Cardiac Tumors Pathology Study Guide

Cardiac Tumors Pathology Video

Cardiac Tumors

Cardiac tumors are neoplastic conditions that effect the heart.

Cardiac tumors to be aware of include:

Myxomas
Rhabdomyomas
Metastatic tumors to the heart

(a) Left atrial myxoma consisting of a mucoid stroma with spindle-shaped cells, with hemorrhage in the centrum of the myxoma (H and E staining), original magnification ×100); (b) High power view (H and E staining, original magnification ×400). Primary cardiac tumors: a single-center 41-year experience. Steger CM, Hager T, Ruttmann E - ISRN cardiology (2012). Not Altered. CC.
Cardiac Tumors. Micrograph of an atrial myxoma, the most common primary tumor of the heart. Nephron - Not altered. CC BY-SA 3.0
Cardiac Tumors Pathology. Micrograph of a papillary fibroelastoma of the aortic valve. H&E Stain. Low magnification. Description: branching avascular papillae with dense eosinophilic material (collagen) covered by endothelium. Nephron. Not altered. CC BY-SA 3.0

Myxoma

Myxomas are benign mesenchymal tumors.

Myxomas are the most common benign primary cardiac tumors.

Myxomas typically present with tachycardia or dyspnea on exertion.

Myxomas typically appear as pedunculated masses in the left atrium on imaging.

Myxomas may causes syncope by blockage the mitral valve.

Myxomas typically have a histologic appearance showing an abundance of ground substance and a gelatinous appearance.

Representative histology of the cardiac myxoma tissue in a 26-year old woman with multiple recurrences of cardiac myxoma (HE, ×100).A: tumor in 2005. B: tumor in 2010. A similar histological appearance with irregular and papillary proliferations in the myxoid stroma between A and B. Bar = 30 µm.Familial cardiac myxoma with multifocal recurrences: a case report and review of the literature. Cao H, Wu Y, Zhu J, Chen Y - Journal of biomedical research (2011). Not Altered. CC.
Myxoma. High magnification micrograph of an atrial myxoma. H&E stain. Atrial myxoma is the most common primary tumour of the heart. It is benign. Features: Hypocellular myxoid polypoid mass with cells that are: Perivascular arrangement, Finely vacuolated eosinophilic cytoplasm, Polygonal/elongated cell shape, Mononuclear or multinucleated. May contain macrophages, other inflammatory cells. May be covered with endothelium. Related images High mag. Intermed. mag. Low mag. High mag. with endothelium. Low mag. with interface to muscular wall. Nephron. Not alteredCC BY-SA 3.0
Myxoma. A myxoma. A gelatinous tumor can be seen attached by a narrow pedicle to the atrial septum. The myxoma has an irregular surface and nearly fills the left atrium. The Armed Forces Institute of Pathology (AFIP) - PEIR Digital Library (Pathology image database). Image# 410012. Not altered. Public Domain.
(a) Left atrial myxoma consisting of a mucoid stroma with spindle-shaped cells, with hemorrhage in the centrum of the myxoma (H and E staining), original magnification ×100); (b) High power view (H and E staining, original magnification ×400). Primary cardiac tumors: a single-center 41-year experience. Steger CM, Hager T, Ruttmann E - ISRN cardiology (2012). Not Altered. CC.

Rhabdomyoma

Rhabdomyomas are benign hamartomas of cardiac muscle.

Rhabdomyomas are the most common type of cardiac tumors in children.

Patients with tuberous sclerosis are at increased risk of rhabdomyomas.

Rhabdomyomas normally arises in the ventricle.

Rhabdomyoma. This is a surgically excised specimen (unfixed) from the tumor illustrated in figure 5-3 showing a whitish tan cut surface. The Armed Forces Institute of Pathology (AFIP) -Not altered. Public Domain
Rhabdomyoma. Photomicrograph of fetal-type rhabdomyoma: Note the plump, pink benign skeletal muscle cells. Jerad M Gardner, MD - Not altered. CC BY-SA 3
Immunohistochemical analysis of skeletal muscle tumors.A: Biopsies from rhabdomyoma and the 3 rhabdomyosarcoma subtypes, alveolar, pleomorphic and embryonal, were analyzed for expression of Dlk1, Pax7 and Myogenin. Dlk1 was strongly expressed by all skeletal muscle tumor types and can thus be considered a solid marker. Expression of Pax7 and Myogenin in all tumors confirmed the skeletal muscle origin. Scalebar representative for all images: 50 µm. B: Dlk1 expression was detected specifically in cells co-expressing either Pax7 or Myogenin, shown as double staining. Two examples of rhabdomyosarcomas with these co-expression patterns are shown. Scalebar representative for all images: 50 µm.Delta-like 1 homolog (dlk1): a marker for rhabdomyosarcomas implicated in skeletal muscle regeneration. Jørgensen LH, Sellathurai J, Davis EE, Thedchanamoorthy T, Al-Bader RW, Jensen CH, Schrøder HD - PloS one (2013). Not Altered. CC.
Rhabdomyoma. (a) Low power view of the rhabdomyoma (left) with adjacent hypercellular parathyroid (right). (b) Normal striated muscle intertwined with tumor cells. (c) High power view of rhabdomyoma; notice the eosinophilic granular cytoplasm with small eccentrically and centrally placed nuclei. Much of the cytoplasm is retracted from the cell membrane. (Hematoxylin-eosin, original magnification ×40 (a), original magnification ×100 (b), and original magnification ×400 (c).)A rare soft tissue tumor masquerading as a parathyroid adenoma in a patient with birt-hogg-dubé syndrome and multiple cervical endocrinopathies. Mikesell KV, Kulaylat AN, Donaldson KJ, Saunders BD, Crist HS - Case reports in pathology (2014). Not Altered. CC.

Metastatic Tumors to the Heart

In the heart, metastatic tumors occur more frequently than primary tumors.

Examples of tumors that may metastasize to the heart include:

Breast cancer
Lung cancer
Melanoma
Lymphoma

Metastatic cancers to the heart most commonly involve the pericardium, leading to a pericardial effusion.

Metastatic Tumors to the Heart. Histopathology of leiomyosarcoma shows variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.[9] Eiji Kobayashi, Takuhei Yokoyama, Satoshi Nakagawa, Shinya Matsuzaki, Toshihiro Kimura, Yutaka Ueda, Kiyoshi Yoshino, Masami Fujita, Yumiko Hori, Eiichi Morii and Tadashi Kimura. Not altered. CC BY 4.0
Hematoxylin and eosin and S-100 staining of the tumors of the thigh treated surgically in 1990 (A, B), recurrent tumor operated in 1995 (C, D) and metastatic tumor in heart (E, F) and lung (G, H) at autopsy in 2007. A, C, E, G: Hematoxylin and eosin staining; B, D, F, H: S-100 immunohistochemistry. Histological factors such as cellularity, degree of nuclear atypia, mitotic counts, and S-100 immunoreactivity were similar among the specimens. Malignant peripheral nerve sheath tumor associated with neurofibromatosis type 1, with metastasis to the heart: a case report. Kitamura M, Wada N, Nagata S, Iizuka N, Jin YF, Tomoeda M, Yuki M, Naka N, Araki N, Yutani C, Tomita Y - Diagnostic pathology (2010). Not Altered. CC.