Intracardiac Teratoma in a Child: A Rare Site of a Common Tumor

Surgical treatment of primary cardiac tumors in children

OBJECTIVE

Summarizing the treatment experience of primary cardiac tumors in children.

METHODS

The date of 24 children with primary cardiac tumors who underwent surgery in our department from July 2003 to September 2022 was collected and analyzed treatment efficacy.

RESULTS

All patients completed the surgery successfully, including 21 cases of complete tumor resection, 2 cases of partial tumor resection, and 1 case of tumor biopsy. The location: 5 cases in the right atrium, 5 cases in the right ventricle, 6 cases in the left atrium, 6 cases in the left ventricle, 1 case in the left, right ventricle and ventricular septum, and 1 case in the ventricular septum. 23 cases were benign: 11 cases of myxoma, 7 cases of fibroma, 3 cases of rhabdomyoma, 1 case of infantile capillary hemangioma, and 1 case of lipoma. There was 1 case of borderline or malignant tumor. 23 patients were discharged successfully, 1 patient died of cardiac failure on the first day after operation. Follow-up was done from 5 months to 19 years and 2 months, 2 cases were lost to follow-up, and 1 case died of cardiac failure in the second year after operation due to severe mitral regurgitation. There was 1 case of tumor biopsy with space-occupying lesion gradually shrinking during follow-up. The prognosis of another 19 children with complete or partial tumor resection was good. There was no recurrence, enlargement, or reoperation of the tumor during the follow-up period.

CONCLUSIONS

Primary cardiac tumors in children are mostly benign. Surgery is effective, but the timing of surgery depends on the patient's condition.

Hyperechoic mass of the right ventricle in adults: A rare presentation of an intracardiac teratoma

Cardiac teratomas are very rare primary tumors; most are intrapericardial, while a few are intracardiac. Furthermore, most reported intracardiac teratomas are in the pediatric population, with few cases of secondary metastases from testicular teratomas reportedly manifesting in adults. Here, we report a rare case of a mature cystic teratoma in the right ventricle complicated by a bicuspid aortic valve (BAV) in an adult. Echocardiography and enhanced computed tomography (CT) were performed, and the mass was surgically excised. A pathological examination confirmed the diagnosis of a mature cystic teratoma. Meanwhile, mechanical valve replacement of the aortic valve was performed. No tumor recurrence or symptoms occurred in the 2-year follow-up. This is the first report of an adult primary intracardiac teratoma with solid hyperechoic findings on echocardiography and a BAV.

Current status of diagnosis and treatment of primary benign cardiac tumors in children

Primary cardiac tumors in children are exceedingly rare overall, which benign account for most part. The onset of the disease is occult, while the clinical manifestations are non-specific-patients may be asymptomatic or show a range of obstructive, arrhythmic, embolic or systemic symptoms. The clinical presentations generally depend on the tumors’ size, localization, and pace of growth of the tumor. Moreover, the diagnosis needs comprehensive judgment based on imaging results and pathological examination. With advances in cardiac imagining and the introduction of cardiopulmonary support, the diagnosis and treatment of these rare tumors have improved the prognosis and outlook for benign tumors. To sum up the above, we sought to integrate articles from recent years for the latest comprehensive review of the clinical manifestations, imaging characteristics, clinic pathologic features and treatment of benign cardiac tumors in children to provide a broader idea for pediatricians to recognize and treat such diseases.