Tumors of the heart

• Primary heart tumors are relatively rare.
• Secondary heart tumors are much more common, affecting up to 20% of patients dying from generalized cancer.

Division of the tumors

We distinguish tumors:

1. primary;
   1. benign (myxoma, fibroma, neurofibroma, lipoma, hemangioma, lymphangioma, rhabdomyoma, teratoma);
   2. malignant (angiosarcoma, fibrosarcoma, rhabdomyosarcoma, malignant mesothelioma);
2. secondary (metastases – malignant tumors of the breast, lungs, etc.).

Even benign tumors can cause serious hemodynamic deficit!

Primary heart tumors

Cardiac rhabdomyoma in the right ventricle in a three-year-old girl externally presenting with a heart murmur.

Cardiac myxoma: gelatinous tumor almost completely filling the left atrium.

Primary heart tumors are significantly less common than secondary tumors.

Benign tumors

Benign heart tumors include:

Papillary fibroelastoma

A warty or tuft-like formation on the heart valves.

Myxoma of the heart

In 80% of cases it is located in the left atrium, in 15% in the right atrium, in 5% in the left or right ventricle.

Clinical symptoms

• in case of embolization: ischemia of the organs supplied by the embolized artery;
• in case of obstruction of the mitral orifice: shortness of breath, increased fatigue, cough, hemoptysis, pulmonary edema;
• in case of obstruction of the tricuspid orifice: symptoms of right-sided heart failure

Cardiac myxoma can be accompanied by a number of non-specific symptoms.

Diagnostics

Cardiac myxoma: 71-year-old man hospitalized for TIA; transesophageal echocardiography showed cardiac myxoma in the left atrium.

• Anamnesis.
• Physical exam.
• Echocardiography.

Therapy

• surgical removal,
• echocardiographic monitoring.

Carney syndrome

= complex myxoma syndrome.

Cardiac myxoma embolus in aa bifurcation. iliacae communes

• This is a rare syndrome in which cardiac myxoma is associated with:
  • multiple pigment nevi,
  • adrenocortical hyperplasia,
  • pituitary tumors,
  • multiple breast fibroadenomas,
  • Sertoli tumor of the testicles,
  • cutaneous myxomas

Rhabdomyoma

See the Rhabdomyoma page for more detailed information.

Malign tumors

Sarcomas

• Angiosarcoma, rhabdomyosarcoma (fibrosarcoma, liposarcoma, osteosarcoma),
• occur at any age,
• most often in the right atrium,
• clinically: manifestations of heart failure, arrhythmia, pain in the precordium, pericardial effusion, cardiac tamponade, sudden cardiac death; embolization (of tumor masses, thrombi; often to the CNS), pulmonary edema, syncope (for tumors in the left atrium); extracardiac metastases (lungs, mediastinum, spine, etc.); prognosis very unfavorable (approx. 3 months),
• diagnosis: weight loss, club fingers, heart failure, arrhythmia, pericardial friction murmur, diastolic tip murmur / regurgitation systolic murmur; hl. ECHO, CT and MRI,
• therapy: surgical removal, but usually only palliative surgery.

Malignant melanoma metastasizing to the heart

Secondary heart tumors

This is a metastatic involvement of the heart:

• no tumor (with the exception of malignant melanoma) metastasizes exclusively to the heart,
• heart metastases: malignant melanoma, bronchogenic carcinoma, breast cancer,
• clinically: acute pericarditis, cardiac tamponade, rapid enlargement of the cardiac shadow, arrhythmia incl. atrioventricular blocks, rapid development of heart failure (however, 90% of metastases are clinically silent),
• therapy: hl. palliation: pericardiocentesis for effusion, radiotherapy, chemotherapy.

Links

Related articles

• Tumors of the mediastinum

References

• KLENER, Pavel, et al. Vnitřní lékařství. 3. edition. Praha : Galén, 2006. 1158 pp. ISBN 80-7262-430-X.

• VANĚK, Ivan, et al. Kardiovaskulární chirurgie. 1. edition. Praha : Karolinum, 2003. 236 pp. ISBN 8024605236.