Cardiac Tumors in a Tertiary Care Cancer Hospital: Clinical Features, Echocardiographic Findings, Treatment and Outcomes

Abstract

Cardiac tumors are a rare entity, comprised of tumors with diverse histology and natural history. We report the clinical characteristics, echocardiograhic findings, therapy and outcome of 59 patients with primary and metastatic cardiac tumors. Our institutional echocardiogram data base from 1993 through 2005 was reviewed to identify patients diagnosed with intra-cardiac tumor. A total of 59 patients with cardiac tumors were identified and included in the study. The patients' characteristics, presenting symptoms, diagnostic tests, location, histology of the tumor, treatment and the one year survival rate of this population was collected from the medical records. Of the 59 cardiac tumor cases, 16 (27%) were primary cardiac tumors and 43 (73%) were secondary cardiac tumors. The most common primary tumor was sarcoma affecting 13 (81%) of the 16 cases. Of these, 5 patients were angiosarcoma, 5 unclassified sarcoma, one myxoid sarcoma and 2 malignant fibrous histiocytoma. The mean age at presentation was 41.1 years, and the most common location was right atrium affecting 6 cases (37.5%). The most common symptom of dyspnea was present in 10 (62.5%) cases. Eleven (25.6%) of the 43 secondary cardiac tumors were metastasis from renal cell carcinoma. The mean age at presentation was 55.4 years. Right atrium was the most frequent location affecting 18 (42%) of the 43 patients. The most common presenting symptom was dyspnea in 15 (35%) cases. For both primary and secondary tumors, dyspnea was the most common symptom and right atrium was most frequently involved. Sarcoma was the most common primary cardiac tumor while metastasis from renal cell carcinoma was the most common secondary tumor.

Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging

“…Most data regarding cancer in the heart are derived from autopsy series1, 2 and may reflect selected patient populations with advanced disease at time of death. In vivo studies have largely used echocardiography,3 which is known to yield varying test performance based on image quality and be limited for the detection of cardiac masses that are small or nonprotuberant 4, 5. Regardless of diagnostic approach, recent advances in oncologic care may correspond to altered patterns of cancer spread to the heart, as well as improved prognosis.…”

Tumors Metastatic to the Heart

“…Although primary cardiac tumors are rare (generally between 0.01% and 0.1% on postmortem analysis), the frequency of secondary metastatic tumors to the pericardium, myocardium, great vessels, or coronary arteries is between 0.7% and 3.5% at autopsy in the general population and up to 9.1% in patients with known malignancies. [1][2][3][4][5] Moreover, the risk of cardiac metastasis rises with metastatic disease burden; 14.2% of patients with multiple distant metastases were found to have cardiac involvement. 1 The incidence of cardiac metastases has increased over the last 30 years, perhaps attributable to increased life expectancy in oncologic patients benefitting from advances in cancer diagnosis and management.…”

Pericardial metastasis in routine pathological diagnostics of pericardial effusion (with description of clinical cases)

“…За последние 30 лет благодаря современным достижениям в области диагностики и лечения онкологи-ческих заболеваний и в связи с увеличением продолжи-тельности жизни онкологических больных частота обна-ружения метастазов в сердце увеличилась. По данным патологоанатомических исследований, вторичные мета-статические опухоли в сердце встречаются от 0,7 до 3,5 % всех аутопсий и до 9,1 % у больных, умерших от рака с отчетливой его диссеминацией [1][2][3].Метастазировать в сердце может любая внесердечная злокачественная опухоль. Как правило, это опухоли, про-растающие из близлежащих органов и распространяющи-еся лимфо-или гематогенным путем.…”

“…К опухолям, часто дающим метастазы в перикард, относятся первичный рак легкого (от 36 до 39 %), молочной железы (10-12 %), меланома (от 28 до 56 %) гематологические злокачественные опухоли (10-21 %) [1][2][3][4]. Из других опухолей метастазируют в сердце рак яичников, желудка, почек и поджелудочной железы.…”

“…Достоверную диагностику пери-кардиального выпота обеспечивают современная ЭхоКГ и компьютерная томография (КТ) сердца [1,5]. В случае тампонады сердца проводят «лечебный» перикардиоцентез, при острых перикардитах с массив-ным перикардиальным выпотом и выпотах неясной этио-логии показано проводить «диагностический» перикар-диоцентез.…”