Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Most common cardiac neoplasm is a metastatic lesion (carcinoma of lung or breast, sarcoma, melanoma)• 75% of primary cardiac neoplasms are benign (myxoma, rhabdomyoma) +++ Myxoma + • 75% of benign primary cardiac tumors• Appearance ranges from smooth, round, firm encapsulated mass to loose conglomeration of gelatinous material• Most attached to fossa ovalis of left atrial septum; some may occur in right atrium or ventricles• Histologically, contains various mesenchymal cells-Abnormal DNA ploidy may correlate with recurrence• Papillary fronds attached to aortic valve associated with cerebral and coronary embolization• Fibromas occur in pediatric patients, slowly invading conduction system-Can cause sudden death from arrhythmias +++ Epidemiology + • Primary tumors of heart are rare-0.002-0.3% of autopsies• Occur in any age +++ Symptoms and Signs + • Presentation depends on type and location of tumor• Malignant tumors: Rapidly progressive congestive heart failure from valvular or myocardial infiltration• Myxoma: Fever, weight loss, anemia, systemic embolization• Mitral stenosis can occur from tumor causing characteristic early diastolic sound "tumor plop"• Fibromas can cause sudden death from arrhythmias +++ Laboratory Findings + • Myxoma: Abnormal ESR, gamma globulin, liver aminotransferases• Anemia, thrombocytopenia common in many tumors• Transesophageal echocardiography: Procedure of choice• MRI and CT may be helpful in infiltrative lesions + • Evaluate for other sites of tumor + • Physical exam• Echocardiography, possibly transesophageal• MRI for invasive lesions + • Most benign lesions: Resectable/curable• Myxomas-Cardiopulmonary bypass required-Resect tumor and rim of normal tissue around attachment stalk• Surgery for cardiac sarcomas and metastatic lesions is usually for diagnosis; occasionally palliative• Orthotopic heart transplantation (rarely) +++ Surgery +++ Indications + • Suspected myxoma, consider repair +++ Complications + • Embolization during tumor manipulation +++ Prognosis + • Operative mortality < 1%• Long-term survival for malignant cardiac lesions remains poor +++ Prevention + • Resect rim of normal tissue around attachment stalk to prevent recurrence of myxomas +++ References ++Araoz PA et al. CT and MR imaging of primary cardiac malignancies. Radiographics. 1999;19:1421. [PubMed: 10555666] ++Lobo A et al. Intracardiac masses detected by echocardiography: case presentation and review of the literature. Clin Cardiol. 2000;23:702. [PubMed: 11016023] ++Shapiro LM. Cardiac tumours: diagnosis and management. Heart. 2001;85:218. [PubMed: 11156679] ++Gavrielatos G. et al. Large left atrial myxoma presented as fever of unknown origin: a challenging diagnosis and a review of the literature. Cardiovascular Pathology. 2007;16(6):365-7. [PubMed: 18005878] Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth