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

Cardiac Sarcoma: Differential Diagnoses & Workup

Author: John H Raaf, MD, PhD, Professor, Department of Surgery, Case Western Reserve University
Coauthor(s): Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic, Billings, Montana; Heather N Raaf, MD, Chief Deputy Coroner, Cuyahoga County Coroner's Office (Retired)
Contributor Information and Disclosures

Updated: Mar 4, 2009

Differential Diagnoses

Angina Pectoris
Atrial Myxoma
Cardiomyopathy, Restrictive
Mediastinitis
Mesothelioma
Pericarditis, Constrictive

Other Problems to Be Considered

Because of the nonspecific presentation of cardiac sarcomas, the number of disease processes that should be considered in the differential diagnosis is vast (eg, bronchogenic carcinoma, congestive heart failure, atrial myxoma, pericarditis, pericardial tamponade, coronary insufficiency, mediastinitis, mesothelioma).

Workup

Imaging Studies

  • Advances in diagnostic techniques have facilitated accurate, noninvasive assessment of cardiac sarcomas.6
    • Echocardiography is the preferred diagnostic procedure for noninvasive imaging of cardiac tumors (2-dimensional and transesophageal echocardiography are complementary).7
    • CT scanning is useful in detecting cardiac lesions, documenting local invasion of adjacent structures, and defining the presence of lung or liver metastases.
    • MRI has the potential to define tumor location and surrounding anatomy and to detect response to chemotherapy.
    • Angiography can help assess coronary artery luminal status and document intracardiac and intravascular tumors as filling defects.
    • Chest radiography may exhibit generalized cardiomegaly or right-sided heart enlargement, widened mediastinum, hilar adenopathy, pulmonary congestion, or pleural effusion.

Other Tests

  • ECG
    • More than 75% of patients with cardiac sarcomas have abnormalities that are generally nonspecific on ECGs.
    • Myocardial tumors can cause arrhythmias or various degrees of heart block.
    • Nonspecific ST and T wave changes may be observed.
    • Pericardial lesions may cause tachycardia and decreased voltage.

Procedures

  • Pericardiocentesis allows cytologic examination and may relieve tamponade.
  • Endomyocardial biopsy provides tissue to use in diagnosis; however, this biopsy is not absolutely necessary preoperatively because tissue is obtained during surgical exploration.

Histologic Findings

Specific subtypes of cardiac sarcomas have characteristic gross and microscopic features (see Pathophysiology).

More on Cardiac Sarcoma

Overview: Cardiac Sarcoma
Differential Diagnoses & Workup: Cardiac Sarcoma
Treatment & Medication: Cardiac Sarcoma
Follow-up: Cardiac Sarcoma
Multimedia: Cardiac Sarcoma
References
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References

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  4. Zhang PJ, Brooks JS, Goldblum JR, Yoder B, Seethala R, Pawel B, et al. Primary cardiac sarcomas: a clinicopathologic analysis of a series with follow-up information in 17 patients and emphasis on long-term survival. Hum Pathol. Sep 2008;39(9):1385-95. [Medline].

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Further Reading

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Keywords

angiosarcoma, metastatic cardiac sarcoma, rhabdomyosarcoma, malignant schwannoma, mesothelioma, fibrosarcoma, malignant fibrous histiocytoma, heart tumor, heart sarcoma, heart malignancy, heart cancer, cancer

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Contributor Information and Disclosures

Author

John H Raaf, MD, PhD, Professor, Department of Surgery, Case Western Reserve University
John H Raaf, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Endocrine Surgeons, American College of Surgeons, American Society of Clinical Oncology, Central Surgical Association, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Coauthor(s)

Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic, Billings, Montana
Disclosure: Nothing to disclose.

Heather N Raaf, MD, Chief Deputy Coroner, Cuyahoga County Coroner's Office (Retired)
Heather N Raaf, MD is a member of the following medical societies: American Academy of Forensic Sciences and National Association of Medical Examiners
Disclosure: Nothing to disclose.

Medical Editor

Robert C Shepard, MD, FACP, Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International
Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
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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