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Pathology of surgically excised primary cardiac tumors
H D Tazelaar1, T J Locke, C G McGregor
1Section of Surgical Pathology, Mayo Clinic, Rochester, MN 55905.
Insights
Surgically treated primary cardiac neoplasms, predominantly benign atrial myxomas, were analyzed. Histologic features like mitotic figures indicated a poorer prognosis in these rare heart tumors.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pathology
Background:
- Primary cardiac neoplasms are rare, necessitating comprehensive analysis of treatment outcomes.
- Surgical intervention is a primary modality for managing cardiac tumors.
Purpose of the Study:
- To review the surgical treatment and pathological characteristics of primary cardiac neoplasms.
- To identify histological features associated with adverse outcomes in cardiac tumors.
Main Methods:
- Retrospective review of 106 patients (110 neoplasms) surgically treated at Mayo Clinic between 1957 and March 1991.
- Pathological analysis of available tumor specimens.
Main Results:
- Benign atrial myxomas were the most common (80 cases), followed by fibromas, lipomatous tumors, papillomas, and hamartomas.
- Eight malignant primary cardiac tumors were identified: angiosarcoma, leiomyosarcoma, malignant fibrous histiocytoma, sarcoma, and osteogenic sarcoma.
- Mitotic figures, high cellularity, and necrosis were associated with malignant behavior and adverse clinical outcomes.
Conclusions:
- Atrial myxomas are the most frequent primary cardiac tumors requiring surgical management.
- Specific histological features, particularly mitotic activity, are critical indicators of prognosis in primary cardiac neoplasms.
Abstract:
Between 1957 and March 1991, 106 patients with 110 neoplasms that originated in the heart were treated surgically at the Mayo Clinic and had pathologic material available for review. The study group consisted of 39 male and 67 female patients, who ranged in age from 2 to 80 years. Benign atrial myxomas (64 in the left atrium and 16 in the right atrium) were the most commonly encountered neoplasm. The other benign tumors were nine fibromas, five lipomatous tumors, seven valvular fibroelastic papillomas, and one cardiac hamartoma (so-called oncocytic cardiomyopathy). In addition, eight patients had a primary cardiac malignant lesion: angiosarcoma, leiomyosarcoma, and malignant fibrous histiocytoma in two patients each and sarcoma (not otherwise specified) and osteogenic sarcoma in one patient each. The angiosarcomas originated in the right atrium, and the other malignant tumors originated in the left atrium. The histologic feature that most frequently predicted an adverse clinical outcome was the presence of mitotic figures, although highly cellular tumors and those with necrosis also tended to have a malignant course.