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| | '''For patient information click [[Atrial myxoma (patient information)|here]]''' |
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| {{Infobox_Disease | | | {{Infobox_Disease | |
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| Image = Cardiac rhabdomyosarcoma 002.jpg| | | Image = Cardiac rhabdomyosarcoma 002.jpg| |
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| {{SI}} | | {{Cardiac tumors}} |
| {{CMG}} | | {{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]] {{HK}} |
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| '''Associate Editor-In-Chief:''' {{CZ}} | |
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| {{Editor Help}} | |
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| ==Overview==
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| The '''primary tumors of the heart''' are [[tumor]]s that arise from the normal tissues that make up the [[heart]]. This is in contrast to secondary tumors of the heart, which are typically either [[metastatic cancer|metastatic]] from another part of the body, or infiltrate the heart via direct extension from the surrounding tissues.
| | ==[[Cardiac tumors overview|Overview]]== |
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| The most common primary tumor of the heart is the [[myxoma]]. In surgical series, the myxoma makes up as much as 77% of all primary tumors of the heart.<ref name="MolinaEdwards">{{cite journal | author=Molina JE, Edwards JE, Ward HB | title=Primary cardiac tumors: Experience at the University of Minnesota | journal=Thorac Cardiovasc Surg | year=1990 | pages=183-91 | volume=38 Suppl 2| id=PMID 2237900}}</ref> Other benign tumors of the heart include [[rhabdomyoma]]s, [[fibroma]]s, [[hemangioma]]s, [[lipoma]]s, [[paraganglioma]]s, myocytic hamartomas, and [[papillary fibroelastoma]]s<ref name="Edwards-1953134">{{cite journal | author=Edwards FH, Hale D, Cohen A, Thompson L, Pezzella AT, Virmani R. | title=Primary cardiac valve tumors | journal=Ann Thorac Surg | year=1991 | volume=52 | issue=5 | pages=1127-31 | id=PMID 1953134}}</ref>.
| | ==[[Cardiac tumors historical perspective|Historical Perspective]]== |
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| About 20 percent of primary tumors of the heart are malignant in nature.<ref name="MolinaEdwards"/> Malignant tumors of the heart include [[rhabdomyosarcoma]]s, [[angiosarcoma]]s, myxosarcomas, [[fibrosarcoma]]s, [[leiomyosarcoma]]s, reticulum cell sarcomas, and [[liposarcoma]]s. The cardiac sarcomas may occur at any age, but are more commonly seen in individuals in their 20s to 40s. They occur equally in males and females.
| | ==[[Cardiac tumors classification|Classification]]== |
| | [[Cardiac tumors classification#Primary cardiac tumors|Primary cardiac tumors]] | [[Cardiac tumors classification#Secondary cardiac tumors|Secondary cardiac tumors]] |
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| A subset of the primary tumors of the heart are tumors that are found on the valves of the heart. Tumors that affect the valves of the heart are found in an equal distribution among the four heart valves.<ref name="Edwards-1953134"/> The vast majority of these are papillary fibroelastomas. Primary tumors of the valves of the heart are more likely to occur in males. While most primary tumors of the valves of the heart are not malignant, they are more likely to have symptoms related to the valve, including neurologic symptoms and (in a few cases) [[sudden cardiac death]].
| | ==[[Cardiac tumors pathophysiology|Pathophysiology]]== |
| | [[Cardiac tumors pathological findings|Pathological Findings]] |
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| ==Epidemiology and Demographics== | | ==[[Cardiac tumors causes|Causes]]== |
| ===Overview===
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| *Prevalence in autopsy series: 1/300 to 1/5900
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| *80% of primary tumors are benign:
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| :*1/2 (40%) are [[myxomas]]
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| :*1/2 (40% ) are of other types
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| ===Benign Tumors of the Heart=== | | ==[[Cardiac tumors differential diagnosis|Differentiating Cardiac Tumors from other Diseases]]== |
| | ==[[Cardiac tumors epidemiology and demographics|Epidemiology and Demographics]]== |
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| The most common primary tumor of the heart is the [[myxoma]]. In surgical series, the myxoma makes up as much as 77% of all primary tumors of the heart.<ref name="MolinaEdwards">{{cite journal | author=Molina JE, Edwards JE, Ward HB | title=Primary cardiac tumors: Experience at the University of Minnesota | journal=Thorac Cardiovasc Surg | year=1990 | pages=183-91 | volume=38 Suppl 2| id=PMID 2237900}}</ref> Other benign tumors of the heart include [[rhabdomyoma]]s, [[fibroma]]s, [[hemangioma]]s, [[lipoma]]s, [[paraganglioma]]s, [[myocytic hamartoma]]s, and [[papillary]] fibroelastomas<ref name="Edwards-1953134">{{cite journal | author=Edwards FH, Hale D, Cohen A, Thompson L, Pezzella AT, Virmani R. | title=Primary cardiac valve tumors | journal=Ann Thorac Surg | year=1991 | volume=52 | issue=5 | pages=1127-31 | id=PMID 1953134}}</ref>.
| | ==[[Cardiac tumors risk factors|Risk Factors]]== |
| | =====[[Cardiac tumors risk factors for embolization|Risk Factors for Embolization]]===== |
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| ===Primary Malignant Tumors of the Heart=== | | ==[[Cardiac tumors screening|Screening]]== |
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| About 20 percent of primary tumors of the heart are malignant in nature.<ref name="MolinaEdwards"/> Malignant tumors of the heart include [[rhabdomyosarcoma]]s, [[angiosarcoma]]s, myxosarcomas, [[fibrosarcoma]]s, [[leiomyosarcoma]]s, reticulum cell sarcomas, and [[liposarcoma]]s. The cardiac sarcomas may occur at any age, but are more commonly seen in individuals in their 20s to 40s. They occur equally in males and females.
| | ==[[Cardiac tumors natural history|Natural History, Complications and Prognosis]]== |
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| A subset of the primary tumors of the heart are tumors that are found on the valves of the heart. Tumors that affect the valves of the heart are found in an equal distribution among the four heart valves.<ref name="Edwards-1953134"/> The vast majority of these are papillary fibroelastomas. Primary tumors of the valves of the heart are more likely to occur in males. While most primary tumors of the valves of the heart are not malignant, they are more likely to have symptoms related to the valve, including neurologic symptoms and (in a few cases) [[sudden cardiac death]].
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| === Secondary (metastatic) Malignant Tumors of the Heart=== | |
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| *20 to 40x more common than primary cardiac tumors
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| *typically carcinomas, melanomas, and leukemias/lymphomas
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| *discrete tumors found in 10 to 12% of all autopsies
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| :*any involvement of heart by a malignancy found in 20% of all autopsies
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| '''Pericardium'''
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| :*frequently bloody effusion containing tumor cells
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| :*tamponade
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| :*may also cause constriction from tumor infiltration of pericardial sac
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| ==Pathophysiology==
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| :*Emboli into coronary arteries
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| :*Retrograde flow through cardiac lymphatics
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| :*Direct extension from mediastinum
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| :*Emboli or spread via great veins => endocardial metastases
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| ::*[[Hypernephroma]]
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| ::*Testicular sarcoma
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| ::*IVC [[leiomyosarcoma]]
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| ::*[[Ovarian cancer]]
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| ::*[[Colon cancer]]
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| ==Diagnosis== | | ==Diagnosis== |
| | [[Cardiac tumors staging|Staging]] | [[Cardiac tumors history and symptoms|History and Symptoms]] | [[Cardiac tumors physical examination|Physical Examination]] | [[Cardiac tumors laboratory tests|Laboratory Findings]] | [[Cardiac tumors electrocardiogram|Electrocardiogram]] | [[Cardiac tumors chest x ray|Chest X Ray]] | [[Cardiac tumors CT|CT]] | [[Cardiac tumors MRI|MRI]] | [[Cardiac tumors echocardiography or ultrasound|Echocardiography]] | [[Cardiac tumors other imaging findings|Other Imaging Findings]] | [[Cardiac tumors other diagnostic studies|Other Diagnostic Studies]] |
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| ===Electrocardiographic Findings=== | | ==Treatment== |
| | | [[Cardiac tumors medical therapy|Medical Therapy]] | [[Cardiac tumors surgery|Surgery]] | [[Cardiac tumors primary prevention|Primary Prevention]] | [[Cardiac tumors secondary prevention|Secondary Prevention]] | [[Cardiac tumors cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Cardiac tumors future or investigational therapies|Future or Investigational Therapies]] |
| Replacement of electrically active tissue by inert tissue such as a tumor or [[Chagas disease]] can result in Q waves. Pericardial [[metastases]] can result in [[atrial fibrillation]] or [[atrial flutter]].
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| ===CT===
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| Labeled images below are courtesy of RadsWiki and copylefted.
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| *'''Atrial Myxoma'''
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| <div align="left">
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| <gallery heights="117" widths="117">
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| Image:Atrial-myxoma-01.jpg|Atrial Myxoma
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| Image:Atrial-myxoma-02.jpg|Atrial Myxoma
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| Image:Atrial-myxoma-03.jpg|Atrial Myxoma
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| </gallery>
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| </div>
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| *'''Cardiac Rhabdomyosarcoma'''
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| <div align="left">
| | ==Case Studies== |
| <gallery heights="117" widths="117">
| | [[Cardiac tumors case study one|Case #1]] | [[Lymphoma case study|Case #2: Cardiac lymphoma]] |
| Image:Cardiac rhabdomyosarcoma 001.jpg|Cardiac Rhabdomyosarcoma
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| Image:Cardiac rhabdomyosarcoma 002.jpg|Cardiac Rhabdomyosarcoma
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| Image:Cardiac rhabdomyosarcoma 003.jpg|Cardiac Rhabdomyosarcoma
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| </gallery>
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| </div>
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| ===MRI=== | | ==Related Chapters== |
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| [[Image:Myxoma CMR.gif|left|400px|thumb|]]
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| ===Pathological Findings===
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| Image shown below is courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <gallery heights="175" widths="175">
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| Image:Cardiac tumor 1.jpg|HEART: Metastatic Tumor: Gross very unusual large metastatic carcinoid in [[right atrium]]
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| Image:Cardiac tumor 2.jpg|Cardiac Myxoma A gelatinous tumor is attached by a narrow pedicle to the atrial septum. The myxoma has an irregular surface and nearly fills the left atrium.
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| </gallery>
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| Image:Cardiac tumor 3.jpg|Cardiac Myxoma There was a calcified right atrial mass on the X ray of a 47-year-old man. Resection demonstrated a smooth-surfaced tumor. The gritty material seen microscopically on cut section was calcified and ossified myxoma.
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| Image:Cardiac tumor 4.jpg|Cardiac Fibroma Cut surface of the tumor shown in figure 6-2. The left ventricular (LV) cavity is present behind the mass. The patient was a 4-month-old child who died suddenly without a previous medical history.
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| <gallery heights="175" widths="175">
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| Image:Cardiac tumor 5.jpg|This tumor was resected from the right atrium of a 1-year-old boy with pericardial effusions. Note areas of hemorrhage and dilated vessels. The patient was well 49 months postoperatively.
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| Image:Papillary fibroelastoma.jpg|Papillary fibroelastomas are often on the arterial surface and may project into the coronary ostium, causing ostial occlusion. This tumor is in the noncoronary sinus.
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Metastatic carcinoma 0001.jpg|
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| Image:jpg|
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| </gallery>
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| </div>
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| Image:jpg|
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| Image:jpg|
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| Image:jpg|
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| </gallery>
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| == Prognosis ==
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| The vast majority of the tumors of the heart have a benign course and are not directly fatal. However, even the benign tumors of the heart can be lethal due to either direct extension into the electrical conduction system of the heart (causing [[third degree AV block|complete heart block]] or a fatal dysrhythmia), or due to [[embolism|emboli]] from the tumor mass that may have lethal sequelae.
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| The malignant tumors of the heart have a worse prognosis. Cardiac sarcomas generally lead to death within 2 years of diagnosis, due to rapid infiltration of the myocardium of the heart and obstruction of the normal flow of blood within the heart.<ref name="Burke-Sarcoma">{{cite journal | author=Burke AP, Cowan D, Virmani R | title=Primary sarcomas of the heart | journal=Cancer | year=1992 | volume=69 | issue=2 | pages=387-95 | id=PMID 1728367}}</ref><ref name="Burke-Osteosarcoma">{{cite journal | author=Burke AP, Virmani R | title=Osteosarcomas of the heart | journal=Am J Surg Pathol | year=1991 | volume=15 | issue=3 | pages=289-95 | id=PMID 1705103}}</ref>
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| ==References==
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| {{Reflist|2}}
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| ==See also==
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| * [[Myxoma]] | | * [[Myxoma]] |
| * [[The heart in oncologic disease]] | | * [[The heart in oncologic disease]] |
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| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |
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