ECHO 2013 / Cardiac Tumors and Masses
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MALIGNANT TUMORS: SARCOMAS
•Nearly all malignant cardiac tumors are sarcoma; only second to myxoma in overall frequency
•Derive from mesenchyme: wide variety of morphological types (angiosarcoma, rhabdomyosarcoma, fibrosarcoma, etc.)
•Most common between the 3rd and 5th decade; unusual in children
ANGIOSARCOMA
•Pathology
–malignant cells forming vascular channels
–may be infiltrative or polypoid
•Predominantly in adults; 2:1 male to female ratio
•Locations: RA, RAA and pericardium (approx 80%)
•Clinical presentation:
–hemopericardium with tamponade
–right-sided CHF
–vena caval obstruction
•Poor prognosis
Angiosarcoma
Secondary Cardiac Tumors:
20-40x more common than primary tumors
Frequency of Cardiac Metastases of Each Different
Primary Tumor
50
40
30
%
20
10
0
Melanoma Leukemia Lymphoma |
Lung |
Breast |
Roberts WC, AJC 2007
Location of Cardiac Metastasis
Lymphatic
Leukemia
Lymphoma
Metastases to the Heart
Venous Extension
IVC: renal cell, adrenal, liver, uterine leimyosarcoma
PV: bronchogenic, sarcomas
SVC: thyroid
Direct Extension
Lung
Breast
Esophagus
Mediastinal
Hematogenous
Melanoma
Breast
Lung
SARCOMA VIA PULMONARY VENOUS
EXTENSION
Metastatic Adrenal Ca with IVC extension
Metastatic Breast Cancer
Tamponade
