Surgical pathology of primary cardiac and pericardial tumors

Our plain-English summary of Surgical pathology of primary cardiac and pericardial tumors, by C. Basso, M. Valente, A. Poletti, et al (European Journal of Cardio-thoracic Surgery, 1997).

The study

• Authors: C. Basso, M. Valente, A. Poletti, D. Casarotto, G. Thiene
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 1997;12(5):730-7; discussion 737-8
• Cited by: 195 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Retrospective study of surgical pathology experience on cardiac and pericardial tumors at the University of Padua in the era of immunohistochemistry and endomyocardial biopsy.

Methods: In the period 1970-1995, we studied 125 bioptic primary neoplasms: specimens were obtained from surgical resection in 116 cases, heart transplantation in 3, pericardiectomy in 3, endomyocardial biopsy in 2 and thoracoscopic biopsy in 1. Tumor histotype was established by light microscopy and more recently by immuno-histochemistry, using a large panel of antibodies, through avidin-biotin peroxidase method, against factor VIII-related antigen, ulex-europaeus, desmin, myoglobin, muscle-specific actin, smooth muscle-specific actin, vimentin, cytokeratins, leukocytic common antigen, neurofilaments and S100-protein.

Results: One hundred and thirteen were benign neoplasms: myxoma was the most frequent (87 cases) followed by pericardial cyst (8), endocardial papilloma (5), fibroma (3), rhabdomyoma (3), hematic cyst (2), teratoma (2), hemangioma (1), celothelioma (1) and lipoma (1). Malignancy was diagnosed in 12 cases, and consisted of pericardial mesothelioma (3), myxosarcoma (3), angiosarcoma (2), fibrosarcoma (2) and leiomyosarcoma (2); 4 of them were intracavitary atrial masses and were supposed to be atrial myxoma on the clinical ground. Differential diagnosis included endocardial thrombosis (10), metastasis of concealed extracardiac tumors (5), echinococcosis (3), and Loeffler's fibroplastic endocarditis (3). In 4 cases, cardiac mass histotype was defined without thoracotomy, through endomyocardial (3) and thoracoscopic (1) biopsy.

Conclusions: A large spectrum of cardiac tumors is observed in the surgical pathology practice. Although the diagnosis of cardiac masses is easily attainable by routine imaging techniques, differential diagnosis between primary and secondary tumors, malignant and benign forms, and non neoplastic masses, is achievable only by a thorough microscopic study of surgical resections. The role of the cardiac pathologist is becoming crucial as in other fields of oncology.

In plain English

This was a retrospective review of primary heart and pericardial (heart sac) tumors examined by the Department of Pathology, University of Padua, Italy, from 1970 to 1995. The authors studied 125 tissue specimens taken from living patients, mostly by surgical removal. Of these, 113 tumors (90.5%) were benign and 12 (9.5%) were malignant. Myxoma was the most frequent benign tumor (87 cases, 77% of benign tumors). The malignant tumors were 3 pericardial mesotheliomas and 9 sarcomas. The 3 mesothelioma patients were a 60-year-old man, a 56-year-old woman and a 62-year-old woman. All three died, with a mean survival of 4 months after diagnosis. The article does not discuss asbestos or any other cause of these tumors. None of the 21 patients operated on for an unspecified heart mass had a primary heart tumor. Of these, 10 had blood clots, 5 had cancer spread from elsewhere, 3 had echinococcosis (a parasitic infection) and 3 had Loeffler's fibroplastic endocarditis. The authors concluded that heart masses should not be assumed to be benign myxoma or clot just because they lie inside the heart chambers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of a consecutive surgical pathology series (one hospital's pathology records)
• Who was studied: 125 primary cardiac and pericardial tumor specimens from living patients (out of 144 primary cardiac tumors in total), studied at the Department of Pathology, University of Padua, Italy, 1970 to 1995
• Exposure: No exposure was studied. The article classifies tumor types and does not mention asbestos or any other cause.
• Main results:
  • Of the 125 tumors, 113 were benign (90.5%) and 12 were malignant (9.5%)
  • Myxoma was the most frequent benign tumor: 87 cases, 77% of benign tumors
  • The malignant tumors included 3 mesotheliomas, 3 myxosarcomas, 2 angiosarcomas, 2 fibrosarcomas and 2 leiomyosarcomas
  • The 3 primary malignant mesotheliomas (pericardial) were diagnosed by exploratory opening of the pericardium
  • All 3 mesothelioma patients (a 60-year-old man, a 56-year-old woman and a 62-year-old woman) died, with a mean survival of 4 months after diagnosis
  • Four of the 12 malignant tumors were round masses inside the atria that mimicked benign myxoma
  • 21 patients had surgery for an unspecified heart mass. None turned out to have a primary heart tumor. Three had echinococcosis (a parasitic infection). In the other 18, tissue examination showed mural blood clot (10), spread of hidden cancers from outside the heart (5) and Loeffler's fibroplastic endocarditis (3).
• The authors' conclusion: The authors concluded that heart masses should not be dismissed as benign myxoma or blood clot just because they lie inside the heart chambers. In their view, only tissue obtained by biopsy or open-chest surgery can establish the diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Pathology, Pericardial, Immunohistochemistry, Biopsy, Neoplasm, Surgical Resection, Pericardiectomy, Thoracoscopy.

Related studies

• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Primary cardiac tumors: experience at the University of Minnesota — J.E. Molina, J.E. Edwards, et al. (1990)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)
• Neoplastic Pericardial Disease — J.J. Maleszewski, N.S. Anavekar (2017)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)
• Surgery for primary intrapericardial tumors in adults — S. Taguchi, R. Yozu (2013)

Browse more research in European Journal of Cardio-thoracic Surgery, or return to medical research.