Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases

Abstract

To investigate the characteristics and pathological features of primary cardiac tumors and to evaluate the diagnostic sensitivity of echocardiography in primary cardiac tumors, all pathologic and echocardiographic records at the Chinese PLA general hospital and its satellite hospitals between January 1st, 1990 and January 1st, 2000 were reviewed to identify patients with a confirmed diagnosis of primary cardiac tumors. A total of 149 patients who had complete echocardiographic records and who were diagnosed with primary cardiac tumors were included in the study. Pathologic and echocardiographic records were reviewed retrospectively to evaluate the presence, location and histologic type of the tumors. The majority (n=118, 79.2%) of cases had been diagnosed with benign tumors. Myxoma was the most common histologic type accounting for 50.0% of total cardiac tumors. Lipoma was the second most common type of benign tumor. Among cases with malignant tumors (n=31, 20.8%), unclassified sarcoma (n=7), angiosarcoma (n=6) and rhabdomysarcoma (n=6) were the common histologic types of primary malignant tumor. Non-myxomatous benign tumors were more likely to have occurred in the ventricle than myxomas (17/43, 39.5% vs. 7/75, 9.3%; P=0.00). The proportion of pericardium involvement in the malignant tumors (8/31, 25.8%) was significantly higher than that in the myxomas (0/75, 0%; P=0.00) and non-myxomas (2/43, 4.7%; P=0.01). The diagnostic sensitivity of transthoracic and transesophageal echocardiography was 93.3% (139/149) and 96.8% (30/31), respectively. The study, using a relatively large sample, confirms that myxoma was the most common primary cardiac tumor. The locations of tumor involvement varied by types of tumor. Echocardiography may be a useful tool for early diagnosis of primary cardiac tumors.

Introduction

Primary cardiac tumors are rare. They mimic other heart diseases and can be easily misdiagnosed. It is estimated that primary cardiac neoplasms are 100–1000 times less prevalent than secondary neoplasms of the heart [1], [2]. Their potentially lethal nature and the possibility of cure with propitious excision make their diagnosis challenging and consequential [2], [3], [4]. As rapid advances have been made in cardiovascular imaging, such as echocardiography, the chances of early identification of cardiac tumors have been dramatically improved. To achieve diagnostic and therapeutic adequacy, clinicians should be knowledgeable about cardiac tumor pathology as well as their frequently atypical clinical presentations [5], [6], [7]. Although several studies on primary cardiac tumors have been conducted in other populations [8], [9], [10], [11], no clinical epidemiologic study in the Chinese population has been done.

The present study was conducted to investigate the characteristics and pathological features of primary cardiac tumors with emphasis on evaluating echocardiographic manifestations that lead to diagnosis of primary cardiac tumors in a Chinese population.