Chapter

Tumours of the heart

Thomas A. Traill

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.1610

Series: Oxford Textbooks

Tumours of the heart

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Cardiac myxoma

Cardiac myxomas are rare benign tumours that grow in the lumen of the atria, usually the left. Most are sporadic, but they can be associated with the Carney complex, where unusual freckling is typically the most obvious clinical clue.

Symptoms and signs most commonly mimic those of mitral stenosis. Systemic emboli occur in about 40% of cases. Constitutional effects predominate in a few patients who present with what seems to be an obscure multisystem disorder. In many patients, specific cardiovascular signs are inconspicuous or absent: an audible ‘tumour plop’ in early diastole, analogous to a mitral opening snap, is often reported only after the diagnosis is established.

The diagnosis is almost always made by echocardiography. Treatment is by urgent surgical removal. Recurrence is uncommon, provided excision has been complete, except in Carney complex.

Other tumours of the heart

The most common tumour seen in adult patients is the benign papillary fibroelastoma, which should be surgically removed only if it has been discovered in the search for a source of otherwise unexplained embolism.

Primary cardiac sarcomas are found more often in the right heart than in the left. Surgical resection is often attempted for obstructive symptoms, but recurrence and metastasis are common, and long-term outcome is very poor.

Microscopic secondary deposits within the myocardium can often be found in patients who die of metastatic cancer, but these are rarely of clinical importance. Intraluminal spread of cancer to the heart by direct extension up the inferior vena cava is a particular feature of renal cell carcinoma.

Chapter.  2539 words.  Illustrated.

Subjects: Cardiovascular Medicine

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