Cardiac Tumours Flashcards

(58 cards)

1
Q

Characteristics of benign tumours?

A
  • Generally not harmful
  • Well-differentiated cells
  • Slow growing
  • Well-circumscibed or encapsulated
  • Non-invasive, non-infiltrative
  • Do not metastasise
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2
Q

Characteristics of malignant tumours?

A
  • Harmful
  • Poorly or undifferentiated cells
  • Rapid growing
  • Poorly circumscribed or not encapsulated; irregular shape
  • Locally invasive, infiltrative
  • Frequently metastasise
  • Primitive appearing, unspecialised
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3
Q

Echo appearance of benign tumours?

A
  • Well-circumscribed or encapsulated
  • Freely mobile in relation to adjacent structures
  • Do not invade or infiltrate surrounding normal tissues
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4
Q

Echo appearance of malignant tumours?

A
  • Poorly circumscribed, irregular in shape
  • Not encapsulated
  • Fixed to adjacent structures
  • Locally invasive, infiltrating surrounding tissue
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5
Q

Characteristics of primary tumours?

A
  • Originate in the heart
  • Can be benign or malignant
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6
Q

Characteristics of secondary tumours?

A
  • Metastasised to the heart
  • Malignant
  • Secondary metastatic malignant disease more common than primary
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7
Q

What are the 4 pathways of metastatic spread of tumours to the heart?

A
  1. Lymphatic
  2. Haematogenous
  3. Direct extension
  4. Venous extension
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8
Q

What is lymphatic spread of tumours to the heart?

A

Tumour cells invade into lymphatic capillaries and travel to heart via lymph channels

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9
Q

What is haematogenous spread of tumours to the heart?

A

Spread through blood; invasion of tumour into local capillaries

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10
Q

What is direct extension of tumours to the heart?

A

Often arises via organs close to the heart in which cause tumour grows into the heart itself

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11
Q

What is venous extension of tumours to the heart?

A

Tumour invades large systemic vein and migrates to involve right heart by way of the vena cava

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12
Q

Example of direct extension tumour?

A

SCC of lung:
- Direct extension into LA via pulmonary veins

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13
Q

Example of venous spread tumour?

A

Renal cell carcinoma:
- IVC and RA extension; finger like mass extending through IVC into RA
- Can track mass back to kidney to confirm origin

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14
Q

Example of lymphatic spread tumour?

A

Pericardial tumour:
- Echo-genetic mass in pericardium
- Can result in pericardial constriction

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15
Q

Example of haematogenous spread tumour?

A

Carcinoid syndrome:
1. Carcinoid TV Disease
- Appearance of thickened and retracted leaflets that remain in fixed semi-open position throughout cardiac cycle
- Severe TR as a result
2. Secondary Cardiac Carcinoid Tumour
- Rarely, carcinoid tumour may metastasise to the heart resulting in an intra-myocardial carcinoid metastasis

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16
Q

Most common primary benign and primary malignant cardiac tumour in adults?

A
  • Benign: myxoma
  • Malignant: angiosarcoma
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17
Q

Most common primary benign and primary malignant cardiac tumour in children?

A
  • Benign: rhabdomyoma
  • Malignant: rhabdomyosarcoma
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18
Q

% of cardiac tumours that are benign/malignant?

A

90% benign
10% malignant

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19
Q

Most common location for cardiac myxomas?

A
  • LA attached to IAS at fossa ovalis
  • Less common in RA, ventricles
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20
Q

Morphological features of cardiac myxomas?

A
  1. Usually solitary
  2. Ovoid and gelatinous; regular smooth surface
  3. Attached via a narrow base (pedicle/stalk)
  4. Range in size from 1-15cm (av. 5-6cm)
  5. Calcification, fibrosis, haemorrhage, necrosis is common
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21
Q

Cardiac myxomas and functional stenosis?

A

LA myxomas usually quite mobile and may prolapse through MV causing functional mitral stenosis

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22
Q

What are the myxoma variants?

A
  • Multi-lobulated
  • Liquefaction (echo-luscent area in myxoma representing hematoma/liquefaction)
  • Calcification (echo-bright areas within myxoma representing calcification)
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23
Q

What is Carney Complex?

A
  • Familial myxomas
  • Autosomal dominant syndrome comprising multiple and recurrent myxomas of the heart and skin, hyperpigmentation of the skin and endocrine dysfunction
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24
Q

What is the most common tumour of cardiac valves?

A

Papillary fibroelastoma (PFE)

25
Most common location of papillary fibroelastomas?
- Aortic and mitral valves - Less common on pulmonary and tricuspid valves
26
Morphological features of papillary fibroelastoma?
1. Usually solitary 2. Small gelatinous polyps with multiple fronds 3. Rarely exceeds 1cm diameter 4. Attached to endocardium by a short pedicle or stalk
27
Echo appearance of papillary fibroelastoma?
- Small, round homogenous masses attached to valve - May appear highly mobile with independent motion - "pom-pom" appearance
28
What is a lipoma?
Benign tumours of 'fat' cells
29
Most common location for lipomas?
Sub-epicardial (larger), sub-endocardial, intra-myocardial
30
Morphological features of lipoma?
1. Homogenous fatty encapsulated tumours 2. Broad based 3. Variable size (larger in sub-epicardium)
31
Echo appearance of lipoma?
Echo-bright, homogenous appearance
32
What is lipomatous hypertrophy of IAS?
- Non-neoplastic condition (may be mistaken for cardiac tumour) - Result of accumulation of excess adipose tissue within IAS with sparing of fossa ovals membrane - Sparring of fossa ovals membrane leading to dumbbell appearance
33
What is a rhabdomyoma?
- Benign tumour of striated muscle - Most common cardiac tumour in children
34
Most common location of rhabdomyomas?
LV and/or RV myocardium; outflow tracts; AV valves (MV and TV)
35
Morphological features of rhabdomyomas?
1. Frequently multiple 2. White-grey to yellow, flesh lesions 3. Well-circumscribed, non-infiltrative 4. Range in size: few mm to several cm 5. Spontaneous regression in size, number or both is common
36
What is Tuberous Sclerosis?
- Rare, multi-system genetic disease (autosomal dominant) - Characterised by formation of hamartomas in multiple organs - Diagnostic criteria based on major and minor criteria; cardiac rhabdomyomas major criteria for diagnosis of tuberous sclerosis
37
Echo appearance of rhabdomyomas?
Acoustic properties similar to myocardium
38
What are cardiac fibromas?
- Benign connective tissue tumours - Second most common cardiac tumours in children
39
Most common location of cardiac fibromas?
LV and ventricular septum
40
Morphological features of cardiac fibromas?
1. Usually solitary 2. Firm, white, and well-circumscribed 3. Tightly adherent to adjacent myocardium 4. Almost always intramural 5. Range in size from 1-10cm 6. Do not regress spontaneously
41
Echo appearance of cardiac fibroma?
Can mimic hypertrophy cardiomyopathy or septal thickening
42
Characteristics of primary cardiac sarcomas?
- Account for 95% of malignant primary cardiac tumours - Fast growing with poor prognosis - Death through widespread infiltration of myocardium, obstruction of blood flow, and/or distant metastases - Show different histologies - Classified based on underlying nature of the tumour
43
Characteristics of angiosarcomas?
- Malignant vascular tumours - Most common malignant cardiac tumour in adults - Most common location = right heart (esp. RA)
44
Characteristics of rhabdomyosarcomas?
- Malignant tumours of striated muscle - Most common malignant cardiac tumour in children - Multiple sites of myocardium
45
Characteristics of fibrosarcomas?
- Malignant tumour of fibrous connective tissue - Often involving more than 1 cardiac chamber
46
Characteristics of leiomyosarcomas?
- Malignant tumours of smooth muscles - Rarely seen in heart - Usually found within atria
47
Characteristics of osteosarcoma?
- Malignant tumours of the bone - May be intramural or intra-cavity - Usually originate in posterior LA wall near pulmonary veins
48
Characteristics of primary cardiac lymphoma?
- Rare (5% of all primary malignant cardiac tumours) - More common in immunosuppressed adults - Most commonly involves right heart and pericardium; less common in left heart and IVS
49
Most common type of tumour in the LA?
Myxoma (70-80% of cases)
50
Most common type of tumour on valves?
Papillary fibroelastoma (> 90% of cases; L > R)
51
Most common type of tumour in the RA?
Angiosarcoma (80 - 90% of cases)
52
Most common type of tumour in the ventricles?
- Fibroma (> 95% of cases) - Rhabdomyoma (60% of cases)
53
Appearance of highly vascular, malignant tumours following contrast?
Greater enhancement compared with surrounding myocardium
54
Appearance of tumours with poor blood supply (e.g. myxomas) following contrast?
Appear hypoenhanced compared with surrounding myocardium
55
Appearance of thrombus following contrast?
No enhancement as thrombus is avascular (thrombus appears black, LV cavity illuminated by bubbles)
56
Appearance of LV lymphomas following contrast?
Lymphomas are highly vascular = complete enhancement of mass
57
Appearance of LA myxoma with contrast?
Myxomas have poor blood supply = partial enhancement of mass
58
Other appropriate imaging modalities to assess cardiac tumours?
- TTE, TOE, CMR and CT all considered appropriate - Cardiac CT and CMR are often combines with TTE