Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

TZ Cardiac Surgery 2016 > Tumor > Flashcards

Tumor Flashcards

1
Q

primary tumors of the heart:

% benign vs malignant

A

90% benign

10% malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

list benign primary cardiac tumors in adult (decreasing frequency)

A
  1. myxoma
  2. lipoma
  3. papillary fibroelastoma
  4. rhabdomyoma
  5. fibroma
  6. hemangioma
  7. teratoma
  8. mesothelioma of AV node
  9. granular cell tumor
  10. neurofibroma
  11. lymphangioma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

list malignant primary cardiac tumors

A
  1. angiosarcoma
  2. rhabdomyosarcoma
  3. mesothelioma
  4. fibrosarcoma
  5. malignant lymphoma
  6. osteosarcoma
  7. neurogenic sarcoma
  8. malignant teratoma
  9. thymoma
  10. leiomyosarcoma
  11. liposarcoma
  12. synovial sarcoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how to differentiate myxoma vs thrombi

A

Myxoma is covered by endothelium and have endothelium-lined crevices and clefts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cell lineage of myxomas

A

pluripotent mesenchymal stem cells

Krikler suggests endocardial sensory nerve cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

embolization risk of myxomas

A

LV 64% (usually to brain)
LA 30-45%
RA or RV 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

constitutional sx of myxomas (esp large LA)

A

fever/wt loss
clubbing of fingers and toes (usually assoc’t w R->L shunt via PFO)
raynaud’s phenomenone
myalgia/arthralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

blood work findings of myxomas

A 
high total globulin level
high ESR/CRP
polycythemia
hemolytic anemia (esp w calcified myxomas)
thrombocytopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

sporadic (non-familial myxomas)

A 
95% of myxomas
middle aged women
94% single
75% in LA
20% aneuploidy
rarely assoc'd w conditions
recurrence in 1-3%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

familial myxomas

A 
5%
young men
dominant inheritance
33% multiple
62% in LA
100% aneuploidy
recurrence in 30-75%
assoc't conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

associated conditions with familial myxomas

A
  • sertoli cell tumors of testes
  • cushing syndrome due to primary adrenocortical nodular dysplasia
  • pituitary tumors
  • centrofacial and labial lentiginosis
  • cutaneous myxomas
  • multiple myxoid mammary fibroadenomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

predominant sx of LA myxoma

A

episodic dyspnea & hemoptysis associated with syncopy

can rapidly progress to intractable heart faillure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

predominant sx of RA myxoma

A

episodic right heart failure (prominant A wave, elevated CVP, hepatomgaly, ascie, peri edema)

absence of orthopnea and PND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

once symptomatic death from myxoma occurs within…..years

A

1-2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

best study for myxomas

A

TEE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which chamber to inject radioopaque dye if cathing for myxoma

A

LA myxoma: inject in PA and wait for dye to get to LA

RA myxoma: inject in cava

*do not cannulate the chamber with the myxoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

mode of myxoma recurrence

average length of time before recurrence

A
  • tumor seeding at time of removal
  • incomplete removal
  • multicentric origin

30months

18
Q

lipoma

A

mature fatty cells; can be encapsulated or diffusely infiltrative

occur anywhere in the heart; atrial septum most common (lipomatous hypertrophy of interatrial septum)

mostly incidental findings

if too large: SCD, VT, ST-T abn, RVOT/LVOT obstruction
–> remove

19
Q

Papillary fibroelastoma % of all cardiac tumors

A

10%

20
Q

papillary fibroelastoma most likely location

A

AV cusp/MV leaflet

TV, IVS infrequently

aortic wall rarely

21
Q

papillary fibroelastoma problem

A

embolism (either the fronds or thromboembolism)

brain, coronary arteries, lungs, retinal arteries

22
Q

when to resect papillarry fibroelastoma

A

when risk of OR is low, or when embolic event

23
Q

list primary cardiac tumors in children

A
  1. rhabdomyoma
  2. cardiac fibroma
  3. myxoma
24
Q

rhabdomyoma

A

most common primary tumor in kids

associated with tuberous sclerosis

benign (spider cell); almost 100% in ventricles (RV=LV); multiples

regresses completely before age 2

resect only if RVOT/LVOT obstruction or ventricular arrythmias

25
Q

fibroma

A

benig, spindle cells mixed with collagen adn elastic fibers
w central foci of calcificcation

exclusively in ventricular myocardium; freq in IVS

solitary, circumscribed, firm, grey white

resect if symptomatic (dyspnea, syncope, HF, CP, VT) or very large. consider transplant if unresecctable

26
Q

pheochromocytoma

A

very rarely involves cardiac structures (within pericardium, on surface of the heart esp LA, PVs, Aorta and mPA, & coronary arteries)

if diagnosed, resect. surgical mortality 25% due to hemorrage

preop alpha & beta blockade key

27
Q

cell lineage of pheochromocytoma

A

chromaffin cells.

produce catecholamines (esp NE)
urine catecholamines diagnostic (also CT & MRI)
28
Q

teratomas

A

rare
cyctic masses, compresses the heart
80% benign, 20% malignant
diagnoed in fetus and infants; occ in adults
leads to early cardiac death unless resected

29
Q

type of cell in sarcomas

A

mesenchymal cells

30
Q

most common types of primary cardiac sarcomas

A

angiosarcoma
rhabdomyosarcoma
fibrosarcoma

31
Q

sarcomas

A

malignant tumors
metastasize widely
right side: more bulky & infiltrative, causes heart failure, met early
left side & PA: more circumscribed, cause HF early adn met late

32
Q

sarcoma symptoms

A

nonspecific (fever malaise weight loss)
pericardial effusion
HF

33
Q

prognosis of cardiac sarcomas

A

90% dead by 1 year

with surgery: MR 7%; median survival 2 yrs

34
Q

surgery for sarcoma

A

complete resection; autotransplantation on left side to allow for radical rsection

indicated iin young pts without evidence of distal mets

35
Q

what proportion of patients with carcinoid tumors get malignant carcinoid syndrome?

what proportion of pts with malignant carcinoid syndrome get carcinoid heart disease

A

10% get MCS

50% of MCS get carcinoid heart

so 5% of pts w carcinoid tumors get carcinoid heart disease!

*nearly all pts with carcinoid heart have hepatic mets!

36
Q

cell lineage of carcinoid tumors

A

argentaffin cells of GI tract (ileum, also pancreas, biliary vessels, ovaries adn testes)

secrete large amt of serotonin

37
Q

malignant carcinoid syndrome: sx

A

flushing, telangiectasias, diarrhea, bronchospasm

hyperdynamic circulation but no HTN

Dx: increased serum serotonin & urine 5-HIAA

38
Q

carcinoid heart disease

A

in 50% of pts w the syndrome; worse outcome

limited to right sided vavles (TR and PS)
glistening white-yellow fibrous deposits on ventricular aspect of TV and downstream of PV

leads to constriction of annulus and adherence of leaflet to RV endocardium

39
Q

what disease does carcinoid heart resemble

A

fen-phen valve disease

fenfluoromine, phentermine diet drugs

40
Q

surgery of carcinoid heart disease

A

TVR +/- PVR

30 day mortality:
50% if over 60 y.o.
0% if under

operate on young pts with imp HF sx

TZ Cardiac Surgery 2016 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions