eMedicine Specialties > Oncology > Carcinomas of the Lung and Other Intrathoracic Carcinomas

Cardiac Neoplasms, Primary: Differential Diagnoses & Workup

Author: Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Aug 7, 2008

Differential Diagnoses

Carney Complex

Workup

Laboratory Studies

Erythrocyte sedimentation rate (ESR) is a nonspecific test for which results may be elevated in the presence of a cardiac tumor.

Imaging Studies

  • Chest radiograph may demonstrate an enlarged cardiac silhouette or atrial enlargement.
  • MRI of the chest will demonstrate intracardiac pathology in the form of a mass.14,15
  • Transesophageal echocardiography (TEE) is the test of choice.16 TEE delineates the position of the tumor and details the integrity or involvement of the septal and valvular structures. (Seventy-five percent of cardiac myxomas arise from the fossa ovalis on the left atrial side.17 )
  • Perform fetal ultrasonography if the diagnosis is suspected in utero.
  • Cardiac catheterization is necessary only if other processes are strongly suspected.
  • Perform metaiodobenzylguanidine (MIBG) radionuclide scan for suspected paraganglioma. This scan uses a radioactive guanidine that is taken up preferentially by neuroendocrine cells.

Other Tests

ECG is ordered to detect potential arrhythmias that may be associated with tumors. These arrhythmias include atrial fibrillation, paroxysmal atrial tachycardia, and ventricular arrhythmias.

Histologic Findings

Myxomas are gelatinous in nature with rests of spindle cells (see Media files 1-2).18 If DNA tetraploidy is present, suspect malignancy. Fibroelastomas are composed of endocardium, fibrous tissue, elastic fibers, and smooth muscle cells arranged in a central stock of collagen and a covering of hyperplastic endothelial cells.

Staging

No particular staging exists for cardiac tumors.

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References
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References

  1. Attar S, Lee YC, Singleton R, et al. Cardiac myxoma. Ann Thorac Surg. May 1980;29(5):397-405. [Medline].

  2. Burke AP, Cowan D, Virmani R. Primary sarcomas of the heart. Cancer. Jan 15 1992;69(2):387-95. [Medline].

  3. Butany J, Nair V, Naseemuddin A, et al. Cardiac tumours: diagnosis and management. Lancet Oncol. Apr 2005;6(4):219-28. [Medline].

  4. O'Neil MB Jr, Grehl TM, Hurley EJ. Cardial myxomas: a clinical diagnostic challenge. Am J Surg. Jul 1979;138(1):68-76. [Medline].

  5. Llombart-Cussac A, Pivot X, Contesso G, et al. Adjuvant chemotherapy for primary cardiac sarcomas: the IGR experience. Br J Cancer. Dec 1998;78(12):1624-8. [Medline].

  6. Basu S, Folliguet T, Anselmo M, et al. Lipomatous hypertrophy of the interatrial septum. Cardiovasc Surg. Apr 1994;2(2):229-31. [Medline].

  7. Smythe JF, Dyck JD, Smallhorn JF, et al. Natural history of cardiac rhabdomyoma in infancy and childhood. Am J Cardiol. Nov 15 1990;66(17):1247-9. [Medline].

  8. Shahian DM, Labib SB, Chang G. Cardiac papillary fibroelastoma. Ann Thorac Surg. Feb 1995;59(2):538-41. [Medline].

  9. Burke AP, Virmani R. Cardiac rhabdomyoma: a clinicopathologic study. Mod Pathol. Jan 1991;4(1):70-4. [Medline].

  10. Burke AP, Rosado-de-Christenson M, Templeton PA, et al. Cardiac fibroma: clinicopathologic correlates and surgical treatment. J Thorac Cardiovasc Surg. Nov 1994;108(5):862-70. [Medline].

  11. Brizard C, Latremouille C, Jebara VA, et al. Cardiac hemangiomas. Ann Thorac Surg. Aug 1993;56(2):390-4. [Medline].

  12. Garson A, Smith RT Jr, Moak JP, et al. Incessant ventricular tachycardia in infants: myocardial hamartomas and surgical cure. J Am Coll Cardiol. Sep 1987;10(3):619-26. [Medline].

  13. Jebara VA, Uva MS, Farge A, et al. Cardiac pheochromocytomas. Ann Thorac Surg. Feb 1992;53(2):356-61. [Medline].

  14. Lund JT, Ehman RL, Julsrud PR, et al. Cardiac masses: assessment by MR imaging. AJR Am J Roentgenol. Mar 1989;152(3):469-73. [Medline].

  15. Sparrow PJ, Kurian JB, Jones TR, et al. MR imaging of cardiac tumors. Radiographics. Sep-Oct 2005;25(5):1255-76. [Medline].

  16. Reeder GS, Khandheria BK, Seward JB, et al. Transesophageal echocardiography and cardiac masses. Mayo Clin Proc. Nov 1991;66(11):1101-9. [Medline].

  17. Read RC, White HJ, Murphy ML, et al. The malignant potentiality of left atrial myxoma. J Thorac Cardiovasc Surg. Dec 1974;68(6):857-68. [Medline].

  18. Ferrans VJ, Roberts WC. Structural features of cardiac myxomas. Histology, histochemistry, and electron microscopy. Hum Pathol. Mar 1973;4(1):111-46. [Medline].

  19. Murphy MC, Sweeney MS, Putnam JB Jr, et al. Surgical treatment of cardiac tumors: a 25-year experience. Ann Thorac Surg. Apr 1990;49(4):612-7; discussion 617-8. [Medline].

  20. Michler RE, Goldstein DJ. Treatment of cardiac tumors by orthotopic cardiac transplantation. Semin Oncol. Oct 1997;24(5):534-9. [Medline].

  21. Basso C, Valente M, Poletti A, et al. Surgical pathology of primary cardiac and pericardial tumors. Eur J Cardiothorac Surg. Nov 1997;12(5):730-7; discussion 737-8. [Medline].

  22. Thomason R, Schlegel W, Lucca M, et al. Primary malignant mesothelioma of the pericardium. Case report and literature review. Tex Heart Inst J. 1994;21(2):170-4. [Medline].

  23. Balasundaram S, Halees SA, Duran C. Mesothelioma of the atrioventricular node: first successful follow-up after excision. Eur Heart J. May 1992;13(5):718-9. [Medline].

  24. Bhan A, Mehrotra R, Choudhary SK, et al. Surgical experience with intracardiac myxomas: long-term follow-up. Ann Thorac Surg. Sep 1998;66(3):810-3. [Medline].

  25. Butany J, Leong SW, Carmichael K, et al. A 30-year analysis of cardiac neoplasms at autopsy. Can J Cardiol. Jun 2005;21(8):675-80. [Medline].

  26. Jelic J, Milicic D, Alfirevic I, et al. Cardiac myxoma: diagnostic approach, surgical treatment and follow-up. A twenty years experience. J Cardiovasc Surg (Torino). Dec 1996;37(6 Suppl 1):113-7. [Medline].

  27. La Francesca S, Gregoric ID, Cohn WE, et al. Successful resection of a primary left ventricular schwannoma. Ann Thorac Surg. May 2007;83(5):1881-2. [Medline].

  28. McAllister HA Jr. Primary tumors and cysts of the heart and pericardium. Curr Probl Cardiol. May 1979;4(2):1-51. [Medline].

  29. Muzzi L, Davoli G, Specchia L, et al. Primary hemangioma of the mitral valve: an unusual presentation. J Heart Valve Dis. Mar 2007;16(2):209-11. [Medline].

  30. Nonami A, Takenaka K, Kamezaki K, et al. Successful treatment of primary cardiac lymphoma by rituximab-CHOP and high-dose chemotherapy with autologous peripheral blood stem cell transplantation. Int J Hematol. Apr 2007;85(3):264-6. [Medline].

  31. Padalino MA, Basso C, Milanesi O, et al. Surgically treated primary cardiac tumors in early infancy and childhood. J Thorac Cardiovasc Surg. Jun 2005;129(6):1358-63. [Medline].

  32. Paul S, Ramanathan T, Cohen DM, et al. Primary Ewing sarcoma invading the heart: resection and reconstruction. J Thorac Cardiovasc Surg. Jun 2007;133(6):1667-9. [Medline].

  33. Peregud-Pogorzelska M, Kazmierczak J, Wojtarowicz A. Intracavitary mass as the initial manifestation of primary pericardial mesothelioma: a case report. Angiology. Apr-May 2007;58(2):255-8. [Medline].

  34. Putnam JB Jr, Sweeney MS, Colon R, et al. Primary cardiac sarcomas. Ann Thorac Surg. Jun 1991;51(6):906-10. [Medline].

  35. Reynen K. Cardiac myxomas. N Engl J Med. Dec 14 1995;333(24):1610-7. [Medline].

  36. Silverman NA. Primary cardiac tumors. Ann Surg. Feb 1980;191(2):127-38. [Medline].

  37. Stern MJ, Cohen MV, Fish B, et al. Clinical presentation and non-invasive diagnosis of right heart masses. Br Heart J. Nov 1981;46(5):552-8. [Medline].

  38. Tatli S, Lipton MJ. CT for intracardiac thrombi and tumors. Int J Cardiovasc Imaging. Feb 2005;21(1):115-31. [Medline].

  39. Wold LE, Lie JT. Cardiac myxomas: a clinicopathologic profile. Am J Pathol. Oct 1980;101(1):219-40. [Medline].

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Further Reading

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Keywords

primary cardiac neoplasms, cardiac tumor, heart tumor, heart cancer, myxoma, Carney complex, atrial myxoma, intracardiac tumor mass, primary neoplasm, rhabdomyoma, fibroma, fibroelastoma, hemangioma, lipoma, teratoma, hamartoma, malignant tumor, benign tumor

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Contributor Information and Disclosures

Author

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Clarence Sarkodee-Adoo, MD, Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting

 
 
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