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Olaya-C M, Franco JA, Messa OA. Symptomatic and lethal congenital primary cardiac rhabdomyoma. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2019-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Congenital tumors, including mesenchymal rhabdomyoma, are highly infrequent. The combination of a congenital tumor and rhabdomyoma is rarer yet, even more so when primary origin is in the heart.
Case presentation
We present a case of fetal hydrops fetalis, wherein the post-mortem exam revealed a cardiac tumor more than twice the size of the heart itself; histological study confirmed primary rhabdomyoma involving the left ventricle.
Conclusion
It is essential to keep in mind that fetal tumors should always be differentiated from malformations; in fetuses tissue immaturity must be taken into account for categorization; despite benign labeling, they can be lethal.
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Affiliation(s)
- Mercedes Olaya-C
- Pontificia Universidad Javeriana , Department of Pathology , Bogota , Colombia
- Hospital Universitario San Ignacio , Department of Pathology , Bogota , Colombia
| | - Jorge Andres Franco
- Pontificia Universidad Javeriana , Department of Morphology , Bogota , Colombia
| | - Oscar Alberto Messa
- Pontificia Universidad Javeriana , Department of Pathology , Bogota , Colombia
- Hospital Universitario San Ignacio , Department of Pathology , Bogota , Colombia
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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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Delmo Walter EM, Javier MF, Sander F, Hartmann B, Ekkernkamp A, Hetzer R. Primary Cardiac Tumors in Infants and Children: Surgical Strategy and Long-Term Outcome. Ann Thorac Surg 2016; 102:2062-2069. [DOI: 10.1016/j.athoracsur.2016.04.057] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 12/12/2022]
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Fan C, Gao Z, Yin NI, Yang J. Surgical treatment of primary cardiac tumors in children: Experience of a single institute. Oncol Lett 2015; 10:2071-2074. [PMID: 26622798 PMCID: PMC4579805 DOI: 10.3892/ol.2015.3529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 07/07/2015] [Indexed: 01/09/2023] Open
Abstract
In order to review the surgical experience of a single institute with regard to the treatment of primary cardiac tumors, data was collected on patients with a histopathological diagnosis of a primary cardiac tumor (with the exception of myxoma) in a retrospective analysis of those treated between 2004 and 2013. In total, 11 patients were identified, with a mean age at diagnosis of 23 months and a mean weight of 13 kg. The most frequent cause of referral was a cardiac murmur and the most frequent cardiac tumor was rhabdomyoma (5 cases), followed by fibroma (3 cases), angiofibroma (2 cases) and fibrosarcoma (1 case). Surgical removal of the tumor was performed in all patients due to the respective clinical symptoms. A subtotal resection was performed in a single patient (with angiofibroma invading the aortic root, superior vena cava and sinus node) due to financial constraints. This patient succumbed to tumor invasion 2 years later. Another of the patients (pericardial fibrosarcoma) succumbed 1 year after the total resection, as they were unable to undergo a repeat surgery for the relapsed tumor due to financial inadequacy. The remaining 9 patients have survived in good condition during the 1-6 year follow-up. Surgery is the preferred treatment for patients with symptomatic primary cardiac tumors, and has good early- and long-term outcomes. However, due to the current health care system inadequacies in China, certain parents cannot afford the medical expenses, thus, more comprehensive social security and medical insurance may require consideration.
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Affiliation(s)
- Chengming Fan
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Zibo Gao
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - N I Yin
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Jinfu Yang
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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Cardiac tumors in infants and children: study of 120 operated patients. Pediatr Cardiol 2013; 34:125-8. [PMID: 22735896 DOI: 10.1007/s00246-012-0399-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
Cardiac tumors in children are rare, and patient series are limited in size. We report 120 children who underwent surgery to treat a cardiac tumor; the tumor type was known in 108 instances. The patients represented <0.1 % of 130,000 cardiac surgeries performed in children from a multi-institutional data base. The most common tumors and the number of patients were rhabdomyoma (n = 42), myxoma (n = 28), and fibromas (n = 10). The remaining 18 tumors of various types occurred in smaller numbers of patients. Nine patients (7 %) died after surgery. The mean age of death was 14 days, and death was most frequent in patients with fibromas (n = 4). Considering the variety of tumors, their varied location in cardiac structures, the patient ages, and the infrequent occurrence in an individual surgeon's experience, the operative mortality was low.
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Abstract
Neoplasms of striated and smooth muscle in children are a diverse group of neoplasms that have some unique aspects in contrast to these tumors in adults. Rhabdomyosarcoma is the most common soft tissue sarcoma of infancy and childhood and is relatively common in adolescents. In contrast, smooth muscle tumors are relatively rare, and the various types of rhabdomyoma and smooth and skeletal muscle hamartomas are very uncommon. In recent years, the understanding of the pathologic and genetic aspects of rhabdomyosarcoma has been enhanced by adjunct techniques, such as immunohistochemistry and cytogenetic or molecular genetic analysis. The current classification of rhabdomyosarcoma emphasizes the histologic-prognostic correlations. This article reviews the clinicopathologic features of striated and smooth muscle tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents and the differential diagnosis.
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Affiliation(s)
- David M Parham
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Gazit AZ, Gandhi SK. Pediatric primary cardiac tumors: Diagnosis and treatment. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 9:399-406. [PMID: 17897569 DOI: 10.1007/s11936-007-0060-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary cardiac tumors are rare in pediatrics. Their clinical presentation differs among the various age groups (fetus to the young adult). Our discussion focuses on the diagnosis and treatment of rhabdomyomas, fibromas, myxomas, and pericardial teratomas in the fetus and neonatal stages. Fetal diagnosis has been described in association with rhabdomyomas, fibromas, and pericardial teratomas. It is made by echocardiography prompted by fetal dysrhythmias, nonimmune hydrops, intrauterine growth restriction, and familial tuberous sclerosis. Based on our experience, it is of the utmost importance to refer these patients to a tertiary center for detailed evaluation, follow-up, and delivery. Tumor diagnosis in the neonatal age group may be prompted by a murmur, dysrhythmia, conduction block, and hemodynamic compromise or hypoxemia due to right or left inflow or outflow tract obstruction. Prenatal diagnosis of a hemodynamically significant mass mandates the presence of a neonatal intensivist in the delivery room for prompt initiation of advanced life support (intubation, mechanical ventilation, and central venous access), and early initiation of prostaglandin E(1) to establish ductus arteriosus patency. Severe inflow obstruction associated with a restrictive atrial septum may require balloon atrial septostomy. Emergent transvenous pacing is indicated in the face of high-degree atrioventricular block. Early surgical removal of the mass after initial stabilization in the neonatal or cardiac intensive care unit may be indicated.
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Affiliation(s)
- Avihu Z Gazit
- Department of Pediatrics, Washington University in Saint Louis, One Children's Place, NWT Box 8116, St. Louis, MO 63110, USA.
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