Cardiac Tumors: Diagnosis, Prognosis, and Treatment

Abstract

Purpose of review: Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors.

Recent findings: Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.

Keywords: Cardiac tumors; Cardio-oncology; Histopathology; Masses; Multimodality imaging; Neoplastic tumors.

Fig. 1

Overview of localization of cardiac tumors. (From Castrichini et al. European Heart Journal - Case Reports. doi:10.1093/ehjcr/ytaa026,by permission of Oxford University Press) [••]

Fig. 2

Metastatic pleomorphic sarcoma. We can see a large neoplastic mass extensively necrotic area destroying the subtotality of the left atrium

Fig. 3

Metastatic pleomorphic sarcoma (EE × 10). The tumor consists of pleomorphic and anaplastic cells, both with spindle pattern and epithelioid cells

Fig. 4

Giant papillary fibroelastoma occluding the right coronary artery ostium

Fig. 5

Flow chart of diagnostic workup

Fig. 6

Giant liposarcoma in the left atrium. a TTE long axis section shown left atrium mass with homogenous echogenicity. b CT scan. c Dedifferentiated liposarcoma with osteogenic areas (EE × 20). d TEE long axis view. e Liposarcoma after surgical abscission