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Medina Perez M, Lichtenberger JP, Huppmann AR, Gomez M, Ramirez Suarez KI, Foran A, Vaiyani D, White AM, Biko DM. Cardiac and Pericardial Neoplasms in Children: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230010. [PMID: 37561644 DOI: 10.1148/rg.230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Primary cardiac and pericardial neoplasms are rare in the pediatric population and can include both benign and malignant lesions. Rhabdomyomas, teratomas, fibromas, and hemangiomas are the most common benign tumors. The most common primary cardiac malignancies are soft-tissue sarcomas, including undifferentiated sarcomas, rhabdomyosarcomas, and fibrosarcomas. However, metastatic lesions are more common than primary cardiac neoplasms. Children with primary cardiac and pericardial tumors may present with nonspecific cardiovascular symptoms, and their clinical presentation may mimic that of more common nonneoplastic cardiac disease. The diagnosis of cardiac tumors has recently been facilitated using noninvasive cardiac imaging. Echocardiography is generally the first-line modality for evaluation. Cardiac MRI and CT are used for tissue characterization and evaluation of tumor size, extension, and physiologic effect. The varied imaging appearances of primary cardiac neoplasms can be explained by their underlying abnormality. Treatment of these lesions varies from conservative management, with spontaneous regression of some lesions such as rhabdomyomas, to surgical resection, particularly in patients with associated heart failure. With adequate imaging techniques and knowledge of the pathologic basis of the neoplasm, it is often possible to differentiate benign from malignant tumors, which can greatly affect adequate and timely treatment. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Mariangeles Medina Perez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - John P Lichtenberger
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Alison R Huppmann
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Mariangela Gomez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Karen I Ramirez Suarez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ann Foran
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Danish Vaiyani
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ammie M White
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - David M Biko
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
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2
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Khalilian MR, Shamsian BS, Baghaei Tehrani R, Kharaz L, Talebian N. Inflammatory myofibroblastic tumor of the pericardium in an 11-month-old infant: A case report. Clin Case Rep 2023; 11:e6949. [PMID: 36789298 PMCID: PMC9913176 DOI: 10.1002/ccr3.6949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Primary cardiac tumors are very rare in infants. Here we present an 11-month-old infant with a pericardial inflammatory myofibroblastic tumor who presented with symptoms of respiratory distress and cardiac tamponade. The tumor was surgically removed, and the patient received medical treatment; the patient had no problem with follow-up.
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Affiliation(s)
- Mohammad Reza Khalilian
- Department of Pediatrics, School of Medicine, Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Bibi Shahin Shamsian
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Childern's HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Ramin Baghaei Tehrani
- Cardiac Surgery, Modarres Hospital, School of MedicineShahid Beheshti University of Medical sciencesTehranIran
| | - Ladan Kharaz
- Department of Pediatrics, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Niki Talebian
- Department of Pediatrics, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
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Zhu LK, Li ZJ, Wang ZB, Chen JT, Zhang HJ, Zhao XW, Liu HY. A rare case of bladder cancer that metastasized to brain, heart, and lung lymph nodes benefited from immunotherapy. World J Surg Oncol 2022; 20:402. [PMID: 36529739 PMCID: PMC9762084 DOI: 10.1186/s12957-022-02876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Bladder cancer is a common malignant tumor of the genitourinary system, with the primary cause of death being metastasis. The most common metastatic sites are the lymph nodes, liver, lung, bone, peritoneum, pleura, kidney, adrenal gland, and the intestine. Brain and heart metastases are rare. In this report, we describe a patient who had pulmonary lymph node metastases more than a year after being diagnosed with bladder cancer, followed by brain and cardiac metastases more than two years later. Following the failure of standard first-line chemotherapy, the patient accepted 6 cycles of tislelizumab immunotherapy. The re-examination revealed that the bilateral frontal brain metastases had vanished, the right temporal lobe metastases had been greatly decreased, the neurological symptoms had been alleviated, and the cardiac metastases had disappeared. This is a rare clinical case with encouraging effects of tislelizumab and can serve as a model for the treatment of similar patients.
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Affiliation(s)
- Lian-kai Zhu
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Zhong-jian Li
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Zhi-bo Wang
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Jin-tao Chen
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Hua-jun Zhang
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Xu-wei Zhao
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Hong-yao Liu
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
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Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.
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5
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Faim D, Francisco A, Pires A. Cardiac tumours in children: a single-centre experience and literature review. Cardiol Young 2022; 32:1-10. [PMID: 35225200 DOI: 10.1017/s1047951122000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac tumours are extremely rare in children. Although more than 90% are benign, children can develop obstructive or embolisation derived symptoms, arrhythmias, constitutional symptoms, cardiac tamponade, or even sudden death. Although the majority are asymptomatic, and some spontaneously regress, appropriate follow-up is needed on a case-by-case basis, as patients may develop late symptoms. Definitive diagnosis is only possible through histological analysis; however, it is possible to infer tumour type with a high grade of certainty based on imaging features, particularly cardiac magnetic resonance. Surgical resection is advocated for those causing symptoms, obstruction, cardiac dysfunction, and high risk of embolisation. The aim of this review is to present the state of the art related to cardiac tumours in the paediatric population, in the context of our own experience.
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Affiliation(s)
- Diogo Faim
- Department of Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreia Francisco
- Department of Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pires
- Department of Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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6
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Surgical Treatment of Primary Cardiac Tumors in Children Systematic Review and Meta-analysis. Pediatr Cardiol 2022; 43:251-266. [PMID: 35113182 DOI: 10.1007/s00246-022-02814-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
This systematic review sought to investigate the current evidence regarding surgical management of primary cardiac tumors in children. Twenty-four studies were deemed eligible, reporting on 713 pediatric patients. Cumulative 30-day mortality rate was 5.5% and 7.5% after surgery. It was revealed a statistically lower mortality rate in the group of patients below 1 year of age, justifying a more aggressive surgical approach for primary cardiac tumors, except for rhabdomyoma that can regress spontaneously.
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Gatti M, D’Angelo T, Muscogiuri G, Dell'aversana S, Andreis A, Carisio A, Darvizeh F, Tore D, Pontone G, Faletti R. Cardiovascular magnetic resonance of cardiac tumors and masses. World J Cardiol 2021; 13:628-649. [PMID: 34909128 PMCID: PMC8641001 DOI: 10.4330/wjc.v13.i11.628] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/19/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses diagnosis and treatment are a true challenge, although they are infrequently encountered in clinical practice. They encompass a broad set of lesions that include neoplastic (primary and secondary), non-neoplastic masses and pseudomasses. The clinical presentation of cardiac tumors is highly variable and depends on several factors such as size, location, relation with other structures and mobility. The presumptive diagnosis is made based on a preliminary non-invasive diagnostic work-up due to technical difficulties and risks associated with biopsy, which is still the diagnostic gold standard. The findings should always be interpreted in the clinical context to avoid misdiagnosis, particularly in specific conditions (e.g., infective endocarditis or thrombi). The modern multi-modality imaging techniques has a key role not only for the initial assessment and differential diagnosis but also for management and surveillance of the cardiac masses. Cardiovascular magnetic resonance (CMR) allows an optimal non-invasive localization of the lesion, providing multiplanar information on its relation to surrounding structures. Moreover, with the additional feature of tissue characterization, CMR can be highly effective to distinguish pseudomasses from masses, as well as benign from malignant lesions, with further differential diagnosis of the latter. Although histopathological assessment is important to make a definitive diagnosis, CMR plays a key role in the diagnosis of suspected cardiac masses with a great impact on patient management. This literature review aims to provide a comprehensive overview of cardiac masses, from clinical and imaging protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Messina 98100, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan 20149, Italy
| | | | | | - Andrea Carisio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Italy
| | - Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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Relan J, Swami M, Rana A, Chaudhary P, Ojha V, Devarapalli S, Dadhwal V, Verma A, Jagia P, Saxena A. Prenatal Pericardiocentesis and Postnatal Sirolimus for a Giant Inoperable Cardiac Rhabdomyoma. JACC Case Rep 2021; 3:1473-1479. [PMID: 34746849 PMCID: PMC8551506 DOI: 10.1016/j.jaccas.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/11/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
We describe the case of an antenatally diagnosed massive cardiac tumor in a fetus requiring cardiorespiratory support immediately following birth. We further discuss the successful management of this case and highlight the importance of a multidisciplinary team in managing such complicated cases. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Swami
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anubhuti Rana
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Chaudhary
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sowmya Devarapalli
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Verma
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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9
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Chen XQ, Wang YY, Zhang MN, Lu Q, Pang LY, Liu LY, Li YF, Zou LP. Sirolimus Can Increase the Disappearance Rate of Cardiac Rhabdomyomas Associated with Tuberous Sclerosis: A Prospective Cohort and Self-Controlled Case Series Study. J Pediatr 2021; 233:150-155.e4. [PMID: 33631166 DOI: 10.1016/j.jpeds.2021.02.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the efficacy and safety of sirolimus in the treatment of cardiac rhabdomyomas associated with tuberous sclerosis complex and the specific benefits in different subgroups. STUDY DESIGN The study was a prospective cohort and self-controlled case series study. Based on the prevalence of cardiac rhabdomyoma at different ages, we estimated the natural tumor disappearance rate. The subgroup analysis was done by Cox regression. Self-controlled case series method was used to assess the magnitude and duration of the drug effect. Adverse events were described. RESULTS A total of 217 patients were included in the cohort study. Tumor disappearance rate was higher in younger age groups (hazard ratio = 0.99, P = .027) and female patients (hazard ratio = 2.08, P = .015). The age-adjusted incidence ratio showed that the disappearance of rhabdomyomas between 3 and 6 months was more related to sirolimus. Adverse events were observed 60 times in 42 of 217 children, mainly stomatitis. CONCLUSIONS Sirolimus can increase the disappearance rate of cardiac rhabdomyoma in the tuberous sclerosis complex population. Efficacy varies by sex and age: female and younger patients have higher tumor disappearance rate. Sirolimus is well-tolerated.
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Affiliation(s)
- Xiao-Qiao Chen
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Pediatrics, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Yang-Yang Wang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Meng-Na Zhang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Lu
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling-Yu Pang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li-Ying Liu
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Neurology, Beijing Jingdu Children's Hospital, Beijing, China
| | - Yu-Fen Li
- Department of Pediatrics, Shandong Linyi People's Hospital, Linyi, China
| | - Li-Ping Zou
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.
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10
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Ding P, Qi J, Mo R, Sun J, Pen W, Wu K, Qian L, Mo X. Clinical Treatment of Pediatric Primary Cardiac Tumors: A Single-Institute 12-Year Experience. J Pediatr Hematol Oncol 2020; 42:488-494. [PMID: 31162296 DOI: 10.1097/mph.0000000000001520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary cardiac tumors in children are extremely rare. This study aimed to analyze clinical treatment and follow-up of pediatric primary cardiac tumors. PATIENTS AND METHODS We performed a retrospective analysis by searching the medical records of 75 patients diagnosed with pediatric primary cardiac tumors from June 2005 to August 2017 in our institution. We followed operative patients every half year in the first postoperative year and then at least every year. If the patients had no serious symptoms or hemodynamic changes, they received nonoperative management and were followed regularly every year. RESULTS Nineteen patients underwent surgery at our department for serious symptoms and critical hemodynamic changes. Four patients had postoperative complications. Two died of low cardiac output syndrome and arrhythmia after surgery. One patient with myxomas had tumor recurrence and one had been found of another rhabdomyoma after surgery. The other 14 patients recovered well. Fifty-six patients had nonoperative management. Four were lost in follow-up. Two patients with malignant tumors died of unknown causes after discharge. The remaining patients had no severe symptoms or tumor growth during follow-up. CONCLUSIONS Clinical treatment of pediatric primary cardiac tumors should be performed individually. Most pediatric primary cardiac tumors are benign, and spontaneous regression is possible, especially for rhabdomyomas. The principle purpose of surgical treatment is to restore normal hemodynamics and protect important structures and cardiac tissue.
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Affiliation(s)
- Peicheng Ding
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Jirong Qi
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Ran Mo
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School of Nanjing University, Nanjing, China
| | - Jian Sun
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Wei Pen
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Kaihong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Longbao Qian
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
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11
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Casavecchia G, Lestuzzi C, Gravina M, Corrado G, Tusa M, Brunetti ND, Manuppelli V, Monte IP. Cardiac Tumors. J Cardiovasc Echogr 2020; 30:S45-S53. [PMID: 32566466 PMCID: PMC7293869 DOI: 10.4103/jcecho.jcecho_7_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/16/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
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Affiliation(s)
| | - Chiara Lestuzzi
- Department of Cardiology, Aviano Hospital, Pordenone, Aviano, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Maurizio Tusa
- Department of Cardiology, Milano San Donato Hospital, Milano, Italy
| | | | | | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
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12
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Olaya-C M, Franco JA, Messa OA. Symptomatic and lethal congenital primary cardiac rhabdomyoma. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2019-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Congenital tumors, including mesenchymal rhabdomyoma, are highly infrequent. The combination of a congenital tumor and rhabdomyoma is rarer yet, even more so when primary origin is in the heart.
Case presentation
We present a case of fetal hydrops fetalis, wherein the post-mortem exam revealed a cardiac tumor more than twice the size of the heart itself; histological study confirmed primary rhabdomyoma involving the left ventricle.
Conclusion
It is essential to keep in mind that fetal tumors should always be differentiated from malformations; in fetuses tissue immaturity must be taken into account for categorization; despite benign labeling, they can be lethal.
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Affiliation(s)
- Mercedes Olaya-C
- Pontificia Universidad Javeriana , Department of Pathology , Bogota , Colombia
- Hospital Universitario San Ignacio , Department of Pathology , Bogota , Colombia
| | - Jorge Andres Franco
- Pontificia Universidad Javeriana , Department of Morphology , Bogota , Colombia
| | - Oscar Alberto Messa
- Pontificia Universidad Javeriana , Department of Pathology , Bogota , Colombia
- Hospital Universitario San Ignacio , Department of Pathology , Bogota , Colombia
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Wu C, Wang Y, Su W, Xia J, Dong N, Wang G. Cardiac rhabdomyomas with atrial septal defect and tricuspid insufficiency: A case report. J Card Surg 2019; 34:1123-1126. [PMID: 31374583 DOI: 10.1111/jocs.14191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary cardiac tumors are very rare and generally benign. The most common type, cardiac rhabdomyoma, comprises 45% to 75% of primary cardiac tumors. Cardiac rhabdomyoma is a rare benign tumor that commonly presents with tuberous sclerosis. We present a case of an infant with multifocal cardiac rhabdomyomas with an atrial septal defect and tricuspid insufficiency and no sign of tuberous sclerosis. She was successfully treated with an operation, the treatment plan included mass resection, tricuspid annuloplasty, and closure of the patent foramen ovale. The right atrial lesion was resected entirely, while the lobulated lesion in the right ventricle was resected as two pieces. There was no evidence of recurrence 1 year after the surgery.
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Affiliation(s)
- Chuangyan Wu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Su
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahong Xia
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Cavalcante CTDMB, Pinto Junior VC, Pompeu RG, Teles ACDO, Bandeira JA, Maia ICL, Tavora FRF, Cavalcante MB, Zamarian ACP, Araujo Júnior E, Castello Branco KM. Perinatal unusual rhabdomyoma location - case report and systematic reviews of the literature. J Matern Fetal Neonatal Med 2019; 34:137-151. [PMID: 30895836 DOI: 10.1080/14767058.2019.1597044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To report a case of prenatal diagnosis of cardiac rhabdomyoma (CR) and neonatal surgical treatment as well as undertaking a systematic review of the literature to determine most frequent localization of CR, common signs and symptoms, associated pathologies, incidence of surgery, and prognoses for CR.Methods: We conducted systematic review of the literature on CR that were diagnosed and treated in the perinatal period, searching for English language articles in the PubMed/Medline database that were published within the past 20 years, using the following search terms: "cardiac rhabdomyoma"; "neonates"; "newborn"; "surgery".Results: Eighty-two studies were selected, but only 46 studies met the inclusion criteria. After birth, the majority of newborns were asymptomatic; however, murmurs and arrhythmia were also the two most prevalent signs of CR. The most prevalent location was the ventricles, corresponding to 40.3% of all cases, with 53% of these having a rhabdomyoma in the left ventricle. The incidence of multiple tumors was 56%, and in those cases the location of tumors was also most common in the ventricles. Tuberous sclerosis was the most commonly associated pathology, being present in 72% of cases of CR. Surgical treatment occurred in 27% of cases, and 3% of cases required surgery and prostaglandin. Regarding the perinatal outcome, 6% of cases resulted in fetal or neonatal death.Conclusion: CR are benign tumors which tend to spontaneously regress during early childhood but may have unfavorable outcomes in the presence of obstructive lesions and arrhythmias. Surgery is generally necessary in symptomatic patients.
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Affiliation(s)
| | | | - Ronald Guedes Pompeu
- Pediatric Cardiac Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | | | - Jeanne Araújo Bandeira
- Pediatric Cardiac Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | | | | | | | - Ana Cristina Perez Zamarian
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Klebia Magalhães Castello Branco
- Pediatric Cardiac Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.,Postgraduation Program in Organ Transplantation, State University of Ceará (UECE), Fortaleza, Brazil
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16
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Koç M, Kutsal A. Rare operations in pediatric heart surgery: Cardiac tumors in childhood. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:544-549. [PMID: 32082795 PMCID: PMC7018197 DOI: 10.5606/tgkdc.dergisi.2018.16147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/05/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In this study, we present our 12-year experience in the surgical treatment of primary cardiac tumors in childhood. METHODS Thirteen pediatric patients (8 males, 5 females; mean age 1.3±1.9 years; range, 3 days to 6 years) who were operated for a primary cardiac tumor in our center between January 2005 and December 2017 were included in this study. The data were evaluated retrospectively based on our medical records. RESULTS All of the masses resected were benign. However, the most common tumor was rhabdomyoma (n=7), followed by fibroma (n=3), myxoma (n=2), and pericardial teratoma (n=1). The mortality rate was 15.4%, as two patients died in the early postoperative period. No residual mass or tumor recurrence was observed in the early and late postoperative period in the remaining patients. CONCLUSION Although primary cardiac tumors in childhood are usually benign, they may cause clinically significant problems depending on the localization and size of the tumor. Surgical tumor excision is often associated with good long-term outcomes.
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Affiliation(s)
- Murat Koç
- Department of Cardiovascular Surgery, Dr. Sami Ulus Maternity and Children?s Training and Research Hospital, Ankara, Turkey
| | - Ali Kutsal
- Department of Cardiovascular Surgery, Dr. Sami Ulus Maternity and Children?s Training and Research Hospital, Ankara, Turkey
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Asakai H. Ventricular fibromas in children: Surgical resection can be a cure to lethal arrhythmias. Heart Rhythm 2018; 15:1513-1514. [DOI: 10.1016/j.hrthm.2018.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Indexed: 10/28/2022]
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Chen R, Deng X, Luo J, Huang P. Calcified inferior vena cava and right atrial myxoma in an 18-month-old male: A case report. Medicine (Baltimore) 2018; 97:e11073. [PMID: 29924000 PMCID: PMC6034566 DOI: 10.1097/md.0000000000011073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cardiac myxomas are the most frequent primary cardiac tumor in adults. The incidence in pediatric patients is extremely low. Heavy calcification of an atrial myxoma is uncommon in children. CASE PRESENTATION An 18-month-old boy was admitted for a significant precordial systolic murmur. Transthoracic echocardiography revealed a cardiac mass extending from the inferior vena cava across the right atrium and tricuspid valve into the right ventricle with severe tricuspid regurgitation. According to the echocardiography result, the patient was diagnosed with an inferior vena cava and right atrial tumor with tricuspid regurgitation. After the diagnosis, the patient underwent removal of the tumor via median sternotomy. The mass was removed under cardiopulmonary bypass with deep hypothermia circulatory arrest. The tricuspid valve was repaired by valvuloplasty and annuloplasty. The postoperative recovery was unremarkable. Follow-up echocardiogram at 1 month revealed moderate tricuspid regurgitation without myxoma recurrence. CONCLUSION Heavy calcification of an atrial myxoma is uncommon especially in children. Definitive therapy for myxomas requires prompt surgical excision and long-term follow-up is recommended in children although recurrence after excision is rare.
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Affiliation(s)
- Renwei Chen
- Department of Cardiothoracic Surgery, Maternal and Child Health Hospital of Hainan Province (Hainan Children's Hospital), Haikou, Hainan
| | - Xicheng Deng
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, Hunan, China
| | - Jinwen Luo
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, Hunan, China
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, Hunan, China
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Syed AU, Al Mutairi MB, Al Muhaya M, Morsey M, Al Hujailey A, al Najjar A. Inflammatory myofibroblastic tumor of heart in a 4-month-old infant. Asian Cardiovasc Thorac Ann 2017; 26:47-49. [DOI: 10.1177/0218492317739474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary tumors of heart are rare in infants. We report a case of inflammatory myofibroblastic tumor in a 4-month-old baby girl who presented with a massive pericardial effusion. She underwent complete surgical excision of the tumor. This is the first reported case from the Middle Eastern region. The clinical behavior and management of these rare infantile cardiac tumors are discussed briefly in this report.
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Affiliation(s)
- Aitizaz U Syed
- Pediatric Cardiac Services, Madinah Cardiac Center, Madinah Munawarrah, Saudi Arabia
| | - Mansour B Al Mutairi
- Pediatric Cardiac Services, Madinah Cardiac Center, Madinah Munawarrah, Saudi Arabia
| | - Mustafa Al Muhaya
- Pediatric Cardiac Services, Madinah Cardiac Center, Madinah Munawarrah, Saudi Arabia
| | - Mofeed Morsey
- Pediatric Cardiac Services, Madinah Cardiac Center, Madinah Munawarrah, Saudi Arabia
| | - Ahmed Al Hujailey
- Department of Pathology, King Fahad Hospital, Madinah Munawarrah, Saudi Arabia
| | - Abdulhameed al Najjar
- Pediatric Cardiac Services, Madinah Cardiac Center, Madinah Munawarrah, Saudi Arabia
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20
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Tzani A, Doulamis IP, Mylonas KS, Avgerinos DV, Nasioudis D. Cardiac Tumors in Pediatric Patients: A Systematic Review. World J Pediatr Congenit Heart Surg 2017; 8:624-632. [DOI: 10.1177/2150135117723904] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This systematic review sought to investigate the current evidence regarding surgical management of primary cardiac tumors in children and adolescents. Twenty-eight studies were deemed eligible, reporting on 745 pediatric patients. Rhabdomyoma was the most prevalent histologic type and echocardiography was the most common diagnostic tool. Cumulative 30-day mortality rate was 6.7%. Rhabdomyomas and teratomas had the highest 30-day mortality. The higher percentage of tumor relapse was noted for myxoma and teratoma. Although cardiac tumors are rare, their atypical clinical presentation, potential for recurrence, and the poor prognosis associated with recurrence elucidate the need for reliable diagnostic and therapeutic management.
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Affiliation(s)
- Aspasia Tzani
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Konstantinos S. Mylonas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Division of Pediatric Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dimitrios V. Avgerinos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Cardiothoracic Surgery, New York Presbyterian Medical Center, Weill Cornell College of Medicine, New York, NY, USA
| | - Dimitrios Nasioudis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Rhabdomyoma is a well characterised entity in a neonate. Herein, we report a massive biventricular rhabdomyoma in a neonate presenting with cyanosis and congestive heart failure which was confirmed on autopsy. The report is for documentation of an unusually large tumour.
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Affiliation(s)
| | - Rimlee Dutta
- Department of Pathology, AIIMS, New Delhi, India
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22
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Han X, Song H, Zhou L, Jiang C. Surgical resection of right ventricular rhabdomyoma under the guidance of transesophageal echocardiography on a beating heart. J Thorac Dis 2017; 9:E215-E218. [PMID: 28449506 DOI: 10.21037/jtd.2017.02.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cardiac rhabdomyoma, a type of benign myocardial tumor, is regarded as the most common fetal cardiac tumor. Rhabdomyomas are usually found before birth or during the first year of life. It is widely accepted that rhabdomyomas are strongly associated with tuberous sclerosis, and tend to regress spontaneously without surgical excision. However, if the tumor has caused significant obstruction or refractory arrhythmias, the surgery should be advocated. Most of the surgeries for pediatric cardiac tumors are performed under cardiopulmonary bypass (CPB) with cardioplegia. Here, we present a case of successful resection of a right ventricular rhabdomyoma obstructing the right ventricular outflow tract (RVOT) and involving pulmonary valve annulus in an infant, performed under the guidance of transesophageal echocardiography (TEE) on a beating heart.
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Affiliation(s)
- Xueguang Han
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Haibo Song
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Li Zhou
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chunling Jiang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Delmo Walter EM, Javier MF, Sander F, Hartmann B, Ekkernkamp A, Hetzer R. Primary Cardiac Tumors in Infants and Children: Surgical Strategy and Long-Term Outcome. Ann Thorac Surg 2016; 102:2062-2069. [DOI: 10.1016/j.athoracsur.2016.04.057] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 12/12/2022]
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24
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Bao M, Zheng C, Zhang H, Ruan Y, Cao A, Wu T, Luo YI. Inflammatory myofibroblastic tumor of the left atrium in infant. Int J Cardiol 2016; 222:965-967. [DOI: 10.1016/j.ijcard.2016.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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25
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Ying L, Lin R, Gao Z, Qi J, Zhang Z, Gu W. Primary cardiac tumors in children: a center's experience. J Cardiothorac Surg 2016; 11:52. [PMID: 27067427 PMCID: PMC4827228 DOI: 10.1186/s13019-016-0448-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/04/2016] [Indexed: 11/06/2022] Open
Abstract
Background Cardiac tumors which may induce sudden death are rare entities with an autopsy frequency of 0.001–0.030 %. This study aims to analyze the characteristics and outcome of pediatric patients with primary cardiac tumors treated in our center. Methods Sixteen patients with primary cardiac tumors treated at our center between January 2000 and December 2014 were included into this retrospective review. The patients’ age ranged from 1 day to 13 years (mean age, 46 months), with weight ranging from 3.2 to 45 kg (mean weight 17.5 kg). All patients were diagnosed by echocardiography, magnetic resonance imaging and computed tomography. Results We did complete resection of the mass in 15 patients with cardiopulmonary bypass (CPB), whereas partial resection was done in one patient. Fifteen children recovered well, and one patient died of low cardiac output syndrome at 5 days after operation. Rhabdomyoma was the most frequent tumor type, followed by myxoma, fibroma, hemangioma; No malignant tumors were found. Conclusions Echocardiography has provided consistent assessment of anatomy and function. Complete surgical resection is valuable treatment for cardiac mass when detected even in asymptomatic patients. Rhabdomyoma is the most frequent tumor type, followed by myxoma and fibroma.
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Affiliation(s)
- Liyang Ying
- Department of Cardiac Surgery Children's Hospital, Zhejiang University School of Medicine, Binsheng Load 3333#, Hangzhou, 310003, PR China
| | - Ru Lin
- Department of Cardiac Surgery Children's Hospital, Zhejiang University School of Medicine, Binsheng Load 3333#, Hangzhou, 310003, PR China
| | - Zhan Gao
- Department of Cardiac Surgery Children's Hospital, Zhejiang University School of Medicine, Binsheng Load 3333#, Hangzhou, 310003, PR China
| | - Jianchuan Qi
- Department of Cardiac Surgery Children's Hospital, Zhejiang University School of Medicine, Binsheng Load 3333#, Hangzhou, 310003, PR China.
| | - Zewei Zhang
- Department of Cardiac Surgery Children's Hospital, Zhejiang University School of Medicine, Binsheng Load 3333#, Hangzhou, 310003, PR China
| | - Weizhong Gu
- Department of Pathology Children's Hospital, Zhejiang University School of Medicine, Binsheng Load 3333#, Hangzhou, 310003, PR China
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Mongé MC, Walterhouse DO, Kalapurakal JA, Rigsby CK, Backer CL. Resection of Intrapericardial Rhabdomyosarcoma in a Child. World J Pediatr Congenit Heart Surg 2015; 7:108-11. [PMID: 26715004 DOI: 10.1177/2150135115581387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe successful surgical resection of an intrapericardial rhabdomyosarcoma, which was accomplished with the aid of cardiopulmonary bypass, in a three-year-old girl. The patient completed adjuvant chemoradiotherapy and has no evidence of disease at one-year follow-up.
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Affiliation(s)
- Michael C Mongé
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David O Walterhouse
- Division of Hematology/Oncology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cynthia K Rigsby
- Division of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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27
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Treatment Strategies for Primary Tumors of the Heart in Children: A 10-Year Experience. Ann Thorac Surg 2015; 100:1744-9. [DOI: 10.1016/j.athoracsur.2015.06.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022]
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Linnemeier L, Benneyworth BD, Turrentine M, Rodefeld M, Brown J. Pediatric Cardiac Tumors. World J Pediatr Congenit Heart Surg 2015; 6:215-9. [DOI: 10.1177/2150135114563938] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Cardiac tumors in children are rare. Of the cases reported in the literature, nearly all are benign and managed conservatively. Methods: This is a retrospective, observational study of pediatric patients <18 years who presented for surgical evaluation of a cardiac tumor, between 1969 and 2014 at a tertiary care children’s hospital. Presentation, pathology, management, and outcomes were evaluated. Results: Over the last 45 years, 64 patients were evaluated for surgical resection of a cardiac tumor. Rhabdomyoma was the most common neoplasm (58%), and 17% of the tumors had malignant pathologies. While 42% of benign cardiac neoplasms required surgical intervention for significant hemodynamic concerns, 73% of malignant neoplasms underwent radical excision, if possible, followed by adjuvant chemotherapy. Despite a 37% mortality in patients with malignant pathology, an aggressive surgical approach can yield long-term survival in some patients. There were no deaths among patients with benign tumors and 17% had postoperative complications mostly related to mitral regurgitation. Conclusion: Cardiac tumors in children are rare but can be managed aggressively with good outcomes. Benign tumors have an excellent survival with most complications related to tumor location. Malignant tumors have a high mortality rate, but surgery and adjuvant chemotherapy allow for prolonged survival in selected patients.
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Affiliation(s)
- Laura Linnemeier
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brian D. Benneyworth
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Turrentine
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Rodefeld
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John Brown
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Hoffmeier A, Sindermann JR, Scheld HH, Martens S. Cardiac tumors--diagnosis and surgical treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:205-11. [PMID: 24717305 DOI: 10.3238/arztebl.2014.0205] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary tumors of the heart are rare even in major cardiac surgery centers. Because of the low case numbers, there is an insufficient evidence base to determine the optimal treatment, particularly for malignant tumors. METHOD The authors review the pertinent literature retrieved by a selective PubMed search on the terms "cardiac tumor," "heart tumor," "cardiac myxoma," and "cardiac sarcoma." They also present operative techniques and their own long-term results in 181 patients with cardiac tumors. RESULTS Patients with cardiac tumors generally have nonspecific symptoms depending on the site of the tumor and the extent of infiltration into the neighboring tissue. The diagnosis is based on the clinical history, echocardiography (in most cases), and, sometimes, computerized tomography and magnetic resonance imaging. Autopsy studies reveal a 0.02% prevalence of cardiac tumors, of which 75% are benign and 25% malignant. Myxoma is the most common benign tumor (50-70%); angiosarcoma is the most common malignant one (30%), followed by rhabdomyosarcoma (20%). About 10% of all tumor patients develop cardiac metastases, but these are only rarely clinically manifest. From 1989 to 2012, 181 patients underwent surgery for cardiac tumors in the authors' institution. The 5-year survival rates were 83% for benign tumors (139 patients), 30% for malignant tumors (26 patients), and 26% for cardiac metastases (16 patients). CONCLUSION Patients with cardiac tumors should undergo surgery in a timely fashion in a specialized center. This holds for both malignant and benign tumors, particularly for atrial myxoma, which can cause serious secondary complications by embolization.
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Affiliation(s)
- Andreas Hoffmeier
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital of Münster
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30
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Tao TY, Yahyavi-Firouz-Abadi N, Singh GK, Bhalla S. Pediatric Cardiac Tumors: Clinical and Imaging Features. Radiographics 2014; 34:1031-46. [DOI: 10.1148/rg.344135163] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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31
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Abstract
We report the case of a large congenital rhabdomyoma of the interventricular septum diagnosed prenatally. The foetus was strictly monitored with ultrasound throughout the gestation period showing that the mass had increased in size until delivery. Despite the size of the mass, which appeared to occupy the right ventricle, the baby presented no symptoms both in utero and after birth. Serial echocardiography was used to document the regression of the mass in childhood.
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Abstract
Primary cardiac tumours in infants and children are extremely rare, with an estimated incidence of 0.2% according to echocardiographic studies. Owing to their rarity, there is very little literature available, and most knowledge is based on collections of case reports. Therefore, we reviewed retrospectively our 27 years of clinical experience on the overall management of cardiac tumours among children in order to improve not only our knowledge but also to provide others with information about the incidence, clinical presentation, management, and long-term outcome of this rare disease. Between April, 1982 and April, 2009, 52 children were diagnosed with cardiac tumours at our Institution. Medical records and follow-up echocardiographic evaluations were studied. The diagnosis was prenatal in 35% of the patients. The most frequent tumour types were rhabdomyomas (61.5%), fibromas (15.4%), and myxomas (5.8%). There were no cases of primary malignant tumours. All diagnoses were achieved using two-dimensional echocardiography, and for 12 patients a pathological analysis was carried out. A total of 41 patients (79%) were managed medically, whereas 11 (21%) patients underwent surgical treatment. At a mean follow-up of 7.2 ± 5.4 years, two patients died of complications related to cardiac transplantation; all the remaining patients are in excellent clinical condition. In conclusion, cardiac tumours in paediatric practice are usually clinically and histologically benign. Only a few cases need surgery. Up to one-third of the cardiac masses are detectable prenatally. Rhabdomyoma is the most common histotype, followed by fibroma and myxoma. The long-term prognosis is generally good.
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33
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A child with purulent pericarditis and Streptococcus intermedius in the presence of a pericardial teratoma: an unusual presentation. J Thorac Cardiovasc Surg 2013; 147:e23-4. [PMID: 24373623 DOI: 10.1016/j.jtcvs.2013.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/11/2013] [Indexed: 11/23/2022]
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34
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Giménez Roca C, Felipe Villalobos A, Cambra Lasaosa F, Prada Martínez F, Caffarena Calvar J, Jou Muñoz C. Fiebre, astenia, mialgia y soplo por mixoma cardíaco. An Pediatr (Barc) 2013; 79:257-60. [DOI: 10.1016/j.anpedi.2013.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/21/2013] [Accepted: 02/23/2013] [Indexed: 11/25/2022] Open
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35
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Nield LE, Mendelson M, Ahmad N, Manlhiot C, Jaeggi ET, McCrindle BW. Clinical Review of Obstructive Primary Cardiac Tumors in Childhood. CONGENIT HEART DIS 2013; 9:244-51. [DOI: 10.1111/chd.12134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Lynne E. Nield
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Michael Mendelson
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Nauman Ahmad
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Cedric Manlhiot
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Edgar T. Jaeggi
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Brian W. McCrindle
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
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36
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Weiss SL, Russell HM, Lay A, Backer CL. Calcified right atrial myxoma in an adolescent. World J Pediatr Congenit Heart Surg 2013; 2:523-5. [PMID: 23804011 DOI: 10.1177/2150135111405857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Images are presented of a 14-year-old patient with chest pain discovered to have a calcified mass overlying the cardiac silhouette on lateral chest radiograph. Further imaging led to a diagnosis of a right atrial myxoma, which was surgically excised. While cardiac neoplasms are typically diagnosed with advanced imaging, the tendency for myxomas to calcify may allow for detection on plain radiographs.
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Affiliation(s)
- Scott L Weiss
- Division of Critical Care Medicine, Department of Pediatrics, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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37
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Navarini S, Latzin P, Kadner A, Carrel T, Hutter D. Giant cardiac fibroma: an unusual cause of failure to thrive. Pediatr Cardiol 2013; 34:1264-6. [PMID: 22644413 DOI: 10.1007/s00246-012-0374-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/08/2012] [Indexed: 11/29/2022]
Abstract
Cardiac fibromas are extremely rare in the general pediatric population and may present with a wide spectrum of clinical signs, including life-threatening arrhythmias and sudden death. We report a 14-month-old boy who presented with failure to thrive as the only symptom. Echocardiography showed a large cardiac fibroma in the right ventricle. Cardiac magnetic resonance imaging confirmed the diagnosis. After complete surgical tumor resection, the boy showed normal catch-up growth. This case underlines the diversity of clinical features of cardiac tumors, which implies that they should be considered early in the differential diagnosis of infants with failure to thrive.
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Affiliation(s)
- Susanne Navarini
- Division of Pediatric Cardiology, University Children's Hospital of Berne, Berne, Switzerland
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38
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Davis JS, Allan BJ, Perez EA, Neville HL, Sola JE. Primary pediatric cardiac malignancies: the SEER experience. Pediatr Surg Int 2013; 29:425-9. [PMID: 23358917 DOI: 10.1007/s00383-013-3261-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE Pediatric cardiac malignancies are exceedingly rare. We sought to examine demographics, presentation, and outcomes for this pathology. METHODS The SEER registry from 1973 to 2008 was queried for all patients <20 years of age with cardiac malignancies. RESULTS A total of 25 pediatric patients were identified with primary cardiac malignancies, with age-adjusted incidence of 0.00686 per 100,000 United States population. Median age at diagnosis was 10 years. The majority of patients were adolescent (n = 13, 52 %), Caucasian (n = 17, 68 %) and males (n = 14, 56 %). The most common histology was soft tissue sarcoma (n = 10, 40%), followed by non-Hodgkin lymphoma and teratoma (both n = 3, 12 %). Six patients presented with distant disease. More than half of patients (n = 16, 64 %) underwent surgical resection, while four patients (16 %) underwent radiation. The mean survival time for the cohort was 47 ± 67 months, with 14 (56 %) patients dying over the study period. Lymphomas had significantly longer survival than other malignancies (108 ± 66 vs. 36 ± 66, p = 0.03), while lack of surgical treatment was associated with worse survival (p = 0.016). CONCLUSIONS Primary malignant cardiac tumors are exceedingly rare in pediatric patients. They are most commonly soft tissue sarcomas and lymphomas demonstrated longer survival.
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Affiliation(s)
- James S Davis
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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39
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Pucci A, Botta G, Sina N, Tibaldi M, Valori A, Grosso E, Zonta A, Giudici M, Agnoletti G, Bergamasco L, Abbruzzese PA, Bartoloni G. Life-threatening tumors of the heart in fetal and postnatal age. J Pediatr 2013; 162:964-9.e1. [PMID: 23219450 DOI: 10.1016/j.jpeds.2012.10.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/12/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the role of histology in diagnosis and management of biologically benign heart tumors causing life-threatening symptoms and even death in children and fetuses. The clinical impact of a multidisciplinary approach including 2-D echocardiography, histology, genetics, and cardiac surgery has not yet been fully elucidated. STUDY DESIGN Forty-one consecutive antenatal (n = 17) or postnatal (n = 24) detected cardiac masses were evaluated by 2-D echocardiography (in alive patients) or at autopsy, and 12/41 cases with definite histologic diagnosis of primary and benign cardiac tumor were entered in this study. RESULTS Rhabdomyomas (n = 6), hemangiomas (n = 3), central fibrous body chondroma (n = 1), fibroma (n = 1), or left atrial myxoma (n = 1) were histologically diagnosed in 4 fetuses and in 8 children. Death occurred in 6 patients showing diffuse or infiltrative tumors, 2/6 experiencing intrauterine death or sudden and unexpected infant death. Seven patients underwent surgery, 4/7 are alive and well at >5 years follow-up, whereas 3 deaths followed partial tumor resection. Two fetuses with extensive tumor/s were aborted. Tuberous sclerosis complex gene mutations were seen in patients with rhabdomyomas. CONCLUSIONS Histology represents the best diagnostic approach in life-threatening pediatric cardiac tumors allowing definite diagnosis in cases other than rhabdomyoma and in sudden deaths, influencing clinical management and counselling. 2-D echocardiography remains the main tool for early clinical diagnosis and follow-up. A multidisciplinary approach is advisable because of rarity, difficult management, and possible associations with inheritable diseases.
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Affiliation(s)
- Angela Pucci
- Department of Anatomic Pathology, University Hospital, Pisa, Italy.
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40
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Kocabaş A, Ekici F, Cetin Iİ, Emir S, Demir HA, Arı ME, Değerliyurt A, Güven A. Cardiac rhabdomyomas associated with tuberous sclerosis complex in 11 children: presentation to outcome. Pediatr Hematol Oncol 2013; 30:71-9. [PMID: 23151153 DOI: 10.3109/08880018.2012.734896] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cardiac rhabdomyomas (CRs) are the most common heart tumors in children and closely associated with tuberous sclerosis complex (TSC). This study was performed to assess the presentation type, clinical course, treatment modalities, and outcome of the patients with rhabdomyoma, associated with TSC. We reviewed our patients with cardiac rhabdomyomas (CRs), who had received a diagnosis of TSC previously or during the follow-up period between June 1996 and January 2012, retrospectively. Thirty-two patients with TSC were evaluated and among them 11 patients (34%) were associated with CRs. Five patients (45%) had multiple tumors and consequently a total of 29 CRs were analyzed in our study. The median follow-up period was 2 years (range: 1 week-15 years). Clinical presentation was cardiac murmur in three patients, cyanosis in two patients and arrhythmia in one patient. Five patients were asymptomatic at the diagnosis and CRs were detected during routine cardiac evaluation for TSC. Cardiac tumors were diagnosed prenatally in two patients. Spontaneous regression rate was 31% and we experienced a complete regression of a tumor with an echogenic bordered tissue defect and septal thinning in a patient. Three patients had hemodynamically significant tumor obstruction; two of them underwent surgery. The other patient, who had multiple CRs, was treated medically with everolimus because of high-risk potential of surgery. Although surgical resection is the preferred treatment in most of the patients with hemodynamic instability, we need novel alternative medical therapies in some critically ill patients who cannot be operated due to various reasons.
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Affiliation(s)
- Abdullah Kocabaş
- Department of Pediatric Cardiology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
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41
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Cardiac tumors in infants and children: study of 120 operated patients. Pediatr Cardiol 2013; 34:125-8. [PMID: 22735896 DOI: 10.1007/s00246-012-0399-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
Cardiac tumors in children are rare, and patient series are limited in size. We report 120 children who underwent surgery to treat a cardiac tumor; the tumor type was known in 108 instances. The patients represented <0.1 % of 130,000 cardiac surgeries performed in children from a multi-institutional data base. The most common tumors and the number of patients were rhabdomyoma (n = 42), myxoma (n = 28), and fibromas (n = 10). The remaining 18 tumors of various types occurred in smaller numbers of patients. Nine patients (7 %) died after surgery. The mean age of death was 14 days, and death was most frequent in patients with fibromas (n = 4). Considering the variety of tumors, their varied location in cardiac structures, the patient ages, and the infrequent occurrence in an individual surgeon's experience, the operative mortality was low.
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42
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Abstract
Cardiac tumours in infancy are rare and are mostly benign with rhabdomyomas, fibromas and teratomas accounting for the majority. The presentation depends on size and location of the mass as they tend to cause cavity obstruction or arrhythmias. Most rhabdomyomas tend to regress spontaneously but fibromas and teratomas generally require surgical intervention for severe haemodynamic or arrhythmic complications. Other relatively rare cardiac tumours too are discussed along with an Indian perspective.
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Affiliation(s)
- O P Yadava
- National Heart Institute, New Delhi, India.
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43
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Nöbauer C, Guenther T, Hörer J, Vogt M, Specht K, Schreiber C, Lange R. Rhabdomyoma operation-intraoperative video of a very rare tumor entity. Heart Surg Forum 2012; 14:E389-90. [PMID: 22956021 DOI: 10.1532/hsf98.20111047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Christian Nöbauer
- Clinic of Cardiovascular Surgery, Technical University, Munich, Germany.
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44
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Padalino MA, Vida VL, Boccuzzo G, Tonello M, Sarris GE, Berggren H, Comas JV, Di Carlo D, Di Donato RM, Ebels T, Hraska V, Jacobs JP, Gaynor JW, Metras D, Pretre R, Pozzi M, Rubay J, Sairanen H, Schreiber C, Maruszewski B, Basso C, Stellin G. Surgery for Primary Cardiac Tumors in Children. Circulation 2012; 126:22-30. [PMID: 22626745 DOI: 10.1161/circulationaha.111.037226] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
To evaluate indications and results of surgery for primary cardiac tumors in children.
Methods and Results—
Eighty-nine patients aged ≤18 years undergoing surgery for cardiac tumor between 1990 and 2005 from 16 centers were included retrospectively (M/F=41/48; median age 4.3 months, range 1 day to 18 years). Sixty-three patients (68.5%) presented with symptoms. Surgery consisted of complete resection in 62 (69.7%) patients, partial resection in 21 (23.6%), and cardiac transplant in 4 (4.5%). Most frequent histotypes (93.2%) were benign (rhabdomyoma, myxoma, teratoma, fibroma, and hemangioma). Postoperative complications occurred in 29.9%. Early and late mortality were 4.5% each (mean follow-up, 6.3±4.4 years); major adverse events occurred in 28.2% of the patients; 90.7% of patients are in New York Heart Association class I. There were no statistically significant differences in survival, postoperative complications, or adverse events after complete and partial resection in benign tumors other than myxomas. Cardiac transplant was associated significantly with higher mortality rate (
P=
0.006). Overall mortality was associated to malignancy (
P
=0.0008), and adverse events during follow-up (
P
=0.005).
Conclusions—
Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most frequent surgical histotypes. Malignant tumors negatively affect early and late survival. Heart transplant is indicated when conservative surgery is not feasible. Lack of recurrence after partial resection of benign cardiac tumors indicates that a less risky tumor debulking is effective for a subset of histotypes such as rhabdomyomas and fibromas.
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Affiliation(s)
- Massimo A Padalino
- UOC Cardiochirurgia Pediatrica e Cardiopatie Congenite, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Centro Vincenzo Gallucci, Via Giustiniani 2, 35128 Padova, Italy.
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45
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Demir HA, Ekici F, Yazal Erdem A, Emir S, Tunç B. Everolimus: a challenging drug in the treatment of multifocal inoperable cardiac rhabdomyoma. Pediatrics 2012; 130:e243-7. [PMID: 22732179 DOI: 10.1542/peds.2011-3476] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary cardiac tumors are rare in childhood. The most common of these are rhabdomyomas. Considering that rhabdomyomas often show spontaneous regression, close follow-up may be sufficient in hemodynamically stable cases. However, hemodynamically significant cardiac rhabdomyomas confer a risk of morbidity and mortality. Herein, we report a newborn infant with multifocal cardiac rhabdomyomas treated with everolimus. The optimal dose of the drug was 0.25 mg 2 times per day, 2 days per week. Patients with inoperable cardiac rhabdomyomas and with symptoms may be candidates for everolimus treatment.
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Affiliation(s)
- Haci Ahmet Demir
- Department of Pediatric Hematology/Oncology, Ankara Children’s Hematology Oncology Education and Research Hospital, Ankara, Turkey.
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46
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Cardiac masses, part 2: key imaging features for diagnosis and surgical planning. AJR Am J Roentgenol 2011; 197:W842-51. [PMID: 22021531 DOI: 10.2214/ajr.11.6903] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objectives of this article are to discuss key radiologic features that differentiate primary and secondary cardiac masses. Clinical scenarios are included to highlight stepwise radiologic workup of tumors of the pericardium, epicardium, myocardium, valves, and chambers. The involvement of key cardiac anatomic structures will also be emphasized to determine resectability and guide surgical planning. CONCLUSION Multimodality imaging plays a pivotal role in diagnosis and surgical planning of cardiac masses. Clinical features, such as patient age, location, and imaging characteristics of the mass will determine the likely differential diagnosis. In addition to radiologic evaluation of the mass itself, involvement of valvular apparatus, extent of myocardial involvement, or presence of associated coronary artery involvement is necessary to determine resectability and surgical technique.
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47
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Miyake CY, Del Nido PJ, Alexander ME, Cecchin F, Berul CI, Triedman JK, Geva T, Walsh EP. Cardiac Tumors and Associated Arrhythmias in Pediatric Patients, With Observations on Surgical Therapy for Ventricular Tachycardia. J Am Coll Cardiol 2011; 58:1903-9. [DOI: 10.1016/j.jacc.2011.08.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/15/2011] [Accepted: 08/09/2011] [Indexed: 10/16/2022]
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48
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Onan B, Haydin S, Onan IS, Akdeniz C, Odemis E, Bakir I. Giant tumor of the right atrium in infancy. Ann Thorac Surg 2011; 92:737-40. [PMID: 21801937 DOI: 10.1016/j.athoracsur.2011.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 01/24/2011] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
Abstract
Cardiac hemangiomas can occur at any age, but they are extremely rare when they occur early after birth. We describe the case of a 5-month-old infant who had a giant right atrial capillary hemangioma associated with massive pericardial effusion. The tumor was incidentally diagnosed during routine clinical follow-up. The hemangioma was removed successfully under cardiopulmonary bypass, and the patient's postoperative course was uneventful. The occurrence of giant capillary hemangioma in infancy represents an unusual event in the relevant literature. Herein, we discuss the clinical features and surgical management of this rare primary tumor of infancy.
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Affiliation(s)
- Burak Onan
- Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Division, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education & Research Hospital, Istanbul, Turkey
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49
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Primary Congenital Infantile Fibrosarcoma of the Heart: The First Confirmed Case. Ann Thorac Surg 2011; 91:1276-80. [DOI: 10.1016/j.athoracsur.2010.08.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/20/2010] [Accepted: 08/30/2010] [Indexed: 11/16/2022]
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50
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Jain D, Maleszewski JJ, Halushka MK. Benign cardiac tumors and tumorlike conditions. Ann Diagn Pathol 2010; 14:215-30. [DOI: 10.1016/j.anndiagpath.2009.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
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