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Lorca MC, Chen I, Jew G, Furlani AC, Puri S, Haramati LB, Chaturvedi A, Velez MJ, Chaturvedi A. Radiologic-Pathologic Correlation of Cardiac Tumors: Updated 2021 WHO Tumor Classification. Radiographics 2024; 44:e230126. [PMID: 38722782 DOI: 10.1148/rg.230126] [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: 06/06/2024]
Abstract
Cardiac tumors, although rare, carry high morbidity and mortality rates. They are commonly first identified either at echocardiography or incidentally at thoracoabdominal CT performed for noncardiac indications. Multimodality imaging often helps to determine the cause of these masses. Cardiac tumors comprise a distinct category in the World Health Organization (WHO) classification of tumors. The updated 2021 WHO classification of tumors of the heart incorporates new entities and reclassifies others. In the new classification system, papillary fibroelastoma is recognized as the most common primary cardiac neoplasm. Pseudotumors including thrombi and anatomic variants (eg, crista terminalis, accessory papillary muscles, or coumadin ridge) are the most common intracardiac masses identified at imaging. Cardiac metastases are substantially more common than primary cardiac tumors. Although echocardiography is usually the first examination, cardiac MRI is the modality of choice for the identification and characterization of cardiac masses. Cardiac CT serves as an alternative in patients who cannot tolerate MRI. PET performed with CT or MRI enables metabolic characterization of malignant cardiac masses. Imaging individualized to a particular tumor type and location is crucial for treatment planning. Tumor terminology changes as our understanding of tumor biology and behavior evolves. Familiarity with the updated classification system is important as a guide to radiologic investigation and medical or surgical management. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Maria Clara Lorca
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Irene Chen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Gregory Jew
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Andrea C Furlani
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Savita Puri
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Linda B Haramati
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Apeksha Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Moises J Velez
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Abhishek Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
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Bzeih W, Kbar M, Rihan O. Congenital single kidney in tuberous sclerosis complex (Bourneville disease). Ann Med Surg (Lond) 2024; 86:2158-2161. [PMID: 38576950 PMCID: PMC10990388 DOI: 10.1097/ms9.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Bournevile disease is a rare global condition that presents a diagnostic challenge due to its diverse multisystemic involvement. Case presentation This report presents the case of a 14-year-old male with a medical history of congenital single kidney, heart rate abnormalities, Bournevile disease with cognitive deficits, brain lesions, and dermatological features. The patient presented with sudden onset renal angiolipomatosis, and the diagnosis was based on specific computed tomography (CT) findings. Despite having these complex medical conditions, the patient had never been admitted to the hospital since infancy, and treatment was limited to surveillance only. Clinical discussion Bourneville disease is a multisystemic disease that affects several organ systems within the human body and thus demands multidisciplinary approach in the treatment and follow-up options. Conclusion This case report highlights Bournevile disease in a patient with a congenital single kidney, a rare finding that further complicates the disease. It emphasises the importance of recognising and managing this condition to ensure appropriate care for affected individuals.
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Affiliation(s)
- Wafaa Bzeih
- Faculty of Medical Sciences, Lebanese University, Hadath
| | - Mohammad Kbar
- Faculty of Medical Sciences, Lebanese University, Hadath
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Okutucu G, Tanacan A, Sahin D. Clinical outcomes of fetuses with cardiac rhabdomyoma: A case series from a tertiary center. J Obstet Gynaecol Res 2024; 50:342-350. [PMID: 38062975 DOI: 10.1111/jog.15846] [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] [Received: 09/30/2023] [Accepted: 11/26/2023] [Indexed: 03/04/2024]
Abstract
AIMS The study aims to evaluate the genetic and clinical outcomes of fetal cardiac rhabdomyoma in our tertiary center. METHODS Data of cases with cardiac rhabdomyoma detected by fetal echocardiography during antenatal follow-up were analyzed retrospectively. RESULTS Nine cases were included in the study. The incidence of cardiac rhabdomyoma was 0.003%. The median fetal diagnosis time was 26th weeks, the most common location was the LV. There was no hemodynamic disorder requiring cardiovascular intervention in any of the cases. Of the eight genetically tested cases, four were tuberous sclerosis complex (TSC) gene-negative, one hereditary TSC2, one de novo TSC1, and two de novo TSC2 gene mutants. Postnatal first-year survival rate of the cases was 88.8%. CONCLUSIONS Cardiac rhabdomyoma is a rare fetal and pediatric pathology that generally is a remarkable finding in the clinical process of TSC. Therefore, cases should be evaluated multisystemically and genetic counseling should be given to the family.
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Affiliation(s)
- Gulcan Okutucu
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara, Turkey
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Machacek ME, Wu CL, Cornejo KM. Pathology of hereditary renal cell carcinoma syndromes: Tuberous sclerosis complex (TSC). Semin Diagn Pathol 2024; 41:8-19. [PMID: 37993384 DOI: 10.1053/j.semdp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 11/24/2023]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease characterized by hamartomatous tumors involving multiple organs such as the brain, skin, heart, lung and kidney. TSC is caused by inactivating mutations in TSC1/TSC2, which encodes hamartin and tuberin, respectively, and forms a complex that regulates mechanistic target of rapamycin complex 1 (mTORC1), resulting in cell overgrowth and oncogenesis. Since a leading cause of morbidity and mortality in TSC relates to chronic kidney disease and the ability to preserve renal function, this review describes the important pathologic findings in TSC-associated renal neoplasms and their correlating sporadic counterparts. The most common renal tumor in TSC patients are AMLs, followed by a heterogeneous spectrum of renal epithelial tumors, which may provide clues to establishing a diagnosis of TSC.
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Affiliation(s)
- Miranda E Machacek
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Chin-Lee Wu
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
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Murata H, Miyauchi Y, Nitta T, Sakamoto SI, Kunugi S, Ishii Y, Shimizu A, Fujimoto Y, Hayashi H, Yamamoto T, Yodogawa K, Maruyama M, Kaneko S, Hayashi H, Soejima K, Nogami A, Asai K, Shimizu W, Iwasaki YK. Electrophysiological and Histopathological Characteristics of Ventricular Tachycardia Associated With Primary Cardiac Tumors. JACC Clin Electrophysiol 2024; 10:43-55. [PMID: 37855769 DOI: 10.1016/j.jacep.2023.08.033] [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] [Received: 04/24/2023] [Revised: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Ventricular tachycardia (VT) associated with primary cardiac tumors (PCTs) originating from the ventricles is rare, but lethal, in young patients. OBJECTIVES This study aimed to clarify the mechanisms underlying primary cardiac tumor-related ventricular tachycardia (PCT-VT) and establish a therapeutic strategy for this form of VT. METHODS Among 67 patients who underwent surgery for VT at our institute between 1981 and 2020, 4 patients aged 1 to 34 years, including 3 males, showed PCT-VT (fibroma, 2; lipoma, 1; and hamartoma, 1), which was investigated using a combination of intraoperative electroanatomical mapping and histopathological studies. RESULTS All 4 patients developed electrical storms of sustained VTs refractory to multiple drugs and repetitive endocardial ablations. The VT mechanism was re-entry, and intraoperative electroanatomical mapping showed a centrifugal activation pattern originating from the border between the tumor and healthy myocardium, where fractionated potentials were detected during sinus rhythm. Histopathological studies of serial sections of specimens acquired from these areas revealed tumor infiltration into the surrounding myocardium with cell disorganization, exhibiting myocardial disarray. Several myocardia entrapped in the tumor edges contributed to the development and sustainment of re-entrant VT activation. In the 2 patients in whom complete resection was unfeasible, encircling cryoablation to entirely isolate the unresectable tumor was effective in suppressing VT occurrence. CONCLUSIONS The mechanism underlying PCT-VT involves re-entry localized at the tumor edges. Myocardial disarray associated with tumor infiltration is a substrate for this form of VT. Cryoablation along the border between the tumor and myocardium is a promising therapeutic option for unresectable PCT-VT.
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Affiliation(s)
- Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. https://twitter.com/Muratahiroshige
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Shinobu Kunugi
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shinji Kaneko
- Department of Cardiology, Toyota Kosei Hospital, Aichi, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University, Tokyo, Japan
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
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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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Haider I, Ullah H, Fatima M, Karim MS, Haq FU, Majid A, Anwar MS, Nawaz FK, Ali I, Sarwar AH, Anwar MT, Khan AW, Humayun O, Alam F. Tissue characterization of benign cardiac tumors by cardiac magnetic resonance imaging, a review of core imaging protocol and benign cardiac tumors. Front Cardiovasc Med 2023; 10:1009411. [PMID: 37441708 PMCID: PMC10333494 DOI: 10.3389/fcvm.2023.1009411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/18/2023] [Indexed: 07/15/2023] Open
Abstract
Generally, cardiac masses are initially suspected on routine echocardiography. Cardiac magnetic resonance (CMR) imaging is further performed to differentiate tumors from pseudo-tumors and to characterize the cardiac masses based on their appearance on T1/T2-weighted images, detection of perfusion and demonstration of gadolinium-based contrast agent uptake on early and late gadolinium enhancement images. Further evaluation of cardiac masses by CMR is critical because unnecessary surgery can be avoided by better tissue characterization. Different cardiac tissues have different T1 and T2 relaxation times, principally owing to different internal biochemical environments surrounding the protons. In CMR, the signal intensity from a particular tissue depends on its T1 and T2 relaxation times and its proton density. CMR uses this principle to differentiate between various tissue types by weighting images based on their T1 or T2 relaxation times. Generally, tumor cells are larger, edematous, and have associated inflammatory reactions. Higher free water content of the neoplastic cells and other changes in tissue composition lead to prolonged T1/T2 relaxation times and thus an inherent contrast between tumors and normal tissue exists. Overall, these biochemical changes create an environment where different cardiac masses produce different signal intensity on their T1- weighted and T2- weighted images that help to discriminate between them. In this review article, we have provided a detailed description of the core CMR imaging protocol for evaluation of cardiac masses. We have also discussed the basic features of benign cardiac tumors as well as the role of CMR in evaluation and further tissue characterization of these tumors.
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Affiliation(s)
- Imran Haider
- Radiology Department, Saint Luke’s Hospital, Chesterfield, MO, United States
| | - Hameed Ullah
- Internal Medicine Department, Hayatabad Medical Complex (HMC), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | | | - Furqan Ul Haq
- Internal Medicine Department, Mayo Hospital, Lahore, Punjab, Pakistan
| | - Abdul Majid
- Department of Radiation Oncology, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Saad Anwar
- Internal Medicine Department, King Edward Medical University, Lahore, Punjab, Pakistan
| | - Fatima Kausar Nawaz
- Sheikh Zayed Medical College, Pakistan
- Khyber Girls Medical College, Peshawar, Pakistan
| | - Ijaz Ali
- Internal Medicine Department, Hayatabad Medical Complex (HMC), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Atif Hussain Sarwar
- Internal Medicine Department, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College Hospital: Shaikh Zayed Hospital, Lahore, Pakistan
| | - Muhammad Tayyab Anwar
- Internal Medicine Department, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Wali Khan
- Internal Medicine Department, Gujranwala Medical College, Gujranwala, Punjab, Pakistan
| | - Omama Humayun
- Internal Medicine Department, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
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8
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Gong K, Yang Y, Shen Y, Liu H, Xie L, Liu J. Successful management of a rare case of juvenile giant right ventricular myxoma. Front Surg 2023; 9:1102742. [PMID: 36713660 PMCID: PMC9874216 DOI: 10.3389/fsurg.2022.1102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Primary cardiac tumors are extremely uncommon in young children and infants. Cardiac myxoma are typically found in the atria, predominately in the left atrium, with relatively few found on the right side, such as in the right ventricle or pulmonary artery. Numerous significant complications, including sudden death, can result from obstruction of the main pulmonary artery trunk and right ventricular outflow tract. Here, we describe the case of a 14-year-old Chinese girl diagnosed with a right ventricular myxoma located in the right ventricle and extended into the main pulmonary trunk. Complete resection of the myxoma and histological confirmation were performed.
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Affiliation(s)
- Ke Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Yadan Shen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China,Extracorporeal Life Support Center of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Haidan Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Li Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Jijia Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China,Correspondence: Jijia Liu
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9
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Feller LE, Sargeant A, Ehrhart EJ, Balmer B, Nelson K, Lamoureux J. Cardiac Rhabdomyoma in Four Göttingen Minipigs. Toxicol Pathol 2023; 51:61-66. [PMID: 36726336 DOI: 10.1177/01926233221148393] [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: 02/03/2023]
Abstract
Göttingen minipigs are increasingly used as an alternative large animal model in nonclinical toxicology studies, and proliferative lesions in this species are rare. Here, we report four cases of cardiac rhabdomyoma in Göttingen minipigs, an incidental and benign mass in the heart. Three cases lacked gross observations and had a microscopic nodule in either the left ventricle or interventricular septum. The last case had a large, firm, raised nodule on a left ventricular papillary muscle noted at necropsy, with additional microscopic intramural masses in the left ventricular wall. In all cases, microscopic evaluation revealed well-circumscribed, expansile nodules composed of bundles of large, highly vacuolated, ovoid to polygonal cells with variable cytoplasmic processes radiating from a centrally located nucleus. Cells displayed patchy accumulation of intracytoplasmic, PAS-positive material and haphazardly arranged cytoplasmic cross-striations. There was no evidence of cardiac insufficiency or other data to suggest the masses were clinically meaningful. Cardiac rhabdomyomas have been reported in meat-hybrid swine, with a breed predisposition in red wattle. This lesion is well established in guinea pigs, but documentation in other laboratory species used in toxicologic studies is limited to two beagle dogs. To our knowledge, this is the first report of spontaneous cardiac rhabdomyoma in Göttingen minipigs.
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Affiliation(s)
- Laine E Feller
- Cornell University, Ithaca, New York, USA
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - E J Ehrhart
- Charles River Laboratories, Spencerville, Ohio, USA
| | | | - Keith Nelson
- Charles River Laboratories, Mattawan, Michigan, USA
- Inotiv, St. Louis, Missouri, USA
| | - Jennifer Lamoureux
- Charles River Laboratories, Mattawan, Michigan, USA
- Inotiv, St. Louis, Missouri, USA
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10
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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: 6] [Impact Index Per Article: 3.0] [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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11
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Gomase S, Kuthe S, Sonkusale M. Case Report-Right atrial myxoma with total anomalous pulmonary venous connection in neonate. Int J Surg Case Rep 2022; 97:107438. [PMID: 35908453 PMCID: PMC9403170 DOI: 10.1016/j.ijscr.2022.107438] [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: 05/20/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Myxoma is the commonest cardiac tumor in adults but is very rare in a newborn. The majority of myxoma arises from the interatrial septum. 75% of myxomas are found in the left atrium and 20% are found in the right atrium. Myxomas can be single or multiple. Multiple myxomas are usually associated with familial syndromes. Myxomas are generally not associated with another congenital heart defect except atrial septal defect. As myxomas are rare in newborns most of the knowledge is through various case reports. CASE PRESENTATION We report a rare case of an 8-day-old neonate presenting with cyanosis and respiratory distress. Transthoracic echocardiography was suggestive of right atrial myxoma which was arising from the atrioventricular junction on the right side of an interatrial septum. It was associated with the total anomalous pulmonary venous connection. The patient underwent successful excision of myxoma and rerouting of the common venous chamber to the left atrium with an uneventful immediate postoperative course. CLINICAL DISCUSSION Cardiac myxomas are rare in newborns and their association with TAPVC even rare. Our patient had single atrial myxoma with TAPVC. The significance of this association is not clear. This association is mostly by chance. Probably it is the first case reported of its kind. CONCLUSION As myxomas are very rare in neonates, it is highly possible to miss other associated structural heart defects. Diagnosis of atrial myxoma can be suggested by echocardiogram but a definite diagnosis can only be confirmed by histology.
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Affiliation(s)
- Shantanu Gomase
- Dept of Pediatrics, Jawaharlal Nehru Medical College, DMIMS, Sawangi (M), India.
| | - Sachin Kuthe
- Department of Cardiovascular and Thoracic Surgery, Jawaharlal Nehru Medical College, DMIMS, Sawangi (M), India
| | - Manish Sonkusale
- Department of Anesthesia, Jawaharlal Nehru Medical College, DMIMS, Sawangi (M), India
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12
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Reaz S, Sammi S, Gholkar G. A rare case of cardiac fibroma diagnosis in Gorlin-Goltz syndrome with information on management. Future Cardiol 2022; 18:561-567. [PMID: 35735206 DOI: 10.2217/fca-2022-0013] [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: 11/21/2022] Open
Abstract
Gorlin-Goltz syndrome is a rare autosomal dominant disease characterized by odontogenic keratocysts and basal cell carcinoma as well as ophthalmic and neurological implications. The following article presents the case of a 20-year-old female with Gorlin-Goltz syndrome incidentally found to have a cardiac mass. An ECG showed diffuse T-wave inversions in the lateral leads despite a lack of any acute coronary symptoms in the patient. Echocardiogram, cardiac MRI and CT scan confirmed a nonvascularized, smoothly marginated mass arising from the left ventricular apex without any hemodynamic compromise. A whole-body PET scan further demonstrated localized hyperactivity associated with a cardiac fibroma without any evidence of metastasis. The cardiac fibroma was surgically excised for definitive management to prevent the possibility of sudden cardiac death and congestive heart failure.
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Affiliation(s)
- Shams Reaz
- Department of Internal Medicine, University of Michigan-West, Michigan
| | - Suhana Sammi
- Department of Pharmacy, Creighton University, Omaha, 69178, Nebraska
| | - Gunjan Gholkar
- Cardiovascular Disease, University of Michigan-West, Wyoming, 49519, Michigan
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13
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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14
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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15
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Islam AKMM. Cardiac myxomas: A narrative review. World J Cardiol 2022; 14:206-219. [PMID: 35582466 PMCID: PMC9048271 DOI: 10.4330/wjc.v14.i4.206] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/28/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.
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Affiliation(s)
- A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka 1207, Bangladesh
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16
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Unmasking Antenatal Tuberous Sclerosis and 13 Years Retrospective Review of Its Diverse Presentations, Clinical-Imaging Follow Up and Learning the Latest Advances in Management. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-021-00330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Vakrilova L, Marinov R, Hitrova-Nikolova S, Dobrev D, Denev M, Lazarov S. Cardiac Myosarcoma in a Newborn Infant-A Case Report and Literature Review. Front Cardiovasc Med 2021; 8:675202. [PMID: 34336944 PMCID: PMC8316586 DOI: 10.3389/fcvm.2021.675202] [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: 03/02/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Malignant cardiac neoplasms are extremely rare in neonates. Prenatal diagnosis is often not available. Initial symptoms can mimic non-cardiac diseases. We present a pre-mature newborn, birth-weight 2,480 g, 34 gestational weeks, which underwent cardiac surgery due to a cardiac tumor. Case Summary: This was a 3–rd pregnancy after two spontaneous abortions to a mother with thrombophilia, diabetes, hydramnios, and retroplacental hematoma. The baby was admitted to NICU with transitory respiratory failure and inborn infection; hence oxygen-supplementation and antibiotics were initiated. On day 11 a deterioration with tachypnea, high oxygen requirements, significantly increasing C-reactive protein values were noted. Chest radiographs were unremarkable. On day 18 a life-threatening condition with clinical symptoms of shock was identified. Echocardiography showed a large tumor formation in the right atrium, reduced blood flow in the right ventricle and pulmonary artery. On day 19 cardiac surgery was performed: a large tumor with a myxomatous appearance that occupied the cavity of the right atrium and infiltrated the annulus of the tricuspid valve was extirpated. The front wall was restored with a patch. Hemodynamics was temporarily stabilized. On the following day, ventricular fibrillation and asystole occurred. Despite life support efforts, the outcome was lethal. The histological result confirmed leiomyosarcoma of the right atrium and right ventricular hypotrophy. Conclusion: Inborn cardiac sarcomas are extremely rare. The prognosis is poor. Due to fast progression in the third trimester, they can be missed by fetal echocardiography in earlier pregnancy. The postnatal clinical course is aggressive, not specific until invasive infiltration or obstruction by the tumor mass occurred. In our case, the sarcoma mimicked an inborn infection, followed by nosocomial infection and septic shock. Despite low incidence, cardiac tumors should be kept in mind and echocardiography should be conducted if there are unclear symptoms with progressive deterioration during the neonatal period.
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Affiliation(s)
- Liliya Vakrilova
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Neonatology, University Obstetrics and Gynecology Hospital "Maichin Dom", Sofia, Bulgaria
| | - Rumen Marinov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Stanislava Hitrova-Nikolova
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Neonatology, University Obstetrics and Gynecology Hospital "Maichin Dom", Sofia, Bulgaria
| | - Dobri Dobrev
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Maxim Denev
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Stoyan Lazarov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
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18
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Ikegami H, Lemaire A, Gowda S, Fyfe B, Ali M, Russo MJ, Lee LY. Case report: surgical resection of right ventricular cardiac fibroma in an adult patient. J Cardiothorac Surg 2021; 16:136. [PMID: 34016147 PMCID: PMC8139114 DOI: 10.1186/s13019-021-01514-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Cardiac fibromas are rare benign cardiac neoplasms, most frequently occurring in the pediatric population; with very rare cases identified in adults. The tumors are comprised of spindled cells with myofibroblastic ultrastructural features embedded in generally collagenous and elastic stroma. The tumors are intramural in the ventricles, most commonly the left ventricle. Clinical symptoms vary by location and size of tumor and some are asymptomatic. Surgical resection is curative, but rare cases require cardiac transplantation. Case presentation We report an asymptomatic, large, right ventricular fibroma in a 64-year-old woman. The patient underwent open incisional tumor biopsy via lower hemi-sternotomy, followed by complete tumor resection via full sternotomy a week later after confirming the tumor is benign. The tumor was resected using cardiopulmonary bypass, and the defect of right ventricular free wall was repaired using a prosthetic double-patch technique. The postoperative course was uneventful. The patient was discharged to home on day 4 post-complete tumor resection. Conclusion This report expands the existing literature for better comprehension and detection of cardiac fibroma patients and also highlights the various imaging modalities, surgical management, and histological analysis.
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Affiliation(s)
- Hirohisa Ikegami
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, USA.
| | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, USA
| | - Subhashini Gowda
- New Brunswick Cardiology Group, 75 Veronica Avenue, Suite 101, Somerset, NJ, USA
| | - Billie Fyfe
- Department of Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, USA
| | - Mahmoud Ali
- Department of Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, USA
| | - Mark J Russo
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, USA
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19
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Abstract
Cardiac rhabdomyoma is a hamartoma comprised of cardiac myocytes. It is the classic cardiac manifestation of tuberous sclerosis complex (TSC) which is an autosomal dominant genetic syndrome with multi-organ involvement, but highly variable phenotype. Cardiac rhabdomyoma is most commonly diagnosed in infancy, 70 to 90% of whom have TSC. However, TSC-associated cardiac rhabdomyoma usually shows spontaneous regression within the first two years of life and hence is extremely rare in adults. We present a 34-year-old woman with TSC who was found to have a cardiac rhabdomyoma when she was referred to the cardiology clinic for evaluation and to establish care. Cardiac rhabdomyoma is usually asymptomatic. However, depending on size and location, it can cause outflow or inflow tract obstruction and aberrant electrical conduction. Hence, appropriate surveillance is important.
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Affiliation(s)
- Somshukla Ghosh
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Mark R Milunski
- Cardiology, Orlando Veterans Affairs Medical Center, Orlando, USA
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20
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Rodriguez-Gonzalez M, Pérez-Reviriego AA, Gómez-Guzmán E, Tejero-Hernández MÁ, Sanz AZ, Valverde I. Primary cardiac fibroma in infants: A case report and review of cases of cardiac fibroma managed through orthotopic heart transplant. Ann Pediatr Cardiol 2021; 14:224-227. [PMID: 34103866 PMCID: PMC8174620 DOI: 10.4103/apc.apc_78_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/30/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiac fibromas (CF) are the second most common cardiac tumors in children. They can be aggressive tumors despite their benign histopathologic nature, accounting for the highest mortality rate among primary cardiac tumors. CF usually show a progressive growth and spontaneous regression is rare. Therefore, a complete surgical excision is the preferred therapeutic approach when patients become symptomatic or if mass-related life-threatening complications are anticipated, even in asymptomatic patients. However, some cases are not good candidates for surgical excision due to the impossibility of preserving a normal cardiac anatomy or function after the tumor resection. Orthotopic heart transplantation (OHT) can be an exceptional but adequate alternative for some giant unresectable CF in children. In this article, we report our experience with the case of a 7-month-old infant with a giant unresectable cardiac fibroma who was successfully managed through OHT.
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Affiliation(s)
| | | | - Elena Gómez-Guzmán
- Pediatric Cardiology Department, Reina Sofia University Hospital, Córdoba, Spain
| | | | - Alicia Zorrilla Sanz
- Department of Pathology and Laboratory Medicine Clinical Anatomic Pathology of Reina Sofia University Hospital, Córdoba, Spain
| | - Israel Valverde
- Pediatric Cardiology Unit, Virgen del Rocío University Hospital/Institute of Biomedicine of Sevilla (IBIS) of Seville, CIBER-CV, Seville, Spain
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21
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Tanaka T, Kawashima A, Marukawa Y, Kitayama T, Masaoka Y, Kojima K, Iguchi T, Hiraki T, Kanazawa S. Imaging evaluation of hereditary renal tumors: a pictorial review. Jpn J Radiol 2021; 39:619-632. [PMID: 33759057 DOI: 10.1007/s11604-021-01109-5] [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: 12/22/2020] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
More than 10 hereditary renal tumor syndromes (HRTSs) and related germline mutations have been reported with HRTS-associated renal and extrarenal manifestations with benign and malignant tumors. Radiologists play an important role in detecting solitary or multiple renal masses with or without extrarenal findings on imaging and may raise the possibility of an inherited predisposition to renal cell carcinoma, providing direction for further screening, intervention and surveillance of the patients and their close family members before the development of potentially lethal renal and extrarenal tumors. Renal cell carcinomas (RCCs) associated with von Hippel-Lindau disease are typically slow growing while RCCs associated with HRTSs, such as hereditary leiomyomatosis and renal cell carcinoma syndrome, are highly aggressive. Therefore, radiologists need to be familiar with clinical and imaging findings of renal and extrarenal manifestations of HRTSs. This article reviews clinical and imaging findings for the evaluation of patients with well-established HRTSs from a radiologist's perspective to facilitate the clinical decision-making process for patient management.
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Affiliation(s)
- Takashi Tanaka
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
| | - Akira Kawashima
- Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Yohei Marukawa
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Takahiro Kitayama
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Yoshihisa Masaoka
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Katsuhide Kojima
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
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22
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Rapid response of a cardiac rhabdomyoma causing severe right ventricular outflow obstruction to Sirolimus in an infant with negative genetics for Tuberous sclerosis. Cardiol Young 2021; 31:312-314. [PMID: 33148352 DOI: 10.1017/s1047951120003819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mammalian target of rapamycin inhibitors was found recently to be an effective treatment for manifestations of Tuberous sclerosis complex, including cardiac rhabdomyomas. Most cases with Cardiac rhabdomyoma treated with mammalian target of rapamycin inhibitors to date were diagnosed with Tuberous sclerosis. We report a case of cardiac rhabdomyoma and severe right ventricular outflow obstruction in a baby with negative genetics for Tuberous sclerosis that responded rapidly to Sirolimus.
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Aggeli C, Dimitroglou Y, Raftopoulos L, Sarri G, Mavrogeni S, Wong J, Tsiamis E, Tsioufis C. Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis. Diagnostics (Basel) 2020; 10:diagnostics10121088. [PMID: 33327646 PMCID: PMC7765127 DOI: 10.3390/diagnostics10121088] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality.
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Affiliation(s)
- Constantina Aggeli
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
- Correspondence:
| | - Yannis Dimitroglou
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Leonidas Raftopoulos
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Georgia Sarri
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Centre, 17674 Kallithea, Attica, Greece;
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital and Royal Brompton Hospital, London UB96JH, UK;
| | - Eleftherios Tsiamis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Costas Tsioufis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
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Abstract
Purpose of Review Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors. Recent Findings Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. Summary A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.
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25
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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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26
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Okmen F, Ekici H, Hortu I, Imamoglu M, Ucar B, Ergenoglu AM, Sagol S. Outcomes of antenatally diagnosed fetal cardiac tumors: a 10-year experience at a single tertiary referral center. J Matern Fetal Neonatal Med 2020; 35:3489-3494. [PMID: 32954877 DOI: 10.1080/14767058.2020.1822316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical and perinatal outcomes along with ultrasonographic characteristics of fetuses with a cardiac tumor. METHODS The data were obtained retrospectively between January 2010 and December 2019 in a tertiary referral center. The Cardiovascular Profile Score (CVPS) was used for the diagnosis of heart failure. Clinical outcomes of the cases identified in the postnatal period were analyzed. RESULTS Fourteen cases were evaluated with the fetal cardiac tumor. One case made the decision to terminate the pregnancy. Perinatal death was seen in 4 (30.7 %) cases out of 13 cases. In 3/14 (21.4%) cases, a solitary cardiac tumor was found while multiple cardiac tumors were found in 11/14 (78.6%) cases. All living cases 9/9 (100%) had the diagnosis of tuberous sclerosis complex (TSC). When the cases which survived were compared with the cases which died during the prenatal period, a significant difference in tumors' biggest diameters (16.44 ± 5.12 mm vs. 32.25 ± 9.28 mm; p: .011, respectively) was found. No statistically significant difference was found in the number of the tumor(s) and heart failure. CONCLUSION Fetal cardiac tumors can have serious perinatal mortality. The cardiac tumor size was found to be associated with perinatal mortality. The survival is not different between the cases with solitary and multiple tumors and those with and without congestive heart failure.
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Affiliation(s)
- Fırat Okmen
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Ekici
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.,Department of Stem Cell, Ege University Institute of Health Sciences, Izmir, Turkey
| | - Metehan Imamoglu
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, CT, USA
| | - Burcu Ucar
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ahmet Mete Ergenoglu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Sermet Sagol
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
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27
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Babu NS, Behera D, Alex AG, Varghese L, George OK. Cardiac tumors in both twins - A case report of a rare occurrence. Ann Pediatr Cardiol 2020; 13:238-240. [PMID: 32863661 PMCID: PMC7437622 DOI: 10.4103/apc.apc_98_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/21/2020] [Accepted: 04/04/2020] [Indexed: 11/17/2022] Open
Abstract
Cardiac tumors in neonates and infancy are one among the many known congenital cardiac diseases. Although fetal cardiac tumors are rare, there is increased detection because of expertise in echocadiographic examination. Rhabdomyomas are the most common cardiac tumors among infants and children. Here, we describe twin neonates who had multiple cardiac tumors. This kind of presentation appears to be a very rare situation.
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Affiliation(s)
- Nm Sharath Babu
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dibyaranjan Behera
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anoop George Alex
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lijo Varghese
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Oommen K George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
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28
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Mohammed F, Tan GC, Hor KN, Arnold M, Wong YP. A case of surgically resected cardiac rhabdomyoma with progressive left ventricular outflow tract obstruction. Cardiovasc Pathol 2020; 49:107226. [PMID: 32574866 DOI: 10.1016/j.carpath.2020.107226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022] Open
Abstract
Cardiac rhabdomyoma is the most prevalent cardiac tumors in the pediatric population, in close association with tuberous sclerosis complex. It is usually detected antenatally or postnatally by echocardiography. Clinical presentations depend greatly on the size and position of the tumor mass. Interestingly, rhabdomyoma has a propensity to regress spontaneously and is not usually operated upon, unless the patient becomes hemodynamically compromised. Herein, we report an unusual case of surgically treated cardiac rhabdomyoma in a baby boy presented at birth with a progressive enlarging intraventricular mass, complicated with left ventricular outflow tract obstruction 7 weeks later. Histopathological examination of the intracardiac mass revealed sheets of tumor cells with spider-like morphology (known as "spider cells"), confirmed the diagnosis of rhabdomyoma. Close disease monitoring of patient's hemodynamic status in a newly diagnosed cardiac rhabdomyoma is inevitable as the tumor, although rare, may progress.
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Affiliation(s)
- Fazarina Mohammed
- Department of Laboratory Diagnostic Services, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia
| | - Geok Chin Tan
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia; Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus OH 43205, USA
| | - Kan N Hor
- The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, OH 43205, USA
| | - Michael Arnold
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus OH 43205, USA; Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Yin Ping Wong
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia.
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29
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Nagpal P, Agrawal MD, Saboo SS, Hedgire S, Priya S, Steigner ML. Imaging of the aortic root on high-pitch non-gated and ECG-gated CT: awareness is the key! Insights Imaging 2020; 11:51. [PMID: 32198657 PMCID: PMC7083991 DOI: 10.1186/s13244-020-00855-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/02/2020] [Indexed: 02/07/2023] Open
Abstract
The aortic pathologies are well recognized on imaging. However, conventionally cardiac and proximal aortic abnormalities were only seen on dedicated cardiac or aortic studies due to need for ECG gating. Advances in CT technology have allowed motionless imaging of the chest and abdomen, leading to an increased visualization of cardiac and aortic root diseases on non-ECG-gated imaging. The advances are mostly driven by high pitch due to faster gantry rotation and table speed. The high-pitch scans are being increasingly used for variety of clinical indications because the images are free of motion artifact (both breathing and pulsation) as well as decreased radiation dose. Recognition of aortic root pathologies may be challenging due to lack of familiarity of radiologists with disease spectrum and their imaging appearance. It is important to recognize some of these conditions as early diagnosis and intervention is key to improving prognosis. We present a comprehensive review of proximal aortic anatomy, pathologies commonly seen at the aortic root, and their imaging appearances to familiarize radiologists with the diseases of this location.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mukta D Agrawal
- Department of Radiology, Non-invasive Cardiovascular Imaging, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Sachin S Saboo
- Department of Radiology, University of Texas Health Center, San Antonio, TX, USA.
| | - Sandeep Hedgire
- Department of Radiology, Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarv Priya
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael L Steigner
- Department of Radiology, Non-invasive Cardiovascular Imaging, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA
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30
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Abstract
Phakomatoses present with characteristic findings on the skin, central or peripheral nervous system, and tumors. Neurofibromatosis type 1 is the most common syndrome and is characterized by Café-au-lait macules, intertriginous freckling, Lisch nodules, and tumors including neurofibromas, malignant peripheral nerve sheath tumors, and gliomas. Tuberous Sclerosis Complex is characterized by benign hamartomas presenting with hypomelanotic macules, shagreen patches, angiofibromas, confetti lesions and tumors including cortical tubers, subependymal nodules, subependymal giant cell astrocytomas and tumors of the kidney, lung, and heart. Managing these disorders requires disease specific supportive care, tumor monitoring, surveillance for selected cancers, and treatment of comorbid conditions.
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Affiliation(s)
- Benjamin Becker
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA; Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA; Translational Science Institute, Wake Forest Baptist Health, Winston Salem, NC 27157, USA
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31
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Kumar R, Raja J. A Mass Causing Right Ventricular Outflow Obstruction - A Dreadful Complication. Braz J Cardiovasc Surg 2019; 34:772-774. [PMID: 31793255 PMCID: PMC6894037 DOI: 10.21470/1678-9741-2018-0314] [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] [Indexed: 11/08/2022] Open
Abstract
The most common cardiac tumour in the pediatric age group is rhabdomyoma. These are usually located in the ventricles, either in the ventricular septum or free wall. Cardiac tumours in early infancy may lead to severely compromised blood flow due to inflow or outflow tract obstruction. The diagnosis of cardiac rhabdomyoma can be established by transthoracic echocardiography (TTE). Rhabdomyomas have a natural history of spontaneous regression; surgical intervention is reserved for patients with symptoms of severe obstruction or hemodynamic instability. In this study, a case of two-year old child who presented with failure to thrive and underwent excision of pedunculated mass from the right ventricular outflow tract was reported.
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Affiliation(s)
- Rupesh Kumar
- Institute of Medical Education and Research Advanced Cardiac Center Department of Cardiothoracic and Vascular Surgery Chandigarh India Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Raja
- Institute of Medical Education and Research Advanced Cardiac Center Department of Cardiothoracic and Vascular Surgery Chandigarh India Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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32
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Frudit P, Vitturi BK, Navarro FC, Rondelli I, Pozzan G. Multiple cardiac rhabdomyomas in tuberous sclerosis complex: case report and review of the literature. AUTOPSY AND CASE REPORTS 2019; 9:e2019125. [PMID: 31641665 PMCID: PMC6771448 DOI: 10.4322/acr.2019.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Abstract
Cardiac rhabdomyoma is a benign tumor which constitutes the most common cardiovascular feature of the tuberous sclerosis complex, a multisystem genetically determined neurocutaneous disorder. Cardiac rhabdomyomas can be detected in the prenatal ultrasound, are usually asymptomatic and spontaneously regress within the first three years of life. Less often, the tumors' size, number, and location can produce a mass effect that may lead to blood flow abnormalities or organ dysfunction (heart failure and arrhythmia). In this setting, severe morbidity, and eventually, a lethal outcome despite clinical and surgical treatment may ensue. We describe a fatal case of multiple cardiac rhabdomyomas in a newborn girl. One of the rhabdomyomas was large and unfavorably located, causing significant obstruction of the left ventricular outflow tract. The autopsy identified, in addition to cardiac rhabdomyomas, brain glioneuronal hamartomas (cortical tubers), subependymal nodules and subependymal giant cell tumors, characteristic of the tuberous sclerosis complex. The newborn's family was investigated for the presence of typical clinical symptoms of the complex and image findings showed significant phenotypical variations and a broad symptom spectrum among the family members. This interesting case underscores the variability of tuberous sclerosis complex and the importance of performing a comprehensive postmortem examination in the identification of the cause of death, especially in the setting of familial disease.
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Affiliation(s)
- Paula Frudit
- Santa Casa de São Paulo School of Medical Sciences. São Paulo, SP, Brazil
| | | | - Flavia Cristina Navarro
- Irmandade da Santa Casa de Misericórdia de São Paulo, Department of Pediatrics. São Paulo, SP, Brazil
| | - Ivan Rondelli
- Irmandade da Santa Casa de Misericórdia de São Paulo, Department of Pathology. São Paulo, SP, Brazil
| | - Geanete Pozzan
- Irmandade da Santa Casa de Misericórdia de São Paulo, Department of Pathology. São Paulo, SP, Brazil
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33
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Flores C, Lundberg J, Richardson RR, Prasad D. Utility of cardiac imaging in diagnosis of atypical presentation of cardiac fibroma. BMJ Case Rep 2019; 12:e230333. [PMID: 31492729 PMCID: PMC6731913 DOI: 10.1136/bcr-2019-230333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 11/04/2022] Open
Abstract
Primary cardiac tumours are relatively rare in the paediatric population, with benign tumours accounting for >90% of cases. Cardiac fibromas are rare primary tumours that typically reside in the ventricles. Symptoms are usually the result of blood outflow obstruction or disruption of the cardiac conduction system. They do not typically regress and usually require surgical intervention. In this case, we report a rare finding of a right atrial fibroma in an 18-month-old female who presented with lethargy and vomiting. Chest X-ray revealed an enlarged cardiac silhouette, and follow-up CT showed a 3.7×3.2×3.7 cm hypodense lesion in the right atrium. Cardiac MRI revealed the diagnosis, which was confirmed on pathology.
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Affiliation(s)
- Catalina Flores
- Phoenix Regional Campus, School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Jaclyn Lundberg
- Phoenix Regional Campus, School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Randy R Richardson
- Phoenix Regional Campus, School of Medicine, Creighton University, Phoenix, AZ, USA
- Department of Radiology, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Deepa Prasad
- Department of Child Health, Banner Desert Medical Center/Cardon Children's Medical Center, Mesa, AZ, USA
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Liddy S, McQuade C, Walsh KP, Loo B, Buckley O. The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning. Curr Cardiol Rep 2019; 21:103. [DOI: 10.1007/s11886-019-1196-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Sarff B, Floyd R, Bildner A, Stormo J, Fisher K. Fetal Echocardiographic Detection of Cardiac Tumors: A Case Report of Multiple Fetal Cardiac Rhabdomyomas. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319847641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac rhabdomyomas are the most common fetal cardiac tumor. They can be detected in the second and third trimesters. Rhabdomyomas are most commonly associated with the genetic disorder tuberous sclerosis complex. When associated with tuberous sclerosis complex, cardiac rhabdomyomas usually regress within the first few years of life, without complications. Symptoms depend on the size, number, and location of the rhabdomyomas. A case report of multiple cardiac rhabdomyomas that was found at 35 weeks’ gestation and is discussed.
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Affiliation(s)
- Bailey Sarff
- Diagnostic Medical Ultrasound Program, University of Missouri, Columbia, MO, USA
| | - Randall Floyd
- Diagnostic Medical Ultrasound Program, University of Missouri, Columbia, MO, USA
| | - Amy Bildner
- Diagnostic Medical Ultrasound Program, University of Missouri, Columbia, MO, USA
| | - Janell Stormo
- Diagnostic Medical Ultrasound Program, University of Missouri, Columbia, MO, USA
| | - Kelsy Fisher
- Diagnostic Medical Ultrasound Program, University of Missouri, Columbia, MO, USA
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36
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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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37
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Husain M, McCanta A, Batra AS. Rare finding of a pericardial lipoma in a pediatric patient presenting with ventricular tachycardia. HeartRhythm Case Rep 2019; 5:277-280. [PMID: 31193190 PMCID: PMC6522641 DOI: 10.1016/j.hrcr.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Majid Husain
- Children's Hospital of Orange County, Orange, California.,UC Irvine Health School of Medicine, Irvine, California
| | - Anthony McCanta
- Children's Hospital of Orange County, Orange, California.,UC Irvine Health School of Medicine, Irvine, California
| | - Anjan S Batra
- Children's Hospital of Orange County, Orange, California.,UC Irvine Health School of Medicine, Irvine, California
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Kaur Bhatia J, Sanjay Deshpande N, Singh Arora H, Bharadwaj R, Garg A. Left atrial cardiac rhabdomyoma: A rare tumour in an unusual location. Med J Armed Forces India 2018; 76:229-231. [PMID: 32476724 DOI: 10.1016/j.mjafi.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 07/12/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Jasvinder Kaur Bhatia
- Associate Professor, Department of Pathology, Armed Forces Medical College, Pune 41040, India
| | | | - Harmeet Singh Arora
- Assistant Professor, (Cardiology), Military Hospital Cardio Thoracic Centre, Pune 411040, India
| | | | - Anurag Garg
- Former, Professor & Head (Cardiology) and Vascular Surgery, Military Hospital Cardio Thoracic Centre, Pune 41100, India
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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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Morin CE, Morin NP, Franz DN, Krueger DA, Trout AT, Towbin AJ. Thoracoabdominal imaging of tuberous sclerosis. Pediatr Radiol 2018; 48:1307-1323. [PMID: 30078036 DOI: 10.1007/s00247-018-4123-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/02/2018] [Accepted: 03/19/2018] [Indexed: 12/19/2022]
Abstract
Imaging of tuberous sclerosis complex has rapidly evolved over the last decade in association with increased understanding of the disease process and new treatment modalities. Tuberous sclerosis complex is best known for the neurological symptoms and the associated neuroimaging findings, and children with tuberous sclerosis complex require active surveillance of associated abnormalities in the chest, abdomen and pelvis. Common findings that require regular imaging surveillance are angiomyolipomas in the kidneys and lymphangioleiomyomatosis in the chest. However multiple rarer associations have been attributed to tuberous sclerosis complex and should be considered by radiologists reviewing any imaging in these children. In this review the authors discuss the spectrum of imaging findings in people with tuberous sclerosis complex, focusing on MR imaging findings in the chest, abdomen and pelvis.
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Affiliation(s)
- Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
| | - Nicholas P Morin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David N Franz
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Darcy A Krueger
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
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Abstract
Cardiac masses present a diagnostic challenge given their relative rarity and the overall difficulty imaging the heart. With the increasing frequency and quality of imaging in general, however, the incidental discovery of cardiac masses is increasing. Cardiac masses seldom produce symptoms, and they are more commonly found during imaging for noncardiac indications. While echocardiography is useful in the initial evaluation of a suspected mass, cardiac magnetic resonance (MR) imaging is the best imaging modality to characterize cardiac tumors due to its superior tissue characterization and its higher contrast resolution. Due to the risk of embolization and arrhythmia, most benign cardiac tumors are removed, and imaging plays an important role in treatment planning. While primary resection remains the mainstay of treatment, new treatment strategies may prolong survival and slow the growth of metastases. A fundamental knowledge of common cardiac masses is vital to all radiologists, and here, we discuss the most pertinent imaging approach to cardiac masses emphasizing MR imaging.
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42
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Maleszewski JJ, Bois MC, Bois JP, Young PM, Stulak JM, Klarich KW. Neoplasia and the Heart. J Am Coll Cardiol 2018; 72:202-227. [DOI: 10.1016/j.jacc.2018.05.026] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022]
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Abstract
Cardiac rhabdomyomas are the most common tumours in children and are typically seen in association with the tuberous sclerosis complex. Although benign and often associated with spontaneous regression, in rare circumstances surgical resection is indicated to relieve obstruction or other mass-related effects. Recent clinical trials have demonstrated the benefits of mammalian target of rapamycin inhibitors for the treatment of other tumour sub-types associated with tuberous sclerosis. Here we report rapid regression of several massive cardiac rhadomyomas in two neonates with the use of the mammalian target of rapamycin inhibitor sirolimus.
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Yabrodi M, Mastropietro CW, Darragh RK, Parent JJ, Ayres MD, Kean AC, Turrentine M. Management of Complications Caused by a Massive Left Ventricle Tumor in a Neonate. Ann Thorac Surg 2018; 105:e259-e261. [PMID: 29409794 DOI: 10.1016/j.athoracsur.2017.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022]
Abstract
We report the case of a neonate born with a giant fibroma occupying the entirety of her left ventricle. Owing to the extensive resection, her postoperative course was complicated by severely diminished left ventricular function and complete heart block necessitating extracorporeal support. Ultimately, cardiac resynchronization therapy was used, after which the infant's ventricular function gradually improved and she was successfully discharged to home.
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Affiliation(s)
- Mouhammad Yabrodi
- Department of Pediatrics, Division of Critical Care, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Christopher W Mastropietro
- Department of Pediatrics, Division of Critical Care, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert K Darragh
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - John J Parent
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark D Ayres
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam C Kean
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark Turrentine
- Department of Surgery, Division of Cardiothoracic Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
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Castro-Monsalve J, Alvarado-Socarras JL, Mantilla KA, Forero L, Moreno A, Prada CE. Cardiac Rhabdomyomas in Tuberous Sclerosis Complex. J Pediatr 2018; 192:264-264.e1. [PMID: 29128117 DOI: 10.1016/j.jpeds.2017.09.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Javier Castro-Monsalve
- Fundación Cardiovascular de Colombia Hospital Internacional de Colombia Floridablanca, Colombia
| | | | - Karen A Mantilla
- Fundación Cardiovascular de Colombia Hospital Internacional de Colombia Floridablanca, Colombia
| | - Laura Forero
- Connecticut Children's Medical Center Hartford, Connecticut
| | - Andres Moreno
- Connecticut Children's Medical Center Hartford, Connecticut
| | - Carlos E Prada
- Fundación Cardiovascular de Colombia Hospital Internacional de Colombia Floridablanca, Colombia; Division of Human Genetics Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati, Ohio
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Saad AM, Abushouk AI, Al-Husseini MJ, Salahia S, Alrefai A, Afifi AM, Abdel-Daim MM. Characteristics, survival and incidence rates and trends of primary cardiac malignancies in the United States. Cardiovasc Pathol 2017; 33:27-31. [PMID: 29414429 DOI: 10.1016/j.carpath.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/17/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The available literature on the incidence, management and prognosis of primary malignant cardiac tumors [PMCTs] is limited to single-center studies, prone to small sample size and referral bias. We used data from the Surveillance, Epidemiology, and End Results [SEER]-18 registry (between 2000 and 2014) to investigate the distribution, incidence trends and the survival rates of PMCTs. METHODS We used SEER*Stat (version 8.3.4) and the National Cancer Institute's Joinpoint Regression software (version 4.5.0.1) to calculate the incidence rates and annual percentage changes [APC] of PMCTs, respectively. We later used SPSS software (version 23) to perform Kaplan-Meier survival tests and covariate-adjusted Cox models. RESULTS We identified 497 patients with PMCTs, including angiosarcomas (27.3%) and Non-Hodgkin's lymphomas [NHL] (26.9%). Unlike the incidence rate of NHL (0.108 per 106 person-years) that increased significantly (APC=3.56%, 95% CI, [1.445 to 5.725], P=.003) over the study period, we detected no significant change (APC=1.73%, 95% CI [-3.354 to 7.081], P=.483) in the incidence of cardiac angiosarcomas (0.107 per 106 person-years). Moreover, our analysis showed that the overall survival of NHL is significantly better than angiosarcomas (P<.001). In addition, surgical treatment was associated with a significant improvement (P=.027) in the overall survival of PMCTs. CONCLUSION Our analysis showed a significant increase in the incidence of cardiac-NHL over the past 14 years with a significantly better survival than angiosarcomas. To further characterize these rare tumors, future studies should report data on the medical history and diagnostic and treatment modalities in these patients.
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Affiliation(s)
- Anas M Saad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Sami Salahia
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anas Alrefai
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Afifi
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed M Abdel-Daim
- Pharmacology Department, Suez Canal University, Ismailia, Egypt; Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
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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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Wataya-Kaneda M, Uemura M, Fujita K, Hirata H, Osuga K, Kagitani-Shimono K, Nonomura N. Tuberous sclerosis complex: Recent advances in manifestations and therapy. Int J Urol 2017; 24:681-691. [DOI: 10.1111/iju.13390] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/01/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Mari Wataya-Kaneda
- Department of Dermatology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Motohide Uemura
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Kazutoshi Fujita
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine; Allergy and Rheumatic Diseases; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Kuriko Kagitani-Shimono
- Department of United Graduate School of Child Development; Osaka University; Suita Osaka Japan
| | - Norio Nonomura
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
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49
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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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Lang JE, Pflaumer A, Davis AM. Causes of sudden death in the young — Cardiac and non-cardiac. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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