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S4 W4 Cardiac Masses > Cardiac Tumours > Flashcards

Cardiac Tumours Flashcards

1
Q

Characteristics of benign tumours?

A
  • Generally not harmful
  • Well-differentiated cells
  • Slow growing
  • Well-circumscibed or encapsulated
  • Non-invasive, non-infiltrative
  • Do not metastasise
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2
Q

Characteristics of malignant tumours?

A
  • Harmful
  • Poorly or undifferentiated cells
  • Rapid growing
  • Poorly circumscribed or not encapsulated; irregular shape
  • Locally invasive, infiltrative
  • Frequently metastasise
  • Primitive appearing, unspecialised
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3
Q

Echo appearance of benign tumours?

A
  • Well-circumscribed or encapsulated
  • Freely mobile in relation to adjacent structures
  • Do not invade or infiltrate surrounding normal tissues
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4
Q

Echo appearance of malignant tumours?

A
  • Poorly circumscribed, irregular in shape
  • Not encapsulated
  • Fixed to adjacent structures
  • Locally invasive, infiltrating surrounding tissue
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5
Q

Characteristics of primary tumours?

A
  • Originate in the heart
  • Can be benign or malignant
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6
Q

Characteristics of secondary tumours?

A
  • Metastasised to the heart
  • Malignant
  • Secondary metastatic malignant disease more common than primary
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7
Q

What are the 4 pathways of metastatic spread of tumours to the heart?

A
  1. Lymphatic
  2. Haematogenous
  3. Direct extension
  4. Venous extension
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8
Q

What is lymphatic spread of tumours to the heart?

A

Tumour cells invade into lymphatic capillaries and travel to heart via lymph channels

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9
Q

What is haematogenous spread of tumours to the heart?

A

Spread through blood; invasion of tumour into local capillaries

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10
Q

What is direct extension of tumours to the heart?

A

Often arises via organs close to the heart in which cause tumour grows into the heart itself

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11
Q

What is venous extension of tumours to the heart?

A

Tumour invades large systemic vein and migrates to involve right heart by way of the vena cava

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12
Q

Example of direct extension tumour?

A

SCC of lung:
- Direct extension into LA via pulmonary veins

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13
Q

Example of venous spread tumour?

A

Renal cell carcinoma:
- IVC and RA extension; finger like mass extending through IVC into RA
- Can track mass back to kidney to confirm origin

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14
Q

Example of lymphatic spread tumour?

A

Pericardial tumour:
- Echo-genetic mass in pericardium
- Can result in pericardial constriction

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15
Q

Example of haematogenous spread tumour?

A

Carcinoid syndrome:
1. Carcinoid TV Disease
- Appearance of thickened and retracted leaflets that remain in fixed semi-open position throughout cardiac cycle
- Severe TR as a result
2. Secondary Cardiac Carcinoid Tumour
- Rarely, carcinoid tumour may metastasise to the heart resulting in an intra-myocardial carcinoid metastasis

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16
Q

Most common primary benign and primary malignant cardiac tumour in adults?

A
  • Benign: myxoma
  • Malignant: angiosarcoma
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17
Q

Most common primary benign and primary malignant cardiac tumour in children?

A
  • Benign: rhabdomyoma
  • Malignant: rhabdomyosarcoma
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18
Q

% of cardiac tumours that are benign/malignant?

A

90% benign
10% malignant

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19
Q

Most common location for cardiac myxomas?

A
  • LA attached to IAS at fossa ovalis
  • Less common in RA, ventricles
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20
Q

Morphological features of cardiac myxomas?

A
  1. Usually solitary
  2. Ovoid and gelatinous; regular smooth surface
  3. Attached via a narrow base (pedicle/stalk)
  4. Range in size from 1-15cm (av. 5-6cm)
  5. Calcification, fibrosis, haemorrhage, necrosis is common
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21
Q

Cardiac myxomas and functional stenosis?

A

LA myxomas usually quite mobile and may prolapse through MV causing functional mitral stenosis

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22
Q

What are the myxoma variants?

A
  • Multi-lobulated
  • Liquefaction (echo-luscent area in myxoma representing hematoma/liquefaction)
  • Calcification (echo-bright areas within myxoma representing calcification)
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23
Q

What is Carney Complex?

A
  • Familial myxomas
  • Autosomal dominant syndrome comprising multiple and recurrent myxomas of the heart and skin, hyperpigmentation of the skin and endocrine dysfunction
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24
Q

What is the most common tumour of cardiac valves?

A

Papillary fibroelastoma (PFE)

25
Q

Most common location of papillary fibroelastomas?

A
  • Aortic and mitral valves
  • Less common on pulmonary and tricuspid valves
26
Q

Morphological features of papillary fibroelastoma?

A
  1. Usually solitary
  2. Small gelatinous polyps with multiple fronds
  3. Rarely exceeds 1cm diameter
  4. Attached to endocardium by a short pedicle or stalk
27
Q

Echo appearance of papillary fibroelastoma?

A
  • Small, round homogenous masses attached to valve
  • May appear highly mobile with independent motion - “pom-pom” appearance
28
Q

What is a lipoma?

A

Benign tumours of ‘fat’ cells

29
Q

Most common location for lipomas?

A

Sub-epicardial (larger), sub-endocardial, intra-myocardial

30
Q

Morphological features of lipoma?

A
  1. Homogenous fatty encapsulated tumours
  2. Broad based
  3. Variable size (larger in sub-epicardium)
31
Q

Echo appearance of lipoma?

A

Echo-bright, homogenous appearance

32
Q

What is lipomatous hypertrophy of IAS?

A
  • Non-neoplastic condition (may be mistaken for cardiac tumour)
  • Result of accumulation of excess adipose tissue within IAS with sparing of fossa ovals membrane
  • Sparring of fossa ovals membrane leading to dumbbell appearance
33
Q

What is a rhabdomyoma?

A
  • Benign tumour of striated muscle
  • Most common cardiac tumour in children
34
Q

Most common location of rhabdomyomas?

A

LV and/or RV myocardium; outflow tracts; AV valves (MV and TV)

35
Q

Morphological features of rhabdomyomas?

A
  1. Frequently multiple
  2. White-grey to yellow, flesh lesions
  3. Well-circumscribed, non-infiltrative
  4. Range in size: few mm to several cm
  5. Spontaneous regression in size, number or both is common
36
Q

What is Tuberous Sclerosis?

A
  • Rare, multi-system genetic disease (autosomal dominant)
  • Characterised by formation of hamartomas in multiple organs
  • Diagnostic criteria based on major and minor criteria; cardiac rhabdomyomas major criteria for diagnosis of tuberous sclerosis
37
Q

Echo appearance of rhabdomyomas?

A

Acoustic properties similar to myocardium

38
Q

What are cardiac fibromas?

A
  • Benign connective tissue tumours
  • Second most common cardiac tumours in children
39
Q

Most common location of cardiac fibromas?

A

LV and ventricular septum

40
Q

Morphological features of cardiac fibromas?

A
  1. Usually solitary
  2. Firm, white, and well-circumscribed
  3. Tightly adherent to adjacent myocardium
  4. Almost always intramural
  5. Range in size from 1-10cm
  6. Do not regress spontaneously
41
Q

Echo appearance of cardiac fibroma?

A

Can mimic hypertrophy cardiomyopathy or septal thickening

42
Q

Characteristics of primary cardiac sarcomas?

A
  • Account for 95% of malignant primary cardiac tumours
  • Fast growing with poor prognosis
  • Death through widespread infiltration of myocardium, obstruction of blood flow, and/or distant metastases
  • Show different histologies
  • Classified based on underlying nature of the tumour
43
Q

Characteristics of angiosarcomas?

A
  • Malignant vascular tumours
  • Most common malignant cardiac tumour in adults
  • Most common location = right heart (esp. RA)
44
Q

Characteristics of rhabdomyosarcomas?

A
  • Malignant tumours of striated muscle
  • Most common malignant cardiac tumour in children
  • Multiple sites of myocardium
45
Q

Characteristics of fibrosarcomas?

A
  • Malignant tumour of fibrous connective tissue
  • Often involving more than 1 cardiac chamber
46
Q

Characteristics of leiomyosarcomas?

A
  • Malignant tumours of smooth muscles
  • Rarely seen in heart
  • Usually found within atria
47
Q

Characteristics of osteosarcoma?

A
  • Malignant tumours of the bone
  • May be intramural or intra-cavity
  • Usually originate in posterior LA wall near pulmonary veins
48
Q

Characteristics of primary cardiac lymphoma?

A
  • Rare (5% of all primary malignant cardiac tumours)
  • More common in immunosuppressed adults
  • Most commonly involves right heart and pericardium; less common in left heart and IVS
49
Q

Most common type of tumour in the LA?

A

Myxoma (70-80% of cases)

50
Q

Most common type of tumour on valves?

A

Papillary fibroelastoma (> 90% of cases; L > R)

51
Q

Most common type of tumour in the RA?

A

Angiosarcoma (80 - 90% of cases)

52
Q

Most common type of tumour in the ventricles?

A
  • Fibroma (> 95% of cases)
  • Rhabdomyoma (60% of cases)
53
Q

Appearance of highly vascular, malignant tumours following contrast?

A

Greater enhancement compared with surrounding myocardium

54
Q

Appearance of tumours with poor blood supply (e.g. myxomas) following contrast?

A

Appear hypoenhanced compared with surrounding myocardium

55
Q

Appearance of thrombus following contrast?

A

No enhancement as thrombus is avascular (thrombus appears black, LV cavity illuminated by bubbles)

56
Q

Appearance of LV lymphomas following contrast?

A

Lymphomas are highly vascular = complete enhancement of mass

57
Q

Appearance of LA myxoma with contrast?

A

Myxomas have poor blood supply = partial enhancement of mass

58
Q

Other appropriate imaging modalities to assess cardiac tumours?

A
  • TTE, TOE, CMR and CT all considered appropriate
  • Cardiac CT and CMR are often combines with TTE

S4 W4 Cardiac Masses (2 decks)

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