Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Oncologic essentials in malignant cardiac masses (approach and follow-up)


Key points

  • Malignant tumors are extremely rare.

  • 25% of primary cardiac tumors are malignant.

  • Most malignant cardiac tumors are metastatic (from breast, lung, melanoma, soft tissue sarcoma, etc.).

  • Sarcoma, lymphoma, and malignant pericardial mesothelioma are three main primary malignant cardiac tumors.

  • Usual imaging studies consist of TTE, CMR, and contrast TTE that are helpful noninvasive tools to diagnose suspicious cardiac masses.

  • Generally, despite multimodal treatment strategies, prognosis of malignant cardiac tumors is poor.

Epidemiology and classification

Malignant cardiac tumors are extremely rare (0.001%–0.03% in most autopsy series) and account for 10%–25% of primary cardiac masses .

Table 23.1
Major outlines of the 2015 WHO classification of tumors of the heart and pericardium .
Benign tumors and tumor-like conditions
Tumors of uncertain biologic behavior
Germ cell tumors
Malignant tumors
Tumors of the pericardium

Table 23.2
Incidence of different subtypes of primary malignant cardiac tumors .
Primary cardiac tumors Incidence
Benign 70%–75%
Malignant 25%–30%
Angiosarcoma 9%
Rhabdomyosarcoma 6%
Mesothelioma 4%
Fibrosarcoma 3%
Lymphoma 2%
Other sarcomas 3%
Teratoma < 1%
Other < 1%

Table 23.3
Incidence of cardiac metastasis in several malignancies .
Secondary cardiac tumors Rate of heart metastasis %
Pleural mesothelioma 48.4%
Melanoma 27.8%
Lung adenocarcinoma 21%
Undifferentiated carcinoma 19.5%
Lung squamous cell carcinoma 18.2%
Breast carcinoma 15.5%
Ovarian carcinoma 10.3%
Lymphoproliferative neoplasms 9.4%
Bronchoalveolar carcinoma 9.8%
Gastric carcinoma 8%
Renal cell carcinoma 7.3%
Pancreatic carcinoma 6.4%

Fig. 23.4, Outlines of malignant cardiac tumors.

Fig. 23.5, Location of different cardiac malignant tumors in heart.

Fig. 23.6, A 44-year-old man with new onset hypertension and abdominal mass extended to IVC and RA. He was diagnosed with metastatic adrenocortical carcinoma.

Fig. 23.7, A 27-year-old man admitted to emergency department because of progressive functional NYHA class 3 dyspnea. Malignant involvement of the pericardium with leukemic cells was detected. He was diagnosed with pre-B-cell ALL.

Fig. 23.8, A 31-year-old man with metastatic primary cardiac rhabdomyosarcoma.

Fig. 23.9, A 33-year-old man with metastatic malignant mesothelioma (postthoracotomy).

Approach and diagnostic workup

The clinical history and physical examination are critical to decide what types of laboratory tests and imaging studies are optimal for an individual. A cardiac mass in a patient with atrial fibrillation or heart failure most probably is intracardiac thrombi; instead in prosthetic valvular disease or endocavitary catheters, vegetation, calcifications, thrombus, and tumors should be taken into account. In most cases, multimodality noninvasive imaging is used. Usual imaging studies consist of TTE, CMR, and contrast TTE that provide useful information before histopathologic procedures .

Fig. 23.10, Schema of approach to a suspected cardiac mass.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts