Cardiac Tumors: Diagnosis, Prognosis, and Treatment

Abstract

Purpose of Review Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors. Recent Findings Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. Summary A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.

A case of primary cardiac sarcoma with an acute presentation: The role of multimodality imaging

“…The benefit of adjuvant chemotherapy and/or radiation is unknown, but is a treatment option, especially for patients with incomplete resections. Furthermore, the role of radiotherapy (RT) is limited, considering that high‐dose radiation protocols used to treat sarcomas in other locations are poorly tolerated by the heart 12,13 . It has to be noted that, despite radical exeresis of the mass, local recurrence and metastasis within 1 year are frequent and the median progression‐free survival is 5.9 months, 13,14 ranging from 6 to 18 months 12 .…”

Primary cardiac tumours: how well can prenatal diagnosis “predict” postnatal outcome?

“…The last mentioned type of foetal cardiac tumour is myxoma, which is very rare during the prenatal period and in newborns. However, later in childhood myxomas are one of the most common cardiac tumours (11). They are usually ovoid, pedunculated tumours with a clinical manifestation of embolism and intracardiac obstruction (12).…”

18F-FDG PET/CT imaging in the workup of cardiac and pericardial masses

“…Cardiac and pericardial masses represent a rare, but large spectrum of different entities with variable morbidity and mortality. 1 Beside intra-cardiac thrombi, calcifications, and vegetations, primary and secondary tumors are the most important differential diagnosis in the workup of cardiac and pericardial masses. 2 Neoplastic lesions of the heart are mostly of secondary etiology, arising from extra-cardiac malignant tumors with a prevalence of 2-18%.…”

“…Especially myxoma, papillary fibroelastoma, and angiosarcoma have characteristic structural patterns, allowing high diagnostic accuracy by the use of echocardiography, CMR and CCT without need for metabolic FDG PET/CT assessments. 1,7 If size, growth dynamic, invasiveness, and vascularization are highly suspicious for malignancy, and in cases of left-sided located benign tumors or right-sided symptomatic benign tumors, it has to be questioned if another imaging modality is necessary or prompt surgical excision should be preferred. 16 Nevertheless, comparison of other imaging modalities to FDG PET/CT is needed.…”

“…To summarize, the management and workup of cardiac and pericardial masses remains challenging and a comprehensive multimodality imaging approach is crucial to delineate malignancy and hemodynamic consequences of cardiac and pericardial masses. 1 Awareness for the strengths and the weaknesses of different imaging modalities is required to choose the most appropriate approach on a case-by-case basis. Taken into account the results of the present study by Yin et al, FDG-PET/CT is useful in patients with cardiac masses of unknown dignity but also in cases with a high pre-test probability for malignancy and extracardiac involvement.…”