Cardiac Tumors

Question 1

What is the most common type of tumor found in the heart?

Answer 1

metastasized tumors from other sites are more common (20-40x) than benign or malignant primary cardiac tumors

Question 2

What are the most common tumors that metastasize to the heart?

Answer 2

• lung
• breast
• melanoma
• lymphoma

Question 3

What is the most common primary cardiac tumor in adults?

Answer 3

myxoma (benign)

Question 4

What is the most common primary cardiac tumor in children?

Answer 4

rhabdomyoma (benign)

Question 5

What is the most common primary cardiac malignant tumor?

Answer 5

angiosarcoma

Question 6

What are general complications of cardiac tumors?

Answer 6

• mass effect limiting heart function
• decreased contractility
• pericardial effusion
• superior vena cava syndrome

Question 7

What are the types of benign cardiac tumors?

Answer 7

• myxoma (most common in adults)
• fibroma
• lipoma
• papillary fibroelastoma
• rhabdomyoma (most common in children)

Question 8

What are cardiac myxomas?

(where)

Answer 8

benign tumor of mesenchymal origin

-typically located in the left atrium in the fossa ovalis of the septum

Question 9

How do cardiac myxomas present?

Answer 9

IL-6 elaboration by tumor -> constitutional symptoms

cardiac obstruction due to tumor:

• dyspnea
• syncope
• palpitations

“tumor plop” heard on auscultation

Question 10

What are complications of cardiac myxomas?

Answer 10

• heart failure
• embolization -> stroke/PE
• mechanical valve damage

Question 11

What familial syndromes are associated with cardiac myxoma?

Answer 11

*most cases are not familial

McCune-Albright syndrome:

• café au lait spots
• endocrine abnormalities
• myxomas

Carney complex:

• skin lentigines
• endocrine abnormalities
• myxomas

*both are autosomal dominant

Question 12

What is the morphology of cardiac myxomas?

Answer 12

firm to gelatinous mass

Histologic:

• abundant mucoid ground substance
• stellate or globular myxoma cells

Question 13

What are cardiac lipomas?

(where)

Answer 13

benign tumor of mature fat cells

-can appear anywhere in the heart (subendo, subepi, and myocardium)

Question 14

What is the morphology of cardiac lipomas?

Answer 14

-well-circumscribed nodule

Question 15

What are cardiac papillary fibroelastomas?

(where)

Answer 15

“sea-anemone-like” lesions

-mostly found on valves

Question 16

What is the morphology of cardiac fibroelastomas?

Answer 16

1-2 cm lesion with hair-like projections up to 1 cm

Histologic:

-hairs consist of a core myxoid cells in muciod ground substance covered by surface epithelium

Question 17

What are complications of cardiac fibroelastomas?

Answer 17

-embolization

Question 18

What are cardiac rhabdomyomas?

(where)

Answer 18

benign hamartoma

• most commonly found in children
• predominantly in the ventricles
• most spontaneously resolve and are only detected if they cause obstruction

Question 19

What is the etiology of cardiac hamartomas?

Answer 19

• 50% sporadic
• 50% associated with tuberous sclerosis (TSC mutation)

Question 20

What is the morphology of cardiac rhabdomyoma?

Answer 20

typically multiple masses that protrude into the ventricle

Histology:

• bizzare, enlarged myocytes
• histologic processing deforms myocytes to a “spider” cell appearance