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Sundari A, Gurusamy U. Cardiac fibroma presenting as hypoplastic left heart syndrome in a foetus: causal or coincidental? BMJ Case Rep 2024; 17:e258742. [PMID: 38514154 PMCID: PMC10961559 DOI: 10.1136/bcr-2023-258742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Primary cardiac tumours are very rare. Cardiac tumours in the perinatal period are even more uncommon with a prevalence of 0.0017% to 0.28% in autopsy series. The majority of benign cardiac tumours are cardiac rhabdomyomas, followed by cardiac fibromas. Another rare congenital heart disease is hypoplastic left heart syndrome (HLHS). Here we present a 21-week-old foetus diagnosed antenatally with HLHS on foetal echocardiogram. An autopsy done on the foetus following medical termination of pregnancy revealed a cardiac fibroma in the ventricular septum. It is very uncommon to have a combination of two congenital heart diseases. An extensive literature review revealed only three cases that had rhabdomyoma and associated HLHS. This case presented with cardiac fibroma which in early gestation would have resulted in left ventricular outflow obstruction leading to the development of HLHS. Small cardiac tumours which are difficult to detect by echocardiogram in early gestation can lead to the development of HLHS. A thorough and hierarchical autopsy examination of such cases can help in a better understanding of the relationship between HLHS and cardiac tumours.
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Affiliation(s)
- Abinaya Sundari
- Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Umamaheshwari Gurusamy
- Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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2
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Wilke PI, Biermann D, Grafmann M, Kozlik-Feldmann R, Papingi D, Sachweh JS, Stute F, Olfe J. Siblings with Gorlin-Goltz syndrome associated with cardiac tumors: a case report and review of literature. Orphanet J Rare Dis 2023; 18:178. [PMID: 37408081 DOI: 10.1186/s13023-023-02792-5] [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: 04/21/2022] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
Primary cardiac tumors in children are very rare and may be associated with severe arrhythmias and sudden infant death syndrome. These cardiac arrhythmias vary depending on the location and size of the tumor. Sixty-four percent of children with cardiac fibroma, the second most common benign cardiac tumor in children, have ventricular arrhythmias, affecting therapeutic management and risk profile of these children. We report on two siblings with cardiac fibromas whose clinical presentations differed depending on their locations and size of the tumors. The first child, a three-year-old girl, was diagnosed with a cardiac fibroma in the left ventricle at the age of 8 months after surviving resuscitation due to ventricular fibrillation. Secondary prophylactic implantation of an ICD was performed. On propranolol, no further malignant arrhythmias have occurred to date. The seven-month-old brother was diagnosed postnatally with a cardiac tumor adjacent to the right ventricle. A few weeks after birth, the boy had refractory supraventricular tachycardia and ventricular arrhythmia that only resolved with amiodarone. In genetic testing, Gorlin-Goltz syndrome was diagnosed in both children. Conservative pharmacological therapy is a therapeutic strategy for asymptomatic patients with cardiac fibromas. The anti-arrhythmic medication depends on the location of the tumor. Implantation of an ICD should be performed in cases of malignant arrhythmias. In rare cases, there is an association between cardiac tumors and genetic syndromes, such as Gorlin-Goltz syndrome. These should always be considered when such a tumor is diagnosed.
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Affiliation(s)
- Paula I Wilke
- Pediatric Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Daniel Biermann
- Pediatric Cardiac Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Maria Grafmann
- Pediatric Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Pediatric Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Dzhoy Papingi
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg S Sachweh
- Pediatric Cardiac Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Fridrike Stute
- Pediatric Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Jakob Olfe
- Pediatric Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Martinistr. 52, 20246, Hamburg, Germany.
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Slack JC, Bründler MA, Nohr E, McIntyre JB, Kurek KC. Molecular Alterations in Pediatric Fibroblastic/Myofibroblastic Tumors: An Appraisal of a Next Generation Sequencing Assay in a Retrospective Single Centre Study. Pediatr Dev Pathol 2021; 24:405-421. [PMID: 33970051 DOI: 10.1177/10935266211015558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pediatric fibroblastic/myofibroblastic tumors (PFMTs) can be challenging to definitively classify. Large case series or diagnostic updates have not been recently published despite identification of molecular alterations that could improve diagnostic accuracy. Our review of the literature found that over two-thirds of the more than 30 types of PFMTs harbor recurrent molecular alterations. We performed an institutional review of PFMTs to highlight limitations of a predominantly morphological classification, and evaluated the utility of a next-generation sequencing assay to aid diagnosis. METHODS PFMTs identified over a period of 12 years were reviewed, categorized per the new WHO classification, and tested using the Oncomine Childhood Cancer Research Assay. RESULTS Eighty-seven specimens from 58 patients were reviewed; 50 were chosen for molecular analysis, 16 (32%) lacking definitive classification. We identified alterations, some novel, in 33% of assayed cases. Expected alterations were identified for most known diagnoses and mutations were identified in 6 of 16 tumors (38%) that were initially unclassified. CONCLUSION We confirmed a significant subset of PFMTs remain difficult to classify using current criteria, and that a combined DNA/RNA assay can identify alterations in many of these cases, improving diagnostic certainty and suggesting a clinical utility for challenging cases.
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Affiliation(s)
- Jonathan C Slack
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Marie-Anne Bründler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Erik Nohr
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - John B McIntyre
- Precision Oncology Hub Laboratory, Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Kyle C Kurek
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Genetics, Cumming School of Medicine, Calgary, Alberta, Canada
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Szczałuba K, Makuła E, Piórecka-Makuła A, Sicińska J, Rydzanicz M, Gasperowicz P, Płoski R, Werner B. Intracardiac tumor as a rare manifestation of genetic syndromes-presentation of a family with Gorlin syndrome and a literature review. J Appl Genet 2020; 61:559-565. [PMID: 32964316 PMCID: PMC7652740 DOI: 10.1007/s13353-020-00582-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Abstract
Intracardiac tumors in children are relatively rare, but their clinical consequences may include severe outflow tract obstruction, embolism, cardiac insufficiency, or rhythm disturbances. In some cases, the tumor may constitute part of a genetic condition and prompt additional investigations, as well as a modification of therapeutic management. Herein, we present a molecularly confirmed familial case of Gorlin syndrome with an early cardiac tumor as a presenting sign. We provide detailed clinical characteristics of the affected individuals and a useful review of syndromic causes of pediatric cardiac tumors in clinical practice.
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Affiliation(s)
- Krzysztof Szczałuba
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Ewa Makuła
- Medical University of Warsaw, Warsaw, Poland
| | - Anna Piórecka-Makuła
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Justyna Sicińska
- Clinical Department of Dermatology, Central Clinical Hospital of the MSWiA, Warsaw, Poland
| | - Małgorzata Rydzanicz
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Piotr Gasperowicz
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland.
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
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Carreon CK, Sanders SP, Perez-Atayde AR, del Nido PJ, Walsh EP, Geva T, Alexander ME. Interdigitating Myocardial Tongues in Pediatric Cardiac Fibromas. JACC Clin Electrophysiol 2019; 5:563-575. [DOI: 10.1016/j.jacep.2019.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
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Ritter AL, Granquist EJ, Iyer VR, Izumi K. Cardiac Fibroma with Ventricular Tachycardia: An Unusual Clinical Presentation of Nevoid Basal Cell Carcinoma Syndrome. Mol Syndromol 2018; 9:219-223. [PMID: 30140199 DOI: 10.1159/000489056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 12/15/2022] Open
Abstract
Pediatric cardiac tumors are rare and often benign with an incidence of approximately 0.03-0.32% and can be associated with genetic conditions. For example, approximately 3% of individuals with nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome, have a cardiac fibroma. NBCCS is also characterized by lamellar or early calcification of the falx, jaw keratocysts, palmar and/or plantar pits, and a predisposition for basal cell carcinomas. Given the management implications of NBCCS, including appropriate cancer screenings and precautions, prompt identification of affected individuals is critical. We report a case of a 6-year-old female presenting with ventricular tachycardia secondary to cardiac fibroma. After diagnosis of recurrent jaw keratocysts, she was clinically and molecularly diagnosed with NBCCS. Identification of a cardiac fibroma should prompt careful assessment of past medical and family history with consideration of a diagnosis of NBCCS.
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Affiliation(s)
- Alyssa L Ritter
- Division of Human Genetics.,Division of Cardiology, Department of Pediatrics
| | - Eric J Granquist
- Divisions of Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | | | - Kosuke Izumi
- Division of Human Genetics.,Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia
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Zhang Q, Wang T, Wang D, Liu J, Yu W, Liu X, Xiang X, Dong K, You F, Zhang G, Ju J, Zhu M, Duan W, Qiao B. Somatic copy number losses on chromosome 9q21.33q22.33 encompassing the PTCH1 loci associated with cardiac fibroma. Cancer Genet 2015; 208:615-20. [DOI: 10.1016/j.cancergen.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 08/12/2015] [Accepted: 09/20/2015] [Indexed: 12/25/2022]
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Basal Cell Carcinoma Aggressiveness, Molecular Factors And Therapy: A Clinician Perspective. ARS MEDICA TOMITANA 2013. [DOI: 10.2478/v10307-012-0011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Basal cell carcinoma represents the most common skin and epithelial cancer. Most of the patients are cured by surgery. However, some cases display fullblown aggressiveness which has a dual connotation. The tumour may reach an impressive size being locally destructive while in rare cases, basal cell carcinomas may metastasize. If this agressivetumour is located on the face or neck, the surgeon is confronted with a clinical dilemma since total removal of the lesion with clear margins is impossible. Therefore, nonsurgical approaches need to be adopted in these cases. A better understand of the molecular pathways could theoretically lead to new improved therapeutic treatments. The current paper presents an update on the molecular factors with clinical importance for the treatment of basal cell carcinoma in parallel with presentation of an aggressive case as well as a review of the current therapeutic methods.
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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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11
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István K, Törő K, Kardos M, Imre C, György D, Ágnes N. Sudden Death Due to Infiltration of Left Bundle Branches by Interventricular Septal Cardiac Fibroma. J Forensic Sci 2012; 57:1669-74. [DOI: 10.1111/j.1556-4029.2012.02255.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 08/25/2011] [Accepted: 09/17/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Kristóf István
- Department of Forensic and Insurance Medicine; Semmelweis University; Üllői út 93; 1091; Budapest; Hungary
| | - Klára Törő
- Department of Forensic and Insurance Medicine; Semmelweis University; Üllői út 93; 1091; Budapest; Hungary
| | - Magdolna Kardos
- 2nd Department of Pathology; Semmelweis University; Üllői út 93; 1091; Budapest; Hungary
| | - Czirják Imre
- Department of Forensic and Insurance Medicine; Semmelweis University; Üllői út 93; 1091; Budapest; Hungary
| | - Dunay György
- Department of Forensic and Insurance Medicine; Semmelweis University; Üllői út 93; 1091; Budapest; Hungary
| | - Nemeskéri Ágnes
- Department of Human Morphology and Developmental Biology; Semmelweis University; Tűzoltó u. 58; 1094; Budapest; Hungary
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Kobayashi D, L'Ecuyer TJ, Aggarwal S. Orthotopic heart transplant: a therapeutic option for unresectable cardiac fibroma in infants. CONGENIT HEART DIS 2011; 7:E31-6. [PMID: 22011311 DOI: 10.1111/j.1747-0803.2011.00577.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary cardiac tumors are rare lesions in childhood, with the two most common being rhabdomyoma and fibroma. We report two infants who successfully underwent orthotopic heart transplant for massive interventricular septal cardiac fibromas. For unresectable infantile cardiac fibroma, orthotopic heart transplant may be considered a therapeutic option.
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Affiliation(s)
- Daisuke Kobayashi
- Division of Pediatric Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201-2119, USA.
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Abstract
UNLABELLED Gorlin syndrome is a rare autosomal dominant disorder exhibiting high penetrance and variable expressivity. It is characterized by facial dysmorphism, skeletal anomalies, multiple basal cell carcinomas, odontogenic keratocysts (OKC), palmar and plantar pits, bifid ribs, vertebral anomalies and a variety of other malformations. Various neoplasms, such as medulloblastomas, meningiomas, ovarian and cardiac fibromas are also found in this syndrome. OBJECTIVE To describe a twelve-year-old patient with Gorlin-Goltz syndrome, with basal cell carcinomas and promyelocytic leukemia developed after receiving craniospinal radiation for a medulloblastoma. Bifid ribs as well as mandibular and maxillar OKC were also diagnosed Conclusion: The patient with Gorlin-Goltz syndrome should receive close follow-up for early detection of malformations nd malignant neoplasias.
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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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Zibat A, Uhmann A, Nitzki F, Wijgerde M, Frommhold A, Heller T, Armstrong V, Wojnowski L, Quintanilla-Martinez L, Reifenberger J, Schulz-Schaeffer W, Hahn H. Time-point and dosage of gene inactivation determine the tumor spectrum in conditional Ptch knockouts. Carcinogenesis 2009; 30:918-26. [PMID: 19321799 DOI: 10.1093/carcin/bgp068] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mutations in Patched (PTCH) have been associated with tumors characteristic both for children [medulloblastoma (MB) and rhabdomyosarcoma (RMS)] and for elderly [basal cell carcinoma (BCC)]. The determinants of the variability in tumor onset and histology are unknown. We investigated the effects of the time-point and dosage of Ptch inactivation on tumor spectrum using conditional Ptch-knockout mice. Ptch heterozygosity induced prenatally resulted in the formation of RMS, which was accompanied by the silencing of the remaining wild-type Ptch allele. In contrast, RMS was observed neither after mono- nor biallelic postnatal deletion of Ptch. Postnatal biallelic deletion of Ptch led to BCC precancerous lesions of the gastrointestinal epithelium and mesenteric tumors. Hamartomatous gastrointestinal cystic tumors were induced by monoallelic, but not biallelic Ptch mutations, independently of the time-point of mutation induction. These data suggest that the expressivity of Ptch deficiency is largely determined by the time-point, the gene dose and mode of Ptch inactivation. Furthermore, they point to key differences in the tumorigenic mechanisms underlying adult and childhood tumors. The latter ones are unique among all tumors since their occurrence decreases rather than increases with age. A better understanding of mechanisms underlying this ontological restriction is of potential therapeutic value.
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Affiliation(s)
- Arne Zibat
- Institute of Human Genetics, University of Goettingen, Germany
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