Key points
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Cardiac neoplasms are rare and most of the malignancies in this organ are metastatic in origin.
Fig. 18.2
Angiosarcoma (gross). Right atrial angiosarcoma in a 49/Y woman: (A) Gross examination shows an irregular creamy-brownish mass with firm consistency M: 8.5 × 5 × 4.5 cm. (B) Cut section shows a heterogeneous dark-brown surface with areas of necrosis.
Fig. 18.3
Angiosarcoma (histopathology). Histopathology of right atrial angiosarcoma: (A) Microscopic examination shows anastomosing vascular channels lined by atypical spindled endothelial cells and areas of solid growth pattern. (B) Tumor infiltration into the cardiac myocytes is seen. (C) High power magnification shows vascular proliferation lined by endothelial cells with large hyperchromatic nuclei and prominent nucleoli. (D) The neoplastic cells show diffuse and strong immunoreaction with CD31.
Fig. 18.4
Malignant fibrous histiocytoma. (A) Polypoid mass at left atrium. (B) Histological examination shows neoplastic tissue composed of spindle cells with fibrohistiocytic appearance, marked pleomorphism and storiform pattern.
Reproduced with permission from Buja LM. Tumors of cardiovascular system heart and blood vessels. In: Cardiovascular pathology. Elsevier; 2016. p. 735–72.c.
Fig. 18.5
Leiomyosarcoma. Left atrial leiomyosarcoma in a 39/Y old woman. (1) Gross examination shows a white mass with a smooth surface (M: mass, LAA: left atrial auricle) (2) (A) Microscopic examination (H&E × 400) shows sheets of spindle cells with hyperchromatic nuclei and moderate pleomorphism. Immunochemical studies show tumoral cells reactivity with (B) vimentin and (C) α-smooth muscle actin. MIB-1 labeling index is 44.1%.
Reproduced with permission from Nakashima K, Inatsu H, Kitamura K. Primary cardiac leiomyosarcoma: a 27-month survival with surgery and chemotherapy. Intern Med 2017;56(16):2145–9.
Fig. 18.6
Rhabdomyosarcoma. (A) Gross examination shows multiple creamy and lobulated, soft to firm masses with foci of necrosis and hemorrhage. (B) Relatively cellular tumor with pleomorphic round to spindle cells in a myxoid background (H & E × 400).
Fig. 18.7
Primary cardiac lymphoma. (A) Diffusely infiltrated tissue showing large atypical lymphocytes with round or irregular nuclei (hematoxylin and eosin staining; magnification, × 400). (B) Immunohistochemical study staining is positive for CD20 (magnification, × 400).
Fig. 18.8
Metastatic papillary thyroid carcinoma. A 50 Y/O man with history of papillary thyroid carcinoma presenting with very large nonhomogeneous mass in right ventricle with extension to right ventricular outflow tract and RV apex. (A and B) Microscopic examination (H&E) reveals neoplastic tissue arranged in sheets and focal papillary structures composed of pleomorphic neoplastic cells with vesicular nuclei, eosinophilic cytoplasm, and prominent nucleoli. Increased mitotic figures with areas of massive necrosis are noted. Immunochemical (IHC) study shows tumoral cells reactivity with CK7 (C) and TTF1 (D). The tumoral cells show negative reaction to CK 20 (E) and NAPSIN A (F).
