment of cardiac masses.

Not all cardiac tumors are myxomas and not all benign tumors are benign: two case reports

Background: Primary cardiac tumors originating in the heart are much less frequent than metastasis from other organs. The majority of cardiac tumors are of benign nature and only 25% are estimated to be malignant. Common symptoms of cardiac tumors include systemic embolization, congestive heart failure, and arrhythmias. Case report: We present two cases of cardiac tumors initially causing heart failure symptoms and valvular disease in relatively young patients. These tumors were initially diagnosed as myxomas, but post-op histological studies revealed the presence of angiosarcoma and hamartoma. It is important to differentiate and have a clear diagnosis because some malignant and invading tumors may require the use of adjuvant chemotherapy agents. Conclusion: It should not be taken for granted that cardiac tumors are of benign nature even if initial evaluation is consistent with myxomas. Early resection and pathological study of primary cardiac tumors are important in identifying the tumor type and targeting management.

Right Atrial Myxoma in Patients with Metastatic Breast Cancer: Multidisciplinary Approach and Surgical Timing

Primary cardiac tumours are very rare. We describe the case of a 69-year-old female suffered from metastatic breast cancer and intestinal polyposis. During periodical follow-up examinations, total body Computed Tomography showed a right atrial mass with heterogeneous contrast enhancement, located near the orifice of inferior vena cava. The trans-thoracic and trans-esophageal echocardiogram confirmed the diagnosis. Thrombus or cardiac metastatic localization was the two principal hypotheses even if the CT scan suggested that was a myxoma. Surgical resection was performed expecially for the high risk of the mass' embolization. The hystological examination confirmed the CT scans suspiction of cardiac myxoma. The patient was discharged from hospital without any complications. After 6 months, she was fine.

Surgical treatment of primary cardiac tumors: 20-year single center experience.

IntroductionPrimary cardiac tumors are a rare condition presenting with a variety of symptoms. The outcomes of their surgical treatment in the modern era from central Europe have not been recently reported.AimTo evaluate the short- and long-term outcomes of the cardiac tumor operations at our department throughout the last 20 years.Material and methodsThis was a retrospective analysis of all primary cardiac tumor operations performed at our institution between 2000 and 2020. Perioperative data were extracted from patient records. Long-term data were provided by the National Registry of Cardiac Surgery.ResultsSixty procedures for primary cardiac tumor were performed throughout the study period. The most common type of tumor was myxoma (88%), followed by fibroelastoma (8%), lipoma (2%) and sarcoma (2%). There were 2 perioperative deaths (3%). The most common perioperative complication was atrial fibrillation (47%). One (2%) patient underwent reoperation 6 years later because of myxoma recurrence. We recorded 13 long-term deaths, but only 1 patient died as a consequence of cardiac tumor (sarcoma) 15 months after the surgery. Long-term survival of the cohort was comparable with the age- and sex-matched general population up to 15 years postoperatively (relative survival 0.91, CI 0.68–1.23). Rich histopathological illustrations are provided in the online supplementary material.ConclusionsSurgical resection is the standard treatment of primary cardiac tumors. The outcomes of benign tumors are excellent and the long-term postoperative survival is comparable with the general population. The prognosis of malignant tumors remains poor.

Anesthetic management of a patient with a primary cardiac tumor that caused partial right ventricular outflow tract obstruction

Anesthetic management of a patient with a primary cardiac tumor that caused partial right ventricular outflow tract obstruction

Incidentally Detected Asymptomatic Cardiac Myxoma in a Patient With COVID-19

Primary cardiac tumors, such as myxomas, are rare. About 75% of myxomas occur in the left atrium of the heart. Myxomas can have a broad clinical spectrum. The clinical presentation varies from asymptomatic to sudden cardiac death. Sometimes, a diagnosis is difficult. Cardiac myxoma can cause hemodynamic disturbances in the setting of pneumonia and hypercoagulable state in patients with Coronavirus disease 2019(COVID-19) and make treatment decisions difficult. We present a case of unusually huge left atrial mass discovered incidentally in a patient with COVID-19. Upon workup, an echocardiogram revealed an incidental 7 × 5 cm left atrial myxoma. Preoperatively, the patient was monitored closely in the ICU. After stabilization in the ICU, the patient was taken to surgery and the tumor was successfully removed. Pathohistological results after surgical removal of the tumor confirmed the diagnosis of cardiac myxoma. We consider our case extremely rare due to the asymptomatic course despite the large size of the tumor.

A Rare Case of Primary Cardiac Synovial Sarcoma with Thromboctopenia

Primary cardiac tumors are of rare presentation. We present a case of primary cardiac synovial sarcoma of the right atrium admitted to our hospital. An initial diagnosis of right atrial myxoma or hydatid cyst was made based on echocardiographic and radiological features. Intraoperatively, an irregular mass was excised, and histopathologically, it was reported as monophasic synovial sarcoma. Immunohistochemistry was positive for TLE-1, BCL-2, and MIC-2.

A Rare Case of a Primary Cardiac Tumor Presenting as Fatal Ventricular Tachycardia

Primary cardiac tumors are extremely uncommon. Here, we report the case of a patient with a primary left ventricular interstitial tumor presenting with hemodynamically unstable ventricular tachycardia. In response to hemodynamically unstable ventricular tachycardia, an implantable cardioverter-defibrillator was inserted. One month after defibrillator implantation, the patient developed episodes of high ventricular tachycardia that could not be effectively terminated by catheter radiofrequency ablation, thus further confirming that the ventricular tachycardia was induced by the left ventricular interstitial tumor. The patient is doing well on medical therapy to date.

Rare case of Left Ventricular Hemangioma

AbstractCardiac tumors are rare in occurrence. Among them, primary cardiac tumors that too hemangiomas are further rare. They usually are asymptomatic and are detected incidentally. Preoperative diagnosis may not correlate with histopathologic diagnosis. We report such a rare case of left ventricular hemangioma presented to us with vague chest discomfort, which preoperatively was suspected to be rhabdomyoma or fibroma.

Cardiac Tumors

Cardiac tumors represent a rare and challenging clinical situation. They can be primary (benign or malignant) or secondary (metastatic). Secondary tumors are more frequent than the primary tumors. Most of the primary cardiac tumors are benign and originate from the endocardium or myocardium, while the metastatic tumors develop from lung, breast, kidney carcinoma, melanoma and lymphoma. The diagnosis of cardiac tumors is often difficult because of their rarity, variety and nonspecific symptoms. The clinical manifestations depend on tumor’s size, location, infiltration and consist of four categories: systemic manifestations, cardiac manifestations, embolic events, and metastatic manifestations. Echocardiography represents the main imaging technique used to detect cardiac masses. Computed tomography (CT) and magnetic resonance imaging (MRI) are used to achieve more information about tumor’s composition, extension, vascularization, and possibility of surgical treatment. The histological evaluation is necessary for a positive diagnosis and staging of the cardiac tumor. The treatment of cardiac tumors depends on the type of tumor and symptomatology.

Left Ventricular Outflow Tract Obstruction due to Primary Cardiac Tumors

Left Ventricular Outflow Tract Obstruction due to Primary Cardiac Tumors