Tumors

Benign tumors

Usually, a cardiac tumor is benign in nature. A benign tumor has a good prognosis at thrombi. Vegetations and some tumors are the most at risk embolism.

(Primary) Benign tumors
Myxoma	Most common primary cardiac tumor (50-75%). Location: 90% atrial (LA 75%), 7% ventricular. Size: 1 - 15cm (usually 5 - 6cm)
Fibroma	The second most common primary cardiac tumor. Location: Almost always ventricular (septal or apical). Size: ± 10cm.
Papillary fibroelastoma	Most common valve tumor. Location: whole heart, usually aortic valve (35%). Size: ± 1cm.
Lipoma	Usually, on the basis of the endocardium. Location: whole heart including valves and pericardium. Size: up to ± 10cm.
Rhabdomyoma	Most common benign cardiac tumor in children. Location: usually ventricular, no valve involvement. Size: 1mm - 9cm.
Hemangioma	Tumor blood, proliferation endothelial cells Location: whole heart
Lambl's excrescences	Valvular choir dd. fibroelastoma, thrombus, vegetation. Location: ventricular side of aortic valve. Size: ± 1cm
Cysts	Congenital unnatural body cavity delimited by epithelium. Location: usually in the right atrium (right cardiophrenic corner).
Thrombi	Clots of blood by slow blood flow. Location: Left atrial appendage in atrial fibrillation, akinetic myocardial infarction or cardiomyopathies, prosthetic valves or infectious valves, atrial septal ASD/PFO.

Malignant tumors

Primary malignant tumors are very rare. The most common malignant cardiac tumors are secondary tumors derived from primary diseases (see table below). 3% of all patients with cancer receive cardiac metastases through the four "pathways": direct infiltration, haematogenically (through blood), lymph vessels (VCI, pulmonary veins). Malignant tumors have a poor prognosis: In malignant tumors the major risk is of the malignancy itself.

Primary malignant tumors
Angiosarcoma	Most common primary malignant cardiac tumor Location: 90% right atrium
Rhabdomyosarcoma	Second most common primary malignant cardiac tumor, often in children than adults Location: whole heart
Mesothelioma	Cover visceral and parietal pericardium, no growth in endocardium.
Secondary malignant tumors
Metastases	Melanoma Lung Cancer Breast cancer Sarcoma Renal cell carcinoma Leukemia Lymphoma Oesophagus cancer Hepatocellular carcinoma Thyroid cancer

Overview of the locations of the most common cardiac tumors
Location	Tumor
left atrium	Myxoma Thrombus Papillary fibroelastoma Sarcoma
Eight atrium	Myxoma Angiosarcoma Lymphoma Thrombus Papillary fibroelastoma
Left ventricular	Fibroma Rhabdomyoma Thrombus Papillary fibroelastoma
Right ventricle	Fibroma Rhabdomyoma Angiosarcoma Lymphoma Thrombus Papillary fibroelastoma

Examples1
Myxoma LA	Thrombus RA
Video
Video
Vegetation TV

References

1 Hamer, J.P.M. “Cardiale massa’s”, in: Hamer/Pieper, ‘Praktische echocardiografie’, (2006), 1e druk 2e oplage, Houten, Bohn Stafleu van loghum, p.198-207.

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