8. cardiac masses Dr Iqra Osman Abdullahi.pptx

Cardiac masses
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1. CARDIAC TUMORS

2. Primary Cardiac tumors  Benign M a li g n a nt Secondary Cardiac Tumors  Benign M a li g n a nt

3. General N eo p l as ia o f t h e h e a rt o r pe r i ca r d i u m :   Secondary more common than Primary

4. General  Primary tumors <3/10,000 autopsies Over ¾ are benign  Secondary 20-40 x more common Present in 20% of patients dying of malignancy Prevalence :

5. Primary Cardiac Tumors B e n i g n    Myxoma Papillary fibroelastoma Fibroma Lipoma Rhabdomyomas

6. Benign Primary Cardiac Tumors      The most common primary cardiac tumor in the Age > 35 75% in the Lt. Atrium near fossa ovalis 15% Rt. Atrium 5 - 1 0% Lt. V e n t r i c l e 5% multiple sites M y x om as

7. Benign Primary Cardiac Tumors Grossly Typically pedunculated Gelatinous consistency Friable Histologically Copious mucopolysaccharide stroma Scattered solitary or clustered polygonal cells. Myxomas

8. Manangement   High propensity for embolization Surgical results excellent

9. Benign Primary Cardiac Tumors   Familial pattern of Myxomas with autosomal dominant features Age < 30 Carney Complex

10. Papillary Fibroelastoma  The most common valvular tumor, followed by Sarcoma Melanoma  Present in all age groups, but most commonly in Age>60

11. 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

12. 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 patien ts

13. F i b r o m a s    Encapsulated, solitary tumors Frequently in the septal myocardium Often encroach on the conduction system as they grow

14. F i b r o m a s    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 a lways possible

15. L i po m a s Affect both myocardium and pericardium Can reach several centimeters in size

16. Rhabdomyoma:   Most common tumor of the heart for Age < 30 yr Almost exclusively in children   Associated with tuberous sclerosis R e g r es s i on of tu m or i n i nfan c y ha s b e en reported

17. A large firm, white tumor mass was found filling the left ventricle. This is a cardiac rhabdomyoma.

18. Malignant Primary Cardiac Tumors Angiosarcomas R h a b d o m y o sa r co m as Mesotheliomas Lymphoma Intrapericardial Pheochromocytomas

19. 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

20. Angiosarcomas   Diffuse, irregularly shaped Mean survival one year  Successful Rx with Chemo and XRT followed by transplant reported

21. 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.

22. M esoth e l i o m a s     Diffuse pericardial tumor Involve both parietal and visceral pericardium Superficially invade the myocardium Rarely invade the cardiac chambers

23. M esoth e l i o m a s   Sx of pericarditis or tamponade Poor prognosis  XTR or chemo only offer temporary improvement

24. L y m ph o m a

25. Malignant Secondary Cardiac Tumors Solid Tumors involving the heart:   Lung B r ea s t Soft tissue sarcomas  Renal carcinoma Melanoma L e uke m i a a n d L y m p h o m a s a l s o co m m o n culprits

26. 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