Cardiac Tumors

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Abstract

Cardiac tumors represent a relatively rare, yet challenging diagnosis. Secondary tumors are far more frequent than primary tumors of the heart. The majority of primary cardiac tumors is benign in origin, with primary malignant tumors accounting for 25% of cases. Metastatic tumors usually arise from lung, breast, renal cancer, melanomas, and lymphomas. Clinical manifestations of cardiac tumors depend on the size and location of the mass and the infiltration of adjacent tissues rather than the type of the tumor itself. Echocardiography is the main diagnostic tool for the detection of a cardiac mass. Other imaging modalities (C-MRI, C-CT, 3D Echo) may offer further diagnostic information and the establishment of the diagnosis is made with histological examination. Management depends on the type of the tumor and the symptomatology of the patient.

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Most cited references 26

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Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases.

Ramesh Gowda, Ijaz Khan, Chandra Nair … (2003)

With the advent of echocardiography, cardiac papillary fibroelastoma (CPF) is being increasingly reported. The demographics, clinical characteristics, pathological features, treatment, and prognosis of CPF are examined. Cases, case series and related articles on the subject in all languages were identified through a comprehensive literature search. Seven hundred twenty-five cases of CPF were identified. Males comprised 55% of patients. Highest prevalence was in the 8th decade of life. The valvular surface was the predominant locations of tumor. The most commonly involved valve was the aortic valve, followed by the mitral valve. The left ventricle was the predominant nonvalvular site involved. No clear risk factor for development of CPF has been reported. Size of the tumor varied from 2 mm to 70 mm. Clinically, CPFs have presented with transient ischemic attack, stroke, myocardial infarction, sudden death, heart failure, presyncope, syncope, pulmonary embolism, blindness, and peripheral embolism. Tumor mobility was the only independent predictor of CPF-related death or nonfatal embolization. Symptomatic patients should be treated surgically because the successful complete resection of CPF is curative and the long-term postoperative prognosis is excellent. The symptomatic patients who are not surgical candidates could be offered long-term oral anticoagulation, although no randomized controlled data are available on its efficacy. Asymptomatic patients could be treated surgically if the tumor is mobile, as the tumor mobility is the independent predictor of death or nonfatal embolization. Asymptomatic patients with nonmobile CPF could be followed-up closely with periodic clinical evaluation and echocardiography, and receive surgical intervention when symptoms develop or the tumor becomes mobile.

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Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging.

Thomas Krausz, Carl M. J. Kirkpatrick, Kirk T Spencer … (2004)

We investigated the usefulness of echocardiographic contrast perfusion imaging in differentiating cardiac masses. Two-dimensional echocardiography is the primary diagnostic modality for cardiac masses. However, differentiation between the different types of cardiac masses may be difficult at times. We hypothesized that echocardiographic contrast perfusion imaging would differentiate the neo-vascularization of malignancies from the avascularity of thrombi and the sparse vascularity of stromal tumors. Sixteen patients with cardiac masses underwent power-modulation imaging after echocardiographic intravenous contrast administration. Pixel intensities in the mass and an adjacent section of myocardium were analyzed visually and by dedicated software. All masses had a pathologic diagnosis or resolved after anticoagulation. In a subset of patients, video-intensity curves of contrast replenishment in the mass and myocardium over time were generated. The post-impulse steady-state pixel intensity (A) and initial rate of contrast replenishment after impulse (beta) were compared with an index of blood vessel area on pathology. In seven of 16 patients, contrast enhancement resulted in greater pixel intensity in the mass than in the adjacent myocardium. All of these masses were classified pathologically as malignant (n = 6) or benign and vascular (n = 1). Nine masses demonstrated decreased pixel intensity, compared with the myocardium, and were diagnosed pathologically as myxomas (n = 2) or thrombi (n = 5), or they resolved with anticoagulation (n = 2). For the subset of patients, beta correlated with the vessel area index (r = 0.60). Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.

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Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

Suhny Abbara, Johnathan Dodd, Vithaya Chaithiraphan … (2009)

This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.

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Journal

Journal ID (nlm-ta): ISRN Oncol

Journal ID (publisher-id): ONCOLOGY

Title: ISRN Oncology

Publisher: International Scholarly Research Network

ISSN (Print): 2090-5661

ISSN (Electronic): 2090-567X

Publication date (Print): 2011

Publication date (Electronic): 26 May 2011

Volume: 2011

Electronic Location Identifier: 208929

Affiliations

¹Second Department of Cardiology, Athens University Medical School, Attikon University Hospital, 1 Rimini St, 12462 Athens, Greece

²Second Department of Cardiology, Hellenic Red Cross Hospital, 1 Erythrou stavrou St, 11526 Athens, Greece

Author notes

*Ioannis A. Paraskevaidis: iparas@ 123456otenet.gr

Academic Editors: A. E. Bilsland and M. L. Stracke

Article

DOI: 10.5402/2011/208929

PMC ID: 3195386

PubMed ID: 22091416

SO-VID: 338f724d-a31f-4f70-89a8-47a018aaec64

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This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cardiac Tumors

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Karger: Oncology

Most cited references 26

Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases.

Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging.

Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

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