Key points
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Malignant tumors are extremely rare.
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25% of primary cardiac tumors are malignant.
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Most malignant cardiac tumors are metastatic (from breast, lung, melanoma, soft tissue sarcoma, etc.).
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Sarcoma, lymphoma, and malignant pericardial mesothelioma are three main primary malignant cardiac tumors.
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Usual imaging studies consist of TTE, CMR, and contrast TTE that are helpful noninvasive tools to diagnose suspicious cardiac masses.
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Generally, despite multimodal treatment strategies, prognosis of malignant cardiac tumors is poor.
Epidemiology and classification
Malignant cardiac tumors are extremely rare (0.001%–0.03% in most autopsy series) and account for 10%–25% of primary cardiac masses .
Table 23.1
Major outlines of the 2015 WHO classification of tumors of the heart and pericardium .
| Benign tumors and tumor-like conditions |
| Tumors of uncertain biologic behavior |
| Germ cell tumors |
| Malignant tumors |
| Tumors of the pericardium |
Table 23.2
Incidence of different subtypes of primary malignant cardiac tumors .
| Primary cardiac tumors | Incidence |
|---|---|
| Benign | 70%–75% |
| Malignant | 25%–30% |
| Angiosarcoma | 9% |
| Rhabdomyosarcoma | 6% |
| Mesothelioma | 4% |
| Fibrosarcoma | 3% |
| Lymphoma | 2% |
| Other sarcomas | 3% |
| Teratoma | < 1% |
| Other | < 1% |
Table 23.3
Incidence of cardiac metastasis in several malignancies .
| Secondary cardiac tumors | Rate of heart metastasis % |
|---|---|
| Pleural mesothelioma | 48.4% |
| Melanoma | 27.8% |
| Lung adenocarcinoma | 21% |
| Undifferentiated carcinoma | 19.5% |
| Lung squamous cell carcinoma | 18.2% |
| Breast carcinoma | 15.5% |
| Ovarian carcinoma | 10.3% |
| Lymphoproliferative neoplasms | 9.4% |
| Bronchoalveolar carcinoma | 9.8% |
| Gastric carcinoma | 8% |
| Renal cell carcinoma | 7.3% |
| Pancreatic carcinoma | 6.4% |
Outlines of malignant cardiac tumors.
Location of different cardiac malignant tumors in heart.
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