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[Frequency of metastatic tumors in the heart]
Saso Rafajlovski1, Vujadin Tatić, Srbislav Ilić
1Vojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd.
Insights
Metastatic heart tumors are rare and often asymptomatic, typically found during autopsy. Pulmonary carcinoma is the most common primary source, with metastases frequently found in the myocardium.
Area of Science:
- Cardiovascular Pathology
- Oncology
- Autopsy Studies
Context:
- Secondary cardiac tumors are more common than primary ones.
- Metastatic heart tumors are rarely symptomatic and often diagnosed post-mortem.
- Autopsy studies provide crucial data on the incidence and characteristics of metastatic cardiac involvement.
Purpose:
- To determine the frequency of heart metastases in autopsy material.
- To identify primary tumor origins of cardiac metastases.
- To analyze the specific locations of metastases within the heart and pericardium.
Summary:
- Over 11,000 autopsies revealed malignant tumors in 25.6% of cases, with heart metastases found in 2.7%.
- Pulmonary carcinoma was the most frequent primary source (18 cases), followed by leukemia and lymphoma (8 cases each).
- Metastases predominantly occurred in the myocardium (60.76%), particularly the left ventricle, and pericardium (30.38%).
Impact:
- Highlights the low clinical diagnosis rate of metastatic heart tumors.
- Provides data on common primary sites and metastatic locations in the heart.
- Underscores the importance of autopsy in understanding the true incidence of cardiac metastases.
Introduction:
Secondary or metastatic tumors in the heart occur more frequently than primary ones, and, according to the published series, their frequency found in autopsic material ranges from 1.6% to 20.6%. Metastatic tumors in the heart are rarely clinically symptomatic, and, therefore, they are rarely diagnosed within the lifetime. They are mostly diagnosed at autopsy. The aim of this study was to analyze the frequency of metastatic tumors of the heart, their primary localization, as well as the localization of the metastases found in the autopsic material within the period 1972-2004.
Methods:
During the autopsy of the patients died of metastatic tumors, we microscopically and macroscopically analyzed all the organs and tissues to determine the metastases of primary tumors in other organs, especially in the heart and pericardium.
Results:
Within the period from 1972-2004, 11 403 autopsies were performed. In 2 928 (25.6%) out of 11 403 autopsies, the presence of malignant tumor was diagnosed, and in 79 (2.7%) of these cases, metastasis of the heart was found out. Only in 5 of the cases, the presence of metastasis in the heart was diagnosed during the lifetime. The most frequent metastases in the heart were caused by pulmonary carcinoma (18 cases), leukemia and malignant lymphoma (8 cases, each), then pancreatic and breast carcinoma, while the metastases of other carcinomas were rather rare. In 40 (60.76%) cases, the metastasis was localized in the myocardium, but more often in the left ventricle, in 24 (30.38%) cases in the pericardium, in 4 cases in the epicardium and in the 3 of them in the mitral and tricuspid valve. Only in one case of renal carcionoma, metastasis was found in the right atrium and it occurred by spreading (dissemination) through the lumen of the inferior vena cava.
Conclusion:
Metastatic tumors of the heart are rather rare, and rarely clinically symptomatic, and, thus, rarely diagnosed during life. The methods of choice for the diagnosis of the metastasis in the heart are echocardiography, computerized tomography, magnetic resonance imaging, cytological analysis of the pericardial effusion and biopsy. The treatment includes surgery, chemotherapy and radiotherapy.
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