Heart tumors can be primary (heart origin), sometimes they can be the spread of a nearby tumor, and sometimes they can be the metastasis of a distant tumor.
The most common among primary benign heart tumors These are myxomas.
Myxoma, Rhabdomyoma, Fibroelastoma (fibroma), Hemangioma, Atrioventricular nodal mass, Lipoma, Fibrous histiocytoma, Epithelioid hemangioendothelioma, Bronchogenic cyst, Teratoma
Primary malignant tumors. is rare and mostly sarcomatous.
Sarcoma (95%), Angiosarcoma, Fibrous histiocytoma, Osteosarcoma, Leiomyosarcoma, Fibrosarcoma, Myxosarcoma, Rhabdomyosarcoma, Liposarcoma, Lymphoma
Secondary (non-cardiac origin) heart tumors, especially originating from the lung and breast or occurring during hematological malignancies.
Heart tumors involve the myocardium, endocardium, epicardium, pericardium, or all of these together. . The most common location of metastasis is the pericardium. Clinical findings are generally nonspecific and variable and appear late. Transesophageal and transthoracic echocardiography are used as diagnostic methods. There are also cases where magnetic resonance and computed tomography are used.
The treatment of benign tumors is, in principle, surgery, and if recurrences in myxomas are ignored, they generally have a good prognosis.
Surgery for malignant tumors. Since treatment often cannot be completed, it is necessary to discuss the approach on a case-by-case basis. Cardiac metastases are treated symptomatically, with exceptions.
70-80% of cardiac tumors are benign and these are also benign. Myxomas constitute the majority (35-50%). Myxomais the most common benign cardiac tumor and accounts for 30% of all primary cardiac tumors and nearly half of all benign cardiac tumors. 70% of myxomas are seen in the left atrium, 20% in the right atrium, and 5% in the left and right ventricles. Valve localization of the tumor is very rare. Its typical location is the fossa ovalis region in the interatrial septum (78%). Endocardial myxoma Its attachment to the surface is mostly via a thin pedicle; 10% of the time it is held on a wide base without a pedicle. Myxomas in the right atrium tend to be more solid and have a wider base than myxomas in the left atrium. They fit into the atrial wall or septum with a wider base than those on the left side. Morphologically, two types of myxoma have been defined: Round, smooth-surfaced, solid mass (globular structure); Fragmented mass with irregular surface (polypoid structure)
Myxoma is divided into sporadic and familial forms. Although the most common sporadic form is the familial form, it has been reported at a rate of 7%. While the sporadic form shows typical location, the familial form is observed with younger age, atypical location and multiple tumor formation. Familialdevelopment is more common in myxomas in the left atrium. Familial myxoma has been reported as part of the Carney complexas a syndrome. ( Carney syndrome is a hereditary autosomal dominant disease complex that includes myxomas, pigmented skin lesions and endocrine neoplasias. Myxomas can be seen in the heart, skin and breast tissue. Familial type myxoma is seen at younger ages than sporadic forms. The most common findings in the endocrine glands are acromegaly, thyroid and testicular tumors, and Cushing syndrome due to adrenocorticotropic hormone production. Myxomas located in the heart usually need to be removed surgically.
Myxomas mimic many cardiovascular diseases and early diagnosis is necessary. It must be suspected. Clinical findings may vary depending on the size of the tumor and the heart cavity in which it is located. Sedimentation and CRP elevation can be seen as biochemical parameters. It has been stated that these symptoms may be due to vasoactive products released from the tumor or the autoimmune response to the tumor.
The complaints that occur in the majority of patients are generally the same as in mitral valve patients, which is the left valve of the heart, that is, the patient has shortness of breath and palpitations occur. Shortness of breath, especially It occurs during exertion, that is, during walking. Sometimes these patients may faint and when they fall to the ground, they wake up again because while standing, the myxoma mass blocks the mitral valve and blood flow to the brain stops and the patient faints. When they fall to the ground, the mass comes out of the mitral valve due to the effect of gravity and the blood to the brain starts again and the patient wakes up. Symptoms of heart failure, palpitations (atrial fibrillation), fatigue, fainting (syncope), muscle pain (myalgia), fever, and joint pain (arthralgia) are frequently observed in the patient. In addition, myxoma fragments enter the circulation and findings related to vascular occlusion (embolization) may also be observed. If it is located on the right side of the heart, the complaints are the same as in tricuspid valve patients, shortness of breath, palpitations are observed, if the diameter is too wide, fullness in the neck veins, redness on the face, and edema in the abdomen and legs may occur. Pulmonary Embolism may occur due to embolization after entering the circulation.
In almost all myxomas, the diagnosis is made by two-dimensional transthoracic or transesophageal echocardiographic examination.
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