Cardiac tumors

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  • Apical thrombus
  • Ruptured pap muscle abcess
  • RV mass
  • Cardiac tumors

    1. 1. CARDIAC TUMORS
    2. 2.  Primary Cardiac tumors  Benign  Malignant Secondary Cardiac Tumors  Benign  Malignant
    3. 3. General Neoplasia of the heart or pericardium :  Secondary more common than  Primary
    4. 4. GeneralPrevalence: Primary tumors • <3/10,000 autopsies • Over ¾ are benign Secondary • 20-40 x more common • Present in 20% of patients dying of malignancy
    5. 5. Outline General Primary Cardiac tumors  Benign
    6. 6. Primary Cardiac Tumors Benign  Myxoma  Papillary fibroelastoma  Fibroma  Lipoma  Rhabdomyomas
    7. 7. Benign Primary Cardiac TumorsMyxomas The most common primary cardiac tumor in the Age > 35 75% in the Lt. Atrium near fossa ovalis 15% Rt. Atrium 5-10% Lt. Ventricle 5% multiple sites
    8. 8. Benign Primary Cardiac Tumors Myxomas  Grossly • Typically pedunculated • Gelatinous consistency • Friable  Histologically • Copious mucopolysaccharide stroma • Scattered solitary or clustered polygonal cells.
    9. 9. MICROSCOPY
    10. 10. Manangement High propensity for embolization Surgical results excellent
    11. 11. Benign Primary Cardiac Tumors Familial pattern of Myxomas with autosomal dominant features Age < 30 Carney Complex
    12. 12. Papillary Fibroelastoma The most common valvular tumor, followed by • Sarcoma • Melanoma Present in all age groups, but most commonly in Age>60
    13. 13. Papillary Fibroelastoma Small tumors (<1cm) with homogeneous speckeled pattern Commonly pedunculated with multiple fronds Affect the Lt and Rt sides with same frequency Attach to • Atrial surface of AV valves, and • Ventricular surface of semilunar valves
    14. 14. Papillary Fibroelastoma Adults  Aortic valve Children  Tricuspid valve Rarely on endocardial surfaces Symptomatic only in the aortic position (other than embolic Sx) • Ostial occlusion  angina, sudden death • Rarely valvular dysfunction Source of embolization in up to 30% of patients
    15. 15. Fibromas Encapsulated, solitary tumors Frequently in the septal myocardium Often encroach on the conduction system as they grow
    16. 16. Fibromas With septal involvement V.Fib is often the first presentation Indications for surgical resection: • Mechanical problems due to size • Arrhythmogenic nidus Resection of septal fibromas is not always possible
    17. 17. LipomasAffect both myocardium and pericardium Can reach several centimeters in size
    18. 18. Rhabdomyoma: Most common tumor of the heart for Age < 30 yr Almost exclusively in children Associated with tuberous sclerosis Regression of tumor in infancy has been reported
    19. 19. A large firm, white tumor mass wasfound filling the left ventricle. This is a cardiac rhabdomyoma.
    20. 20. Malignant Primary Cardiac Tumors Angiosarcomas Rhabdomyosarcomas Mesotheliomas Lymphoma Intrapericardial Pheochromocytomas
    21. 21. Angiosarcomas Most common primary malignancy of the heart Malignant cells that form vascular channels Most commonly affect the • Rt. Heart  Rt. Atrium • Pericardium  Hemorrhagic effusion  Thrombus
    22. 22. Angiosarcomas Diffuse, irregularly shaped Mean survival one year Successful Rx with Chemo and XRT followed by transplant reported
    23. 23. Rhabdomyosarcomas Most commonly seen in adults No chamber selectivity No pericardial involvement Multiple sites of cardiac involvement is common Poor prognosis Limited success with resection and adjuvant Rx.
    24. 24. Mesotheliomas Diffuse pericardial tumor Involve both parietal and visceral pericardium Superficially invade the myocardium Rarely invade the cardiac chambers
    25. 25. Mesotheliomas Sx of pericarditis or tamponade Poor prognosis XTR or chemo only offer temporary improvement
    26. 26. Lymphoma
    27. 27. Malignant Secondary Cardiac Tumors Solid Tumors involving the heart:  Lung  Breast  Soft tissue sarcomas  Renal carcinoma  Melanoma Leukemia and Lymphomas also common culprits
    28. 28. Malignant Secondary Cardiac Tumors IVC tumors in General  Renal carcinoma • 80% 5 year survival for surgical resection of tumors migrating up the IVC  Hepatoma  Ovarian CA
    29. 29. Q U I Z TIME
    30. 30. How about this one?
    31. 31. Any Guesses??
    32. 32. Any Guesses??
    33. 33. Guesses?
    34. 34. What is this?

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