Intracardiac rhabdomyomas in neonates: report of three cases

Clinical value of prenatal echocardiographic examination in the diagnosis of fetal cardiac tumors

The aim of the present study was to explore the clinical value of prenatal echocardiographic examination in the diagnosis of fetal cardiac tumors. In total, the cases of 8 fetuses with fetal cardiac tumors, which were identified by prenatal ultrasound examination in The First Affiliated Hospital of Nanchang University between January 2012 and January 2014, were retrospectively analyzed. The size, shape, location, activity and hemodynamic changes of the lesions were described in detail, and the patients were followed up. Out of the 8 identified cases of fetal cardiac tumors, 2 fetuses contained tumors only in the left ventricular cavity and 6 fetuses contained tumors of the left and right ventricular cavities, interventricular septum and apex of the heart. Overall, 5 of the 8 female patients requested termination of the pregnancy and labor was induced. The fetuses were pathologically confirmed to possess rhabdomyoma. In addition, 1 patient was followed-up for 5 weeks, and the tumor in the fetal heart cavity was found to have enlarged and developed in multiple regions when follow-up was performed. The patient then requested termination of the pregnancy and labor was induced. The fetus was pathologically confirmed to possess rhabdomyoma. The remaining 2 patients insisted on continuation of the pregnancy and the fetuses were followed up during gestation and subsequent to birth by echocardiographic examination. Prenatal echocardiography may precisely position and diagnose occupying lesions of the fetal heart, which is of considerable value in clinical decision making and instruction for treatment.

Myogenic tumors in children and adolescents

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.

Prenatal diagnosis of cardiac rhabdomyomas: incidence of associated cerebral lesions of tuberous sclerosis complex

OBJECTIVES

To determine the prevalence of specific cerebral lesions of tuberous sclerosis complex (TSC) and neurological outcome in cases diagnosed prenatally with cardiac rhabdomyomas.

METHODS

We reviewed all fetuses diagnosed prenatally with cardiac rhabdomyomas which had undergone detailed ultrasound evaluation and cerebral magnetic resonance imaging (MRI) and which were recorded in the database of a single institution covering the period January 1992 to December 2005.

RESULTS

Fifty-one fetuses were included in the study. MRI was performed at a mean +/- SD gestational age of 30 +/- 3 gestational weeks and showed specific lesions of TSC in 49% of cases. Termination of pregnancy was chosen by the parents in 26 cases. Neurological development was studied in 20 cases, follow-up lasting 4.8 +/- 2.9 years. Neurodevelopmental events occurred during the follow-up period in 45% of cases. Neurological complications occurred in 67% of patients who had cerebral lesions at MRI and in 33% of patients with normal MRI results. There was no significant difference between the two groups of patients (P = 0.2).

CONCLUSION

In fetuses with cardiac rhabdomyomas detailed ultrasound examination and third-trimester cerebral MRI are able to diagnose most TSC cerebral lesions, but fail to determine neurological outcome.

Fetal and neonatal cardiac tumors

Primary tumors of the heart are uncommon in the fetus and neonate. Nevertheless, the widespread use of new imaging techniques has contributed significantly to earlier diagnosis, treatment, and thus improved survival. The clinical findings, imaging studies, pathology, and outcome of 224 fetuses and neonates with cardiac tumors collected from the literature are evaluated and discussed. Most tumors are benign, and of these rhabdomyoma is the most common, followed by teratoma, fibroma, oncocytic cardiomyopathy, vascular tumors, and myxoma. Malignant and metastatic tumors are described but are rare. Murmurs, arrhythmias, cyanosis, respiratory distress, and cardiac failure are the main presenting signs of cardiac tumors in the perinatal period. Disturbances in hemodynamic function are correlated with the size and location of the tumor. Cardiac vascular tumors have the best outcome, whereas malignant tumors have the worst. The purpose of this review is to concentrate on the fetus and neonate in an attempt to determine the various ways cardiac tumors differ clinically and morphologically in this age group from those occurring in older children and adults and to show that certain types of tumors have a better prognosis than others.

Left ventricular outflow obstruction in rhabdomyoma of infancy: meta-analysis of the literature

Primary heart tumors are exceptional in infants and children. Most common is the rhabdomyoma, often associated with tuberous sclerosis (Bourneville's disease). This tumor is generally believed to have no hemodynamic effects in the majority of cases. Recently, severe obstruction of the left ventricular outflow tract by a solitary tumor was diagnosed during pregnancy and emergency surgery was needed soon after birth.

Surgical ablation of a cardiac rhabdomyoma in an infant with tuberous sclerosis

Cardiac rhabdomyoma is a rare tumor. Because of its rate of regression, mainly in the first year of life, conservative therapy is generally suggested when diagnosis occurs in infancy. We report surgical ablation of a rhabdomyoma in a 2-month-old boy in whom the tumor extended into the subaortic outflow tract. The tumor, which had a dual attachment to the aortic and mitral valves, was safely removed without any valvar damage. We suggest immediate surgical intervention for those rhabdomyomas which are life-threatening because of their size, location, or arrhythmogenicity.

Left ventricular thrombosis during infancy: report of two cases

Two patients with left ventricular thrombosis diagnosed by echocardiography are presented. The first patient was a 6-week-old girl with supraventricular tachycardia. Cross-sectional echocardiography showed a rounded and mobile structure protruding from the left ventricular wall. The girl was in heart failure and had signs of peripheral embolization. After sinus rhythm had been restored the thrombus diminished gradually and the girl recovered. The second patient was a newborn boy with severe aortic stenosis and a large massive thrombus along the left side of the interventricular septum. The boy died after valvotomy, the post-mortem examination confirmed the diagnosis of a large thrombus. Left ventricular thrombosis is uncommon in neonates and infants but may appear secondary to abnormal hemodynamics.