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Metastatic and invasive tumours involving the heart in a geriatric population: a necropsy study
1Department of Pathology, Geneva, Switzerland.
Insights
Malignant tumors frequently involve the heart, particularly the pericardium and epicardium, in necropsied patients. Suspicion for neoplastic cardiac involvement is raised by isolated pericardial or epicardial abnormalities in elderly patients.
Area of Science:
- Cardiovascular Pathology
- Oncology
- Autopsy Studies
Background:
- Cardiac involvement by malignancy is a significant finding in necropsy studies.
- Differentiating neoplastic cardiac disease from other causes of cardiac dysfunction in the elderly can be clinically challenging.
Purpose of the Study:
- To investigate the incidence and patterns of cardiac involvement in patients with diffuse malignant processes.
- To identify the primary tumor types and routes of cardiac invasion.
Main Methods:
- Retrospective analysis of 744 necropsied subjects with a diffuse malignant process.
- Detailed examination of cardiac structures (pericardium, epicardium, myocardium, endocardium) for neoplastic infiltration.
Main Results:
- Cardiac involvement was observed in 57 cases (7.7%), predominantly metastatic carcinomas (50 cases) and lymphomas/myeloproliferative disorders (7 cases).
- Pericardial and epicardial involvement were most common, associated with lung or breast carcinoma, suggesting lymphatic spread.
- Myocardial involvement was less frequent, linked to melanoma and lymphoma, indicating hematogenous spread. Endocardial involvement was rare.
Conclusions:
- Neoplastic cardiac involvement, especially of the pericardium and epicardium, is a notable finding in necropsy series.
- Isolated pericardial or epicardial abnormalities in elderly patients warrant consideration of an underlying neoplastic process.
Abstract:
In a series of 744 necropsied subjects with a diffuse malignant process, 57 cases of cardiac involvement were observed (50 metastatic carcinomas and 7 lymphomas or myeloproliferative disorders). The most frequent site of involvement was the pericardium and epicardium in lung or breast carcinoma, suggesting regional lymphatic invasion. Myocardial involvement was rarer and usually associated with cutaneous melanoma and lymphoma, suggesting haematogenic invasion. Endocardial involvement was exceptional. The multiple causes of heart disturbance in the elderly cloud the clinical diagnosis of such cardiac involvement; however, isolated pericardial and/or epicardial abnormalities should heighten suspicion of a neoplastic process.