Tumours of the Heart

Tumours rarely involve the heart; secondary neoplasms (cardiac metastases from lung carcinoma, lymphoma, breast, hepatic, and kidney cancer) are much more frequent than primary neoplasms (20:1).

Ninety per cent of all primary cardiac tumours are benign. Myxoma, by far the most frequent benign tumour (70%), is typically located in the left atrium, and manifests with intracavitary obstruction, embolism, and constitutional symptoms but may also be silent and discovered incidentally by echocardiography. It is also observed in children. Papillary fibroelastoma is an endocardial papilloma, which although quite small, may become symptomatic through embolic events. Typical tumours of the paediatric age group are fibroma, rhabdomyoma, and teratoma.

Primary malignant neoplasms account for 10% of all primary cardiac tumours and are represented by sarcomas (angiosarcoma, leiomyosarcoma, fibrosarcoma, liposarcoma, rhabdomyosarcoma, undifferentiated pleomorphic sarcoma) and primary lymphomas. They usually infiltrate the cardiac walls, but may also be solely intracavitary, mimicking myxoma. Histology with immunohistochemistry of any cardiac mass is mandatory for diagnosis, therapy, and prognosis. Endomyocardial biopsy may be of help for histological investigation without thoracotomy. Malignancies may be cured with surgery and/or chemotherapy/radiotherapy.

Non-neoplastic masses may consist of thrombi and infections, which again can be identified by a thorough surgical pathology examination.

Cardiac non-invasive imaging through transthoracic and transoesophageal echocardiography easily detects heart masses. Cardiac magnetic resonance and computed tomography are helpful complementary investigations, for refining diagnosis and in the post-surgery follow-up.