Oncologic essentials in benign cardiac masses (approach and follow-up)





Key points




  • •

    Cardiac tumors consist of a diverse group of conditions with various characteristics, most of them being benign lesions


  • •

    Association of benign cardiac lesions with genetic syndromes mandates thorough evaluation of these patients


  • •

    Most common type of cardiac benign tumors is myxoma followed by fibroelastoma, rhabdomyoma, fibroma, lipoma, and other less common types


  • •

    Presentation and symptoms depend on the tumor location and histopathology, including constitutional symptoms, thromboembolism, obstructive symptoms, and arrhythmias


  • •

    Diagnosis is by echocardiography, and frequently cardiac MRI


  • •

    Treatment of benign tumors is mainly by excision or close observation


Fig. 22.1


Benign cardiac tumor symptom mechanisms.




Cardiac tumors cause symptoms by various means. Aortic valve and left atrial tumors are more likely to be complicated by embolization, which is mostly systemic . Obstructing blood flow might result in heart failure symptoms. Valvular regurgitation is also possible if the tumor interferes with the heart valves. Though true invasion is less likely with benign tumors, direct pressure by the mass may lead to ventricular dysfunction, arrhythmias, or pericardial effusion. The pressure effect of tumor may also cause bronchogenic symptoms. Constitutional symptoms like fatigue, weakness, and light headedness are also noticeable.



Table 22.2

Clinical manifestations of benign cardiac tumors by location .


































Mechanism Sign/symptom Example
Left atrium Obstruction




Embolization 		Dyspnea, pulmonary edema, fatigue, cough, orthopnea
Mitral regurgitation
Tumor plop
Stroke		 Myxoma
Lipoma
Right atrium Obstruction



Embolization 		Peripheral edema, hepatomegaly, ascites, fatigue
Tricuspid regurgitation
Pulmonary emboli		 Myxoma
Lipoma
Left ventricle Obstruction
Embolization
Direct effect 		Heart failure

Arrhythmia		 Fibroma
Rhabdomyoma
Right ventricle Obstruction Peripheral edema, hepatomegaly, ascites, syncope Fibroma
Rhabdomyoma
Valves Valve interference Regurgitation Fibroelastoma


Table 22.3

Causal association of benign cardiac tumors with genetic predispositions .


































Genetic syndrome Gene involved Inheritance Tumor type Association
Gorlin syndrome PTCH1 AD Fibroma Nevoid basal cell carcinoma, skeletal abnormalities, medulloblastoma, meningioma
Carney complex PRKAR1A AD Myxoma Endocrine hyperfunction, skin pigmentation
Von Hippel–Lindau syndrome VHL AD Paraganglioma Renal cell carcinoma, pancreatic NET
Tuberous Sclerosis TSC1 , TSC2 AD Rhabdomyoma Hamartoma, brain tumors, angiomyolipoma, skin changes

AD , autosomal dominant; NET , neuroendocrine tumor.

Fig. 22.4


Diagnostic approach to benign cardiac mass in adults .

Adapted from Kilani S, Gaxotte V, Midulla M, Beregi JP. Cardiac mass: algorithms for an integrative diagnostic approach. ECR 2012; C-0729. 10.1594/ecr2012/C-0729; with permission.




Table 22.5

Diagnostic modalities in benign cardiac tumors .


























Indication Considerations
Imaging
Echocardiography



Cardiac CT


Cardiac MRI



PET scan		 Initial study



MRI unavailable
MRI prohibited





Functional assessment

  • •

    Direct visualization


  • •

    Transesophageal might be more informative




  • •

    Ionizing radiation


  • •

    Less expensive




  • •

    Slightly preferred to CT


  • •

    Provide clues to tumor type


  • •

    Differentiate thrombus


  • •

    Useful to rule out metastasis

Coronary angiography
Epicardial tumors

  • •

    Tumor blood supply delineation

Biopsy
Unresectable or diffuse tumors

  • •

    Gold standard


  • •

    Risk of embolization (e.g. myxomas)


  • •

    Risk of perforation

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Oct 27, 2024 | Posted by in CARDIOLOGY | Comments Off on Oncologic essentials in benign cardiac masses (approach and follow-up)

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