Overall approaches to cardiac tumors:Still an unsolved enigma?

Cardiac tumors are neoplasms involving heart structures at any level,meaning the myocardium,valves,and cardiac chambers.When considering cardiac masses,it is not uncommon for surgeons to be surprised when they diagnose one.The real incidence of this complex group of diseases has been explored only after cardiac diagnostic tools became more appropriate.Despite differential diagnosis being relevant,surgical indication is usually requested for all malignant cardiac tumors and also for many types of benign tumors.The development of cardiac imaging techniques,therefore,has been the key point for a better understanding of the history of cardiac tumors and especially of the relevance of surgical indication in such conditions.Systematic and combined applications of echocardiography,cardiac computed tomography and magnetic resonance allow in the majority of case a clear definition of the nature of a newly discovered cardiac mass.The presence of a Li-Fraumeni syndrome seems to be the trigger aspect in accelerating the propensity of developing a cardiac tumor.Despite the revolutionary usefulness of the cardiac imaging techniques available,it is still considered a hazard to diagnose a malignant cardiac mass just with radiological imaging;the mainstay of the final diagnosis stands in surgical excision of the mass and histopathological report.

Primary Cardiac Tumors Operated on in Côte d’Ivoire: They Are Almost All Myxomas

Objective: Through this surgical series, we present the epidemiological and anatomical-clinical aspects and the surgical results concerning patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Materials and Method: This is a retrospective descriptive study covering the period of January 1982 to December 2022, based on the medical records of patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Results: Twenty-seven (27) patients underwent surgery for a primary cardiac tumor, including 14 women and 13 men with a mean age of 41.5 years (range 19 - 76 years). The main circumstances of discovery were exertional dyspnea, palpitation and syncope or pseudo-syncope. The main site was the septal wall of the left atrium. The diagnosis of myxoma was confirmed by pathological examination of the surgical specimen in 96.3% (n = 24) of the patients and it was a malignant large cell immunoblastic lymphoma of the myocardium in 3.7% (n = 1) of the patients. The mean largest diameter was 46.1 mm. The postoperative course was marked by an ischaemic stroke (n = 1);recurrence of a left atrial myxoma 5 years after the first tumor removal (n = 1). Two cases of death were noted, one due to the evolution of immunoblastic large cell lymphoma and the other due to an extracorporeal circulation accident. Conclusion: Almost all primary cardiac tumors operated on in Abidjan are myxomas. The circumstances of the discovery of these cardiac tumors are multiple and varied but dominated by exertional dyspnea, palpitation and syncope. Whatever their histological type, primary cardiac tumors are serious affections, in view of the haemodynamic and rhythmic disorders they cause.

THE CLINICOPATHOLOGICAL AND PROGNOSTIC STUDY ON 42 CASES WITH CARDIAC TUMOR

: Objective: To analyze the relation between the pathological changes and the clinical manifestations and the prognosis of cardiac tumors through the pathological study on 42 cases with cardiac tumor, in order to improve the knowledge of the tumors, to make early diagnosis and to raise the curative ratio.Materials and Methods: 42 confirmed cardiac tumors of our department were selected, among whick 41was surgical specimen and 1 was autopsy. The study was Pcrformed by using the common and special histochemical staining.Results: 41 is Primary and 1 is secondary which is a metastazed hepatocelular carcinoma. In the Primary ones,39 (95.1%) is benign, including myxoma, fibroma,rhabdomyoma and Pericardial cyst, while 2 (4. 9%) is malignant, including neuroleminafibrosarcoma and malignant mesothelioma. In the myxomas, female patients occupy 75%, 91.7% exists in the left atrium and every one has got a peduncle adbesive to the fossa ovalis or adjacency of the atrial septum.Conclusions: The results of the pathological and prognostic study sbowes cardiac tuinors are quite different from the tumors in other sites, i.e., cven benign ones could cause fatal hemodynamic disturbance. Hence early diagnosis and early operation are necessary and if in such instance, the Prognosis of inost of the benign oncs would be good. But the prognosis of the malignant tumors is worst. The myxomas are different from the organized thrombi in heart cavity. And also the criteria of diagnosis and differential diagnosis are discussed.

Mediastinal Tuberculoma Mimicking Malignant Cardiac Tumor:A Case Report

Background:The clinical manifestations of cardiac masses are diverse and lack specifi city.Here we report a cardiac mass detected by transthoracic echocardiography.Multimodality imaging and pathological fi ndings after the operation confi rmed the mass as mediastinal tuberculoma.Case presentation:A 45-year-old male patient was admitted to our hospital reporting chest tightness,weight loss,and dyspnea for 3 months after exercise.Transthoracic echocardiography showed that there were a large number of pericardial effusions and a soft tissue mass measuring 7.7 cm×4.5 cm in the upper mediastinum,which oppressed the right pulmonary artery and accelerated the blood fl ow of the left pulmonary artery.Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass.Contrast-enhanced chest CT revealed punctate and patchy calcifi cation in and uneven enhancement of the mass and the lymph nodes around the aortic arch.The mass was diagnosed as a malignant mediastinal tumor.Pathological analysis of the mass revealed chronic granulomatous tuberculosis.The symptoms abated signifi cantly after antituberculosis treatment.The patient remained asymptomatic during follow-up.Conclusion:This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor.Multimodality imaging should be incorporated for differentiation of cardiac masses.

A Rare Case of a Primary Cardiac Tumor Presenting as Fatal Ventricular Tachycardia

Primary cardiac tumors are extremely uncommon.Here,we report the case of a patient with a primary left ventricular interstitial tumor presenting with hemodynamically unstable ventricular tachycardia.In response to hemodynamically unstable ventricular tachycardia,an implantable cardioverter-defibrillator was inserted.One month after defibrillator implantation,the patient developed episodes of high ventricular tachycardia that could not be effectively terminated by catheter radiofrequency ablation,thus further confirming that the ventricular tachycardia was induced by the left ventricular interstitial tumor.The patient is doing well on medical therapy to date.

Theatment strategies for pediatric patients with primary cardiac tumors

Objective To analyze the experience of treatment strategies for pediatric patients with primary cardiac tumors. Methods The clinical data of 27 patients with primary cardiac tumors which detected by echocardiography from May 1999 to May 2009 was analyzed retrospectively. There were 20 male and 7 female patients,aged from 24 d to 12. 6 years. There were 59. 2% less than 1 year old at the time of diagnosis. A single tumor were present in 22 cases and multiple in 5 cases. Surgery was performed on 22 patients due to the varied

Conduction disorder and primary cardiac tumor: a fatal case of multiple lipomas of the right atrium

Cardiac primary tumors are uncommon with an estimated prevalence between 0.17%and 0.19%.[1,2]Cardiac lipoma are extremely rare representing only 10%?19%of primary cardiac tumors and only few are symptomatic,depending on their location within the heart.[3,4]They originate from the subendocardium(50%),subepicardium(25%)or myocardium(25%)and with different sizes and locations.[5]Few cases of sudden death due to primary cardiac tumors are reported in literature(0.0025%);in these cases,conductive and haemodinamic abnormalities have been indicated as the cause of death.

Approach to cardiac masses: Thinking inside and outside the box

In this editorial we comment on the article by Huffaker et al,published in the current issue of the World Journal of Clinical Cases.Cardiac masses encompass a broad range of lesions,potentially involving any cardiac structure,and they can be either neoplastic or non-neoplastic.Primitive cardiac tumors are rare,while metastases and pseudotumors are relatively common.Cardiac masses frequently pose significant diagnostic and therapeutic challenges.Multimodality imaging is fundamental for differential diagnosis,treatment,and surgical planning.In particular cardiac magnetic resonance(CMR)is currently the gold standard for noninvasive tissue characterization.CMR allows evaluation of the relationship between the tumor and adjacent structures,detection of the degree of infiltration or expansion of the mass,and prediction of the possible malignancy of a mass with a high accuracy.Different flow charts of diagnostic work-up have been proposed,based on clinical,laboratory and imaging findings,with the aim of helping physicians approach the problem in a pragmatic way(“thinking inside the box”).However,the clinical complexity of cancer patients,in particular those with rare syndromes,requires a multidisciplinary approach and an open mind to go beyond flow charts and diagnostic algorithms,in other words the ability to“think outside the box”.

Cardiac and pericardial tumors:A potential application of positron emission tomography-magnetic resonance imaging

Cardiac and pericardial masses may be neoplastic, benign and malignant, non-neoplastic such as thrombus or simple pericardial cysts, or normal variants cardiac structure can also be a diagnostic challenge. Currently, there are several imaging modalities for diagnosis of cardiac masses; each technique has its inherent advantages and disadvantages. Echocardiography, is typically the initial test utilizes in such cases, Echocardiography is considered the test of choice for evaluation and detection of cardiac mass, it is widely available, portable, with no ionizing radiation and provides comprehensive evaluation of cardiac function and valves, however, echocardiography is not very helpful in many cases such as evaluation of extracardiac extension of mass, poor tissue characterization, and it is non diagnostic in some cases. Cross sectional imaging with cardiac computed tomography provides a three dimensional data set with excellent spatial resolution but utilizes ionizing radiation, intravenous iodinated contrast and relatively limited functional evaluation of the heart. Cardiac magnetic resonance imaging(CMR) has excellent contrast resolution that allows superior soft tissue characterization. CMR offers comprehensive evaluation of morphology, function, tissue characterization. The great benefits of CMR make CMR a highly useful tool in the assessment of cardiac masses.(Fluorine 18) fluorodeoxygluocse(FDG) positron emission tomography(PET) has become a corner stone in several oncological application such as tumor staging, restaging, treatment efficiency, FDG is a very useful imaging modality in evaluation of cardiac masses. A recent advance in the imaging technology has been the development of integrated PET-MRI system that utilizes the advantages of PET and MRI in a single examination. FDG PET-MRI provides complementary information on evaluation of cardiac masses. The purpose of this review is to provide several clinical scenarios on the incremental value of PET and MRI in the evaluation of cardiac masses.

Xuebijing alters tumor necrosis factor-alpha, interleukin-1beta and p38 mitogen activated protein kinase content in a rat model of cardiac arrest following cardiopulmonary resuscitation

We established a rat model of cardiac arrest by clamping the endotracheal tube of adult rats at expiration. Twenty-four hours after cardiopulmonary resuscitation, nerve cell injury and expression of tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase content were increased. Rats injected with Xuebijing, a Chinese herb compound preparation, exhibited normal cellular structure and morphology, dense neuronal cytoplasm, and decreased tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase expression at 24 hours following cardiopulmonary resuscitation. These data suggest that Xuebijing can attenuate neuronal injury induced by hypoxia and reperfusion during cardiopulmonary resuscitation.

Tumors of the cardiac conduction system:are they an explanation for otherwise unexplained sudden cardiac death?

Cardiac tumors are well described in the literature. The first reports of cardiac tumors date back hundreds of years.The prevalence of primary cardiac tumors at autopsy ranges from 0.001% to 0.3% with secondary tumors more common than in primary tumors. ……

Neuronal injury and tumor necrosis factor-alpha immunoreactivity in the rat hippocampus in the early period of asphyxia-induced cardiac arrest under normothermia

Low survival rate occurs in patients who initially experience a spontaneous return of circulation after cardiac arrest（CA）. In this study, we induced asphyxial CA in adult male Sprague-Daley rats, maintained their body temperature at 37 ± 0.5°C, and then observed the survival rate during the post-resuscitation phase. We examined neuronal damage in the hippocampus using cresyl violet（CV） and Fluore-Jade B（F-J B） staining, and pro-inflammatory response using ionized calcium-binding adapter molecule 1（Iba-1）, glial fibrillary acidic protein（GFAP）, and tumor necrosis factor-alpha（TNF-α） immunohistochemistry in the hippocampus after asphyxial CA in rats under normothermia. Our results show that the survival rate decreased gradually post-CA（about 63% at 6 hours, 37% at 1 day, and 8% at 2 days post-CA）. Rats were sacrificed at these points in time post-CA, and no neuronal damage was found in the hippocampus until 1 day post-CA. However, some neurons in the stratum pyramidale of the CA region in the hippocampus were dead 2 days post-CA. Iba-1 immunoreactive microglia in the CA1 region did not change until 1 day postCA, and they were activated（enlarged cell bodies with short and thicken processes） in all layers 2 days postCA. Meanwhile, GFAP-immunoreactive astrocytes did not change significantly until 2 days post-CA. TNF-α immunoreactivity decreased significantly in neurons of the stratum pyramidale in the CA1 region 6 hours post-CA, decreased gradually until 1 day post-CA, and increased significantly again 2 days post-CA. These findings suggest that low survival rate of normothermic rats in the early period of asphyxia-induced CA is related to increased TNF-α immunoreactivity, but not to neuronal damage in the hippocampal CA1 region.

小儿心脏肿瘤超声心动图术前诊断准确性及术后早期结果

目的:总结心脏肿瘤患儿的超声心动图诊断经验和外科手术治疗的早期结果。方法:回顾性分析2018年1月至2023年6月期间在中国医学科学院阜外医院行超声心动图检查并诊断为心脏肿瘤的患儿27例,总结其临床表现、超声心动图特点、外科手术情况及早期结果。结果:27例患儿中男性16例,年龄1个月至11岁,平均(3.2±2.5)岁;体重5.7~40.0 kg,平均(17.2±11.2) kg;其中病理证实为心脏肿瘤25例,包括纤维瘤14例,横纹肌瘤5例,粘液瘤3例,脂肪瘤2例,血管瘤1例,超声心动图与病理诊断一致共14例。超声心动图将2例非肿瘤病变误诊为肿瘤。所有患儿均接受了外科手术治疗,术后2例患儿出现并发症并进行外科处理,术后恢复良好。随访29.8(6.5,72.0)个月,无死亡病例,1例粘液瘤患儿复发。结论:部分心脏肿瘤患儿具有特征性的超声心动图表现,需要不断总结以提高诊断的准确率。良性心脏肿瘤患儿手术短期结果良好。

单中心180例心脏肿瘤的诊断及外科治疗效果分析

目的总结单中心10年心脏肿瘤的诊断及外科治疗策略,讨论心脏肿瘤临床治疗效果及预后。方法回顾性分析2013年01月至2022年12月于高州市人民医院心血管外科住院诊断为心脏肿瘤并外科手术治疗的患者资料。收集整理患者的围术期临床资料及随访情况,分析其诊断及外科治疗策略。结果全组180例,其中男76例,女104例,年龄为(55.96±16.01)岁;良性肿瘤为165例(91.67%),恶性肿瘤为15例(8.33%)。术中完整切除肿瘤169例(93.89%),次全切除11例(6.11%)。术中同期合并冠状动脉旁路移植术10例(5.5%),主动脉瓣置换1例(0.55%),二尖瓣成形2例(1.11%),三尖瓣成形术3例(1.67%)。体外循环时间为(105.22±11.24)min,主动脉阻断时间为(43.17±24.61)min,机械通气时间为(14.21±3.18)h,术后重症监护病房(ICU)停留时间为(2.46±1.21)d,胸液总量为(317.25±43.15)mL。全组围术期无死亡,随访时间为45.28(1~120)个月,黏液瘤复发3例(1.9%),恶性肿瘤复发3例(20%),死亡17例(9.4%)。结论心脏肿瘤缺乏特征性临床表现,需要综合影像学检查明确诊断。原发性良性心脏肿瘤的手术效果满意,安全可行;并且可采用更加微创化的治疗方式。恶性心脏肿瘤的预后差,建议及早治疗及个体化治疗。

免疫检查点抑制剂相关心肌炎的诊断与治疗研究进展

随着肿瘤学及免疫学在临床上的广泛发展,将其应用于恶性肿瘤患者的治疗现已成为抗肿瘤治疗领域的最为先进的治疗方式。作为新型抗肿瘤药物,免疫检查点抑制剂(ICIs)是肿瘤患者实施免疫治疗的重要方法,现已被广泛应用于恶性肿瘤患者的治疗。ICIs的使用对改善晚期恶性肿瘤患者的预后尤为重要,为恶性肿瘤患者的治疗带来突破性进展,可在极大程度上延长患者生存时间、提升患者的生活质量。但ICIs在治疗的同时,不可避免地带来免疫相关的不良反应,其中以ICIs相关的心肌炎发生风险较高,目前临床上对于ICIs相关心肌炎的发病机制及病因暂无明确定义,可能与T细胞激活、免疫检查、自身抗体的产生等因素存在密切联系,在此过程中若患者不及时诊断及治疗,可对其生命安全造成严重威胁。本文分别从ICIs相关心肌炎定义及发病机制分析、ICIs相关心肌炎的临床诊断、ICIs相关心肌炎的临床治疗等方面展开综述,以为临床治疗ICIs相关心肌炎提供有效的参考依据。

6例心内血性囊肿临床及病理特征分析

目的:分析心内血性囊肿的临床与病理特征,以提高对罕见心脏肿瘤的认识。方法:收集首都医科大学附属北京安贞医院2015年3月至2023年5月,诊断的6例心内血性囊肿病例,进行临床资料分析与病理形态学特征观察。结果:女性2例,男性4例;年龄25~59岁,中位年龄52.5岁。血性囊肿位于二尖瓣3例、主动脉瓣1例、三尖瓣1例、右心房1例。组织病理学表现为囊壁由纤维结缔组织构成,衬覆血管内皮细胞,腔内可见出血及血栓形成。免疫组织化学染色示CD31(+)、CD34(+)、D2-40(-)、Calretinin(-)。所有病例均完整切除,术后随访6例,均健在、无复发。结论:心内血性囊肿是极其少见的心脏良性肿瘤,术前通过超声心动图检查可高度提示此肿物可能,确诊需组织病理学检查。本病手术完整切除后通常预后良好。

国内外原发心脏恶性肿瘤研究现状与趋势的文献计量学分析

目的基于文献计量学方法,分析国内外原发心脏恶性肿瘤的研究现状,并预测其未来发展趋势。方法分别检索2004年1月1日—2024年6月1日中国知网(CNKI)和Web of Science(WOS)数据库核心合集中有关“原发心脏恶性肿瘤(primary cardiac malignant tumor)”的文献。统计发文量,并基于CiteSpace和VOSviewer软件分析纳入文献的国家发文量、作者情况、作者机构、发文期刊,以及关键词的共现、聚类和突现情况。结果CNKI数据库和WOS核心合集中分别纳入文献312篇和775篇。WOS核心合集数据显示,中国的发文量位居全球第2位,国际间的合作相对较少(中心性为0.01)。CNKI中高发文量作者以陈东、徐志云和宋书田为代表;WOS核心合集中则以Reardon Michael J、Gaudino Mario为代表,有一定数量的中国研究者的发文,中国学者缺乏研究合作与持续的学术产出。关键词图谱分析显示,“病理分型”“超声心动图”“外科手术”等是国内外长期研究焦点;近年,有关化学治疗与分子机制的研究增多,免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)等免疫治疗方案已逐步应用于该疾病;与国内相比,国外创新影像学技术、深入病理分型、综合治疗、预后管理和多中心研究合作更多。多数研究以个案报道为主。结论手术治疗和影像诊断技术是原发心脏恶性肿瘤领域的研究焦点;基于病理分型和分子机制探讨改善患者预后的综合治疗可能是其未来发展趋势,基于多中心、多学科协作的高质量临床研究是重点。

基于心电心音图—血液指标的列线图对化疗后心脏不良事件风险的预测研究

目的探讨心电心音图联合血液指标预测恶性肿瘤患者化疗后发生心脏不良事件的风险。方法前瞻性收集171例恶性肿瘤患者。根据患者化疗结束后是否出现心脏不良事件分为心脏不良事件组和无心脏不良事件组,分析两组患者一般资料、化疗前血液指标与化疗早期(1~3周期)心电心音图相关指标,将可能影响因素进行二元Logistic回归分析确定独立预测因素并绘制列线图,利用受试者操作特征(ROC)曲线评估列线图预测能力。结果171例患者化疗结束后有44例发生心脏不良事件,发生率25.73%。二元logistic回归结果表示年龄、化疗前红细胞分布宽度(RDW)、活化部分凝血酶原时间(APTT)和化疗早期心脏电−机械激动时间(EMAT)是化疗患者发生心脏不良事件的独立预测因子,基于此绘制列线图,ROC曲线评估AUC为0.768(95%CI:0.693~0.843,P<0.001)。结论基于年龄、化疗前RDW、APTT和化疗早期EMAT绘制的列线图有助于早期评估化疗患者发生心脏不良事件的风险。

国内外心脏肿瘤相关研究的CiteSpace和VOSviewer可视化分析

目的:应用CiteSpace和VOSviewer软件对国内外近20年心脏肿瘤相关研究进行可视化分析,探究领域内研究热点和发展趋势。方法:以中国知网和Web of Science为数据来源对获得的文献进行发表年份、作者、期刊、机构、关键词可视化分析。结果:共纳入中文文献1767篇、英文文献16330篇。国内外作者以许建屏、王红月、Reardon Michael J、Maleszewslci Joseph J等为代表,均已形成了各自的合作团队。发文期刊主要涉及影像学和心血管外科领域。研究机构以各大学附属医院的影像科及心血管外科为主。关键词图谱提示心脏肿瘤的诊断分型以及相关影像学技术是研究重点。结论:非手术疗法的有效性和副作用有待进一步实验验证,应用分子病理机制来开发和应用靶向治疗药物是未来的发展趋势和研究热点。

儿童原发性心脏肿瘤的影像特征

目的探讨儿童原发性心脏肿瘤的超声心动图、CT和MR影像特征,并分析每种检查的诊断价值及临床检查策略。方法收集2008年6月至2022年2月在复旦大学附属儿科医院经手术病理证实的原发性心脏肿瘤患儿的临床、病理及影像资料,在MR图像上对肿瘤大小、位置、运动、不同序列上的信号特征、心包是否受累进行评估分析。结果共纳入23例患儿(男性16例、女性7例),发病年龄1个月至13岁,平均(54.45±58.57)个月,其中横纹肌瘤发病年龄最小,平均(7.23±6.30)个月。临床表现:6例心脏杂音、3例心功能不全、3例癫痫、2例脑梗、1例心律不齐。病理结果:22例良性肿瘤(纤维瘤9例、黏液瘤8例、横纹肌瘤4例、脂肪瘤1例),1例恶性肿瘤(横纹肌肉瘤)。超声心动图对黏液瘤的诊断准确率高。CT显示1例恶性横纹肌肉瘤侵犯心包,肺动脉及气管受压。MR可见纤维瘤延迟增强明显强化;横纹肌瘤T1WI等信号,T2WI、灌注及延迟增强信号轻度增高;黏液瘤T2WI高信号,延迟增强可见强化,在电影成像中运动度大;脂肪瘤各个序列信号与脂肪一致,无灌注及延迟增强高信号。结论儿童各类型原发性心脏肿瘤各有影像特征,MR对心脏肿瘤的鉴别诊断具有较大优势,临床检查时需要结合实际情况选择合适的影像检查方法。