Download Free Medical Cardiac Tumors PowerPoint Presentation

Cardiac Tumors PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Carney Complex, which is titled "Cardiac Tumors", to know about cardiac tumors. Know about cardiac masses like thrombus, vegetations, and how tumor is an uncommon event.

Tags : Carney Complex, Cardiac Tumors, cardiac masses, thrombus, vegetations,

Published on : May 13, 2021 | Views : 4123 | Downloads : 47

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

CARDIAC TUMOURS Dr Rakesh K Senior Resident
Slide 2-

Cardiac tumors are mostly an incidental finding. Cardiac masses –Most common DDs Thrombus Vegetations Tumor is an uncommon event. INTRODUCTION
Slide 3-

Primary Tumors of the heart are rare. Prevalence of 0.001% to 0.03% in autopsy series. Secondary Cardiac Tumors are 30 times more common. The incidence is 0.7% to 3.5% (average- 2.3%) in the general population. Cardiac tumors Incidence
Slide 4-

Primary cardiac tumors Benign >80% Vs Malignant < 20% Cardiac myxoma constitute half of them(50%).
Slide 5-

Metastatic tumors The incidence -1.7% to 14% (average, 7.1%) in cancer patients.(General population Avg. incidence-2.3%) Cardiac metastases can occur either by Direct extension( Ca Lung, Ca breast) Blood stream( melanoma) Lymphatic( Lymphomas ) Intra cavitary diffusion through the IVC (RCC/Uterine tumors). Pericardial metastasis - 69% Epicardial - 34% Myocardial - 32% Endocardial metastases -5%
Slide 6-

ppt slide no 6 content not found
Slide 7-

EPIDIMEOLOGY The types of tumors predominantly seen in adults (>16 years) are different from that seen in children (<16 years). 85% of benign tumors in adults are myxomas, lipomatous tumors, and papillary fibroelastomas. 80% of benign tumors in children are rhabdomyomas, teratomas, and fibromas.
Slide 8-

Incidence of benign cardiac tumors
Slide 9-

Incidence of primary malignant cardiac tumors
Slide 10-

ppt slide no 10 content not found
Slide 11-

CLINICAL MANIFESTATIONS The clinical manifestations can be divided into four general mechanistic categories: Systemic manifestations Embolic manifestations Cardiac manifestations Phenomena secondary to metastatic diseases
Slide 12-

SYSTEMIC MANIFESTATIONS Constitutional symptoms Fever Fatigue Malaise Weight loss Myalgia Arthralgia Muscle weakness Raynaud phenomenon. Lab findings Leukocytosis –Polycythemia –Anemia –Thrombocytosis or –Thrombocytopenia –Hypergammaglobulinemia –Increased ESR.
Slide 13-

These systemic manifestations are believed to be produced by secretory products released by the tumor or by tumor necrosis like IL-6. Most commonly seen in - Cardiac Myxoma
Slide 14-

EMBOLIC PHENOMENON Can be Systemic or Pulmonary embolism. Tumor emboli or Thromboemboli from tumor surface. The propensity to embolize depends The origin of the tumor (intramural or intra cavitary) The type of the tumor (soft/friable/pedunculated) Associated RWMA/LVD/Thrombophilic states Most commonly seen in Cardiac Myxoma (specially with villous surface)
Slide 15-

The brain is the most common site of emboli. Brain emboli most commonly causes TIA or ischemic stroke but rarely ICH can be the presentation. Coronary Artery Embolism can be seen rarely and mimicks as MI. Pulmonary embolization is also rare, more with Right sided tumors and Left sided tumors in presence of Intracardiac L-R shunt.
Slide 16-

CARDIAC MANIFESTATIONS Mechanisms 1. Direct mechanical interference with myocardial or valvular function. 2. Interruption of coronary blood flow. 3. Interference with electrophysiologic conduction. 4. Pericardial effusion.
Slide 17-

METASTATIC DISEASES Truly metastatic diseases are by definition features of malignant primary cardiac tumors. Common sites of metastases lung, brain, and bone, although metastases to the liver, lymph node, adrenal gland, spleen, and skin are also seen.
Slide 18-

DIAGNOSTIC APPROACH For diagnosis –High index of suspicion needed. When cardiac tumor is considered in the DD, Echocardiography (TTE/TEE) has to be taken. TEE is better due to Proximity to heart No interference with lung and bone High frequency transducer with good resolution Chest CT with contrast enhancement and CMR with contrast are superior modalities for delineation of the extent of tumor involvement/in doubtful cases.
Slide 19-

Features suggestive of malignant cardiac tumors Large broad-based lesion occupying most of the affected cardiac chamber Hilar lymphadenopathy Extensive pericardial involvement Hemorrhagic pericardial effusions. For definite diagnosis HPR is mandatory. Less invasive methods such as cytologic evaluation of pericardial or pleural fluids might yield diagnosis in some cases only.
Slide 20-

PET scan useful in metastatic work up. CAG may be needed before surgery to know the feeding vessel to the mass. More invasive methods of tumor biopsy through intravenous route, mediastinoscopy or even thoracotomy may be necessary to obtain a definitive diagnosis.
Slide 21-

ECHO EVALUATION A cardiac mass is defined as an abnormal structure within or immediately adjacent to the heart. There are three basic types of cardiac masses Tumor Thrombus Vegetation Localiased Hypertrophy of muscle
Slide 22-

The first step - to ensure it is not an artifact. Appropriate transducer selection, scanning technique, and evaluation from multiple examining windows will help to distinguish artifacts from actual anatomic structures. Experience really counts..
Slide 23-

DIFFIRENTIAL DIAGNOSIS OF MASS
Slide 24-

ppt slide no 24 content not found
Slide 25-

DIFFIRENTIAL DIAGNOSIS OF MASS
Slide 26-

The Nodes of Arantius (nodes of the semilunar cusps) are thickenings of the tunica intima layer covering the ventricular aspect of the leaflets of the aortic valve. (Shown as blue marking) Lambl’s excrescences are mobile, thin, filiform structures that occur at sites of valve closure.
Slide 27-

The clinical context in which the image was obtained is critical. The is movement of the mass and related structures during a motion image. Progression of an image over time may also indicate the pathologic process. If a cardiac mass changes in size from one image to the next, suspicion of a cardiac tumor is much higher. Knowledge regarding certain characteristic presentation.
Slide 28-

A specific type of cardiac involvement the extension of renal cell carcinoma up the inferior vena cava. RCC appears like a “fingerlike” projection into the right atrium (RA) from the inferior vena cava. Uterine tumors also occasionally present in this fashion.
Slide 29-

46% 27% 8% 7% 12% attached to Valves Myxomas 41 % Thrombi 16% Fibroelastoma 13% RCC 9% Case series of 75 cases cardiac masses
Slide 30-

BENIGN TUMORS
Slide 31-

MYXOMAS Most common type of primary cardiac tumor. >50% of all primary tumors. Most commonly presents in adults 30 to 50years and 65% in Women. Arises from multipotent mesenchymal cells. 5 to 10% myxomas are familial. Hallmark histological feature is –Myxoma cells or Lepidic cells. Myxoma cells can produce VEGF & IL-6.
Slide 32-

Lepidic cell
Slide 33-

Majority of the patients with myxoma will present with at least one of the classic triad of obstructive cardiac, embolic, and constitutional or systemic symtoms/signs. Obstructive Cardiac Findings Dizziness Dyspnea ( may be positional) Cough Pulmonary edema Heart failure.
Slide 34-

On Physical examination If LA is involved with myxoma Loud S1 and some times S1 split occurs. Holosystolic murmur of MR MDM from turbulent blood flow through the mitral orifice Occasionally a tumor “plop.” Signs of pulmonary congestion
Slide 35-

TUMOR PLOP The sudden bolus of blood plus tumor protruding into the ventricle causes a third sound, called a "tumor plop“. Sound is evanescent and positional. It occurs later than an OS but earlier than an S3. 80-120 ms after A2. There would be an abrupt y-descent in the left atrial pressure after tumor plop.
Slide 36-

In RA myxomas Findings of rapidly progressive right-sided heart failure seen Fatigue Peripheral edema Ascites Hepatosplenomegaly Elevated JVP with a prominent a wave If PRO present- systemic hypoxia, cyanosis, clubbing, and polycythemia SVC obstruction in large RA tumor The diagnosis is often delayed.
Slide 37-

The obstructive cardiac findings are due to the mechanical interference of mitral valve by the tumor. Tumor embolism Most common cardiac tumor to embolise Virtually to every organ, mostly to CNS. Symptoms depend on the location of the tumor and the patency of the foramen ovale.
Slide 38-

Investigations ECGs may show LA enlargement Atrial arrythmias and conduction disorders are rare. CXR shows evidence of elevated LA pressure, such as LA enlargement (1/3cases), vascular redistribution, prominent pulmonary trunk Pulmonary edema, is found in about 1/2 of patients with LA myxoma.
Slide 39-

Intracardiac tumor calcification is a rare in LA myxomas but it is seen in most of the cases with RA myxoma. Echocardiography is the most commonly used modality for diagnostic purposes, and TEE is the preferred echo modality. Most cardiac myxomas appear as spherical or ovoid masses with lobular contour on CT and CMR scans.
Slide 40-

Contrast-enhanced CT reveals that most myxomas have an overall attenuation lower than that of myocardium On CT- two thirds of myxomas are heterogeneous, whereas one third appear homogeneous.
Slide 41-

83% in LA and 12.7% occur in RA and 1.3% are biatrial. Only 1.7% and 0.6% of myxomas occur in the LV and RV respectively. Usually pedunculated tumors with a fibrovascular stalk attaching to the subendothelial base of IAS in the region of the fossa ovalis. Rarely, cardiac myxoma can involve heart valves directly.
Slide 42-

ppt slide no 42 content not found
Slide 43-

Size usually 4 to 8 cm in diameter with maximum reported as 16cms. Half of the cardiac myxomas have a smooth compact surface, and half have a villous surface. Myxomas with a villous surface are more likely to embolize.
Slide 44-

ppt slide no 44 content not found
Slide 45-

“Syndrome myxoma” refers to one of several genetic disorders which should be suspected in patients< 40 years with multiple cardiac myxomas. Myxoma syndromes include LAMB (lentigines, atrial myxomas, mucocutaneous myxomas, and blue nevi), NAME (nevi, atrial myxomas, myxoid neurofibroma, and ephelides) Carney syndrome (atrial, cutaneous and mammary myxomas, lentigines, blue nevi, endocrine disorders and testicular tumours)
Slide 46-

CARNEY SYNDROME Autosomal Dominant syndrome Myxoma in cardiac and several extracardiac locations Spotty skin pigmentation Endocrine hyperactivity Other tumors (such as testicular Sertoli cell tumor, pituitary adenoma, and thyroid tumors). Mutations in PRKAR1A( protein kinase A 1regulatory subunit) or MYH8-myosin isoform. HPR- PAS, Vimentin, S-100 and NSE positivity.
Slide 47-

ppt slide no 47 content not found
Slide 48-

Carney syndrome No age or gender predilection. Single or multiple Any intracardiac location Recurrence rate 20% despite adequate surgical excision. Sporadic cardiac myxoma Women of middle age. Isolated lesions in the left atrial aspect of interatrial septum. Lower recurrence rate (roughly 3%) than those mentioned previously.
Slide 49-

Treatment The treatment is prompt surgical resection. Complete excision is the goal, although this may not be possible in all instances. Postoperative mortality in most series ranges from 0% to 7.5%. Recurrence rate is 3% which can be local or in extracardiac locations, such as the brain, lung, skeletal muscle, bone, kidney, gastrointestinal tract, skin, and other soft tissue sites.
Slide 50-

LIPOMAS AND LIPOMATOUS HYPERTROPHY Benign lipomatous tumor is the second most common primary neoplasm of the heart. It can be divided into two major groups on the basis of the degree of encapsulation Lipoma Lipomatous hypertrophy of the atrial septum (LHAS).
Slide 51-

Sporadic with equal occurences in both genders. Clinically, mostly asymptomatic and typically are incidental findings. Can occur at any atrial or ventricular surface most commonly in the subepicardial and subendocardial locations, although intramyocardial lesions have also been reported.
Slide 52-

Subendocardial lipomas with a prominent intracavitary component can result in symptoms of heart failure. Subepicardial tumors are usually asymptomatic, but large lesions may cause compression of the heart and produce pericardial effusion. Intramyocardial lipoma may interfere with electrical conduction in the heart and cause arrhythmias.
Slide 53-

TEE followed by CT is the modality of choice as they display a low attenuation signal similar to subcutaneous or mediastinal fat. Size typically ranges from 1 to 8 cm in diameter. The treatment of symptomatic cardiac lipomas is surgical resection, and the postoperative prognosis is excellent.
Slide 54-

LHAS(Lipomatous hypertrophy of the atrial septum) LHAS are massive fatty deposits of the atrial septum. It is a nonencapsulated excessive accumulation of fat in the atrial septum at the level of the fossa ovalis. It is more than 2 cm in thickness and typically occurs in elderly, obese patients. Mean age of diagnosis - 70yrs. Basically a developmental disorder caused by expansion of adipose tissue trapped in the IAS during embryogenesis.
Slide 55-

ppt slide no 55 content not found
Slide 56-

Clinically LHAS does not usually cause any symptoms. But at times result in rhythm disturbances and even SCD. The fatty tissue infiltration into atrial myocyte tissue can alters the architecture and function of the myocytes. Rarely the tumor protrudes into the right atrium and the superior vena cava and can present with symptoms related to blood flow obstruction.
Slide 57-

CT and CMR are the most desirable than Echo. Atrial septum is thickened to up to 7 cm, whereas normally it is less than 1 cm but this thickening always avoids the fossa ovalis, giving the atrial septum a dumbbell or hourglass shape. LHAS with symptomatic arrhythmias can be managed medically. Surgical management should be restricted to hemodynamically compromised patients.
Slide 58-

Papillary fibroelastoma Papillary fibroelastoma is the third most common primary cardiac tumor Incidence 0.33% Fibroelastic growth distinct from lambl excrescences and does not spontaneously regress which may have focal calcification Clinically mostly asymptomatic.
Slide 59-

Papillary fibroelastomaPom Pom or sea anemone appearance.
Slide 60-

A series showed 50% pts having TIA, stroke, angina, myocardial infarction, and dyspnea. Cerebral embolic symptoms are present in>50% of the symptomatic patients. Rarely, patients present with IE and PE and sudden death have also been reported. Firmly attached to the valvular or mural endocardium.
Slide 61-

TEE is the recommended imaging modality for the diagnosis for lesions measuring 2 cm or more. Generally appears as a round, oval or irregular lesion well demarcated 80% to 90% are found on the valvular endocardium most commonly on Aortic Valve.
Slide 62-

ppt slide no 62 content not found
Slide 63-

ppt slide no 63 content not found
Slide 64-

ppt slide no 64 content not found
Slide 65-

Around 40% of papillary fibroelastoma have a 1-to 3-mm stalk. This mobile type appears more likely to give rise to embolism. The treatment - Surgical excision or tumor shaving from the valvular leaflets with either reconstitution or, replacement of the valve. Asymptomatic patients with small, left-sided, nonmobile-type can be observed. Tumors >1cm, mobile, left sided & symptomatic cases need excision.
Slide 66-

Management in short
Slide 67-

RHABDOMYOMA Most frequent PCT in infants and children. 80% in <1 year but adult presentation also seen while rare. Child hood rhabdomyoma regress in most the cases, it is believed to be due to high expression of ubiquitin in these tumors from 34weeks onwards. Spider cells are characteristic of regressing rabdomyoma. In about 80-90% of patients, it is associated with tuberous sclerosis.
Slide 68-

Arrhythmias represent the most common presentation in adults. Imaging- well-circumscribed masses with hyperintense T1- and T2-weighted spin-echo images and hypointense images after the administration of gadolinium
Slide 69-

70% atrial origin and 30% ventricular. In symptomatic patients with arrhythmias, antiarrhythmic drugs may be used. Surgical excision is indicated if the drugs fail to control symptoms. No recurrence. Prognosis of this disease is excellent.
Slide 70-

ppt slide no 70 content not found
Slide 71-

ppt slide no 71 content not found
Slide 72-

FIBROMAS Cardiac fibroma- 2nd most common PCT in infants and children. 90% in children <1 year No sex predilection Majority appear to be nonfamilial. Majority of cardiac fibromas have no tendency to recur or to grow aggressively. Do not regress as rabdomyoma.
Slide 73-

Heart failure due to mechanical obstruction is the most common symptom. Can causes arrhythmogenic disorders as VT, AF, and RBBB and LBBB. also causes myocardial dysfunction. 1/3rd of patients with cardiac fibroma can remain asymptomatic. The average size of the tumor is 5 cm. Generally single lesions. Commonly found in the LV septum or the LV free wall Occurrence in the RV or the atria in less than 10% of cases.
Slide 74-

ECG may show evidence of LVH,RVH, BBB, AV blocks and VTs CXR may reveal cardiomegaly with or without a focal bulge, and calcification is visible in 15% of cases. ECHO - cardiac fibroma usually appears as a solitary homogeneous echogenic lesion. CT and CMR are more desirable for evaluating the resectability of the lesion.
Slide 75-

The differential feature favoring fibroma over rhabdomyoma is calcification, which occurs in fibromas but not in rhabdomyomas Complete surgical resection in symptomatic cases is recommended. The postoperative prognosis is typically good. For large, unresectable tumors, cardiac transplantation may be considered.
Slide 76-

Teratomas Second most common cardiac tumor in infants. Usually arise from pericardium. Generally benign but can cause obstructive symtoms and hydrops fetalis in inutero. Can cause cardiac tamponade also. Immediate surgical excision can be curative. Recurrence rare.
Slide 77-

Purkinje cell tumors A multifocal Purkinje cell tumor of the heart is rare. One of the cause of sudden infant death due to intractable VT. Consist of small sheets of cells & MC location is LV. Cannot be localised by ECHO and radiological means. ECG shows RBBB and EP study may be need to localise the tumors. Surgical removal is curative.
Slide 78-

Hamartomas/paragangilomas Cardiac hamartomas also present with tachyarrhythmia. Usually single, localised by ECHO and MC site ventricles. Paragangliomas can hormonaly active/inactive. Norepinephrene secreting pargangliomas may produce, headache,palpitaion,sweating, hypertension. Pericardium is the most common site. Can be localised by ECHO. Highly vascular tumors. Hence difficult to excise sometimes if it is particularly hormone secreting also.
Slide 79-

PRIMARY VASCULAR TUMORS HEMANGIOMA LYMPHANGIOMA HEMOENDOTHELIOMA
Slide 80-

Extremely rare Benign with tendency to recur No age/ gender predilection Usually asymptomatic But can present with Palpitations Arrhythmias Heart failure Pericardial effusion Ventricular outflow tract obstruction Pseudoangina Cerebral embolism In extreme cases as SCD.
Slide 81-

It can cause Kasabach-Merritt syndrome- Thrombosis Consumative coagulopathy Thrombocytopenia Giant hemangioma. ECHO is a sensitive, noninvasive method for detection of the tumor, with cardiac hemangioma appearing typically as a hyperechoic lesion. Tumor Blush - Typically seen on coronary angiogram. Ventricles>Atrial Treatment is surgical resection/embolisation.
Slide 82-

Tumor blush
Slide 83-

MALIGNANT TUMOURS 1/5TH of PCT are malignant ( <20%) Most common of them are sarcomas followed by lymphomas. Metastatic tumors are 30 times more common than PMCT. Mostly metastasis come from lung and breast cancer. Hodgkin disease, NHL, Malignant melanoma, numerous primary gastrointestinal malignant neoplasms, and various types of sarcomas arising from extracardiac locations can also secondarily involve the heart.
Slide 84-

Common malignant PCT Angiosarcomas Rhabdomyosarcomas Leiomyosarcomas Fibrosarcomas Malignant fibrous histiocytomas Undifferentiated sarcomas Malignant lymphomas Mesotheliomas Sarcomas
Slide 85-

Sarcomas have a worse prognosis if shows High mitotic activity (>5 mitotic figures/10 high-power fields) Extensive tumor necrosis Poor cellular differentiation The presence of metastases
Slide 86-

CMR is usually the method of choice for imaging of sarcomas. On CT or CMR - large, heterogeneous, broad-based masses that frequently occupy most of the affected cardiac chambers. Extension into other cardiac chambers,pericardium with effusions may be seen. Hilar lymphadenopathy can also occur.
Slide 87-

ANGIOSARCOMA Most common primary cardiac sarcoma in adults. In adults 30 to 50 years old A slight male predilection exists Occur sporadically. 65% to 90% of patients at diagnosis have evidence of metastatic disease. 90% in RA and involvement of structures such as the tricuspid valve, pulmonary valve, and vena cava as well as extension into the pericardium may occur.
Slide 88-

ECG reveals nonspecific ST changes, arrhythmias, and AV block. CXR may show nonspecific changes like cardiomegaly, widened mediastinum, hilar lymphadenopathy, and pleural effusion. TEE is the initial imaging modality of choice. On CT & CMR- appear as low-attenuation, invasive, irregular nodular masses showing heterogeneous enhancement with frequent pericardial involvement and hemorrhagic pericardial effusion.
Slide 89-

Immunohistochemical analysis is done for final diagnosis It is an aggressive neoplasms with a poor prognosis and mean survival of 9 to 10 months. Common sites of metastases - lung, liver, brain, and bone A multidisciplinary approach to the treatment of cardiac angiosarcoma is advocated including a combination of surgery, irradiation, adjuvant or neoadjuvant chemotherapy, and immunotherapy with interleukin-12 (IL-12).
Slide 90-

Chemotherapy - Doxorubicin, Ifosfamide, Docetaxel and Gemcitabine. Surgery -Complete tumor resection if possible. Neoadjuvant chemotherapy may be administered to reduce the tumor mass. The use of heart transplantation remains controversial in this setting.
Slide 91-

RHABDOMYOSARCOMA Most common primary sarcoma of the heart in children. Usually in the second decade of life with slight male preponderance. Heart failure, arrhythmias, cardiac murmurs, and constitutional symptoms are common manifestations of the disease. Occasional cases are also associated with hypereosinophilia, hypertrophic osteoarthropathy, and polyarthritis.
Slide 92-

ECHO followed by CT/CMR to delineate the extent of tumour. In contrast to angiosarcomas, cardiac rhabdomyosarcomas show no predilection for a specific cavity, and multiple lesions are frequently present . Aggressive neoplasms with a tendency to metastasize most commonly to the lung and lymph nodes, with survival <1 year.
Slide 93-

The primary aim of treatment is complete surgical resection Poor response to radiotherapy and chemotherapy. In selected cases, heart transplantation may be considered if no obvious distant metastases are present
Slide 94-

LEIOMYOSARCOMA A type of malignant mesenchymal tumors with smooth muscle differentiation. Mean age -fourth decade, and there is no apparent sex predilection. The common clinical presentations include dyspnea, pericardial effusions, chest pain, atrial arrhythmias, and heart failure. 70-80% arise from the left atrium, and they tend to extend into the pulmonary trunk.
Slide 95-

Multiple origin in 30% of patients. ECHO followed by CT/CMR for diagnosis. Rapidly growing tumors with a high rate of local recurrence and distant metastases Prognosis is poor, with a mean survival of 6 months. Effective treatment of this progressively lethal disease is unknown.
Slide 96-

LYMPHOMAS 1.3% to 2% of all primary cardiac tumors. Seen in both immunocompetent and immunocompromised ,but more in latter. Commonly associated with HIV, Post transplant lymphoproliferative disorder and EBV infections. The average age - 62 to 67 with male predominance.
Slide 97-

The common clinical presentations include chest pain, heart failure, pericardial effusion, palpitation, and arrhythmias. Less common presentations are cardiac tamponade, pulmonary and systemic embolism. ECG findings are nonspecific ECHO followed by CT/CMR.
Slide 98-

Right side involvement more common. Size range from 3 to 12 cm in size with a mean of 7 cm. Treatment  Early implementation of anthracycline and rituximab based chemotherapy with or without radiation therapy has become the mainstay for treatment of primary cardiac lymphomas. 60% of patients die of the disease within 2 months after the initial diagnosis
Slide 99-

Secondary Cardiac Tumours Incidence-1.7% to 14% in cancer patients and from 0.7% to 3.5% in the general population. Cardiac metastases can occur either by direct extension, through blood stream or lymphatics, or by intracavitary diffusion through the inferior vena cava (IVC). Pericardial metastasis (69%) is the most common, followed by epicardial (34%), myocardial (32%), and endocardial metastases (5%).
Slide 100-

The pericardium is most often involved because of direct invasion by thoracic cancer, including breast and lung cancer. Abdominal and pelvic tumors may reach the right atrium through the IVC. The most common tumor exhibiting this tendency is renal cell carcinoma. In men- lung cancer followed by esophageal cancer and lymphoma In women- lung cancer followed by lymphoma and breast cancer.
Slide 101-

Clinical Manifestations of SCT Peripheral edema is a common clinical findings. Heart failure, cardiac arrhythmias, heart blocks, acute myocardial infarction, myocardial rupture, systemic embolization, and superior vena cava (SVC) syndrome ECG - ST-T wave changes (mimicking myocardial ischemia or injury), new atrial fibrillation or flutter, and low voltages, with electrical alternans indicating a significant pericardial effusion
Slide 102-

Causes of Pericardial Effusion in cardiac malignancies Malignant effusion Radiation- or drug-induced Idiopathic Infectious causes (TB Bacterial) Iatrogenic secondary to procedures Drug-induced pericarditis-high-dose anthracycline or cyclophosphamide therapy.
Slide 103-

CARDIAC TAMPONADE Usual presentation of pericardial effusion. Immediate treatment is directed towards fluid drainage. Cytologic examination has 85% sensitivity in yielding a positive result in malignant effusion. Risk for recurrence is reduced by extended catheter drainage (3 ± 2 days- 11.5% recurrence) as opposed to simple pericardiocentesis. Intrapericardial instillation of chemotherapeutic agents or sclerosing agents can be used Some percutaneous balloon pericardiotomy or pericardiectomy may be required
Slide 104-

CARCINOID Tumors also can affect the cardiac structures indirectly, as is seen in carcinoid heart disease. Metastatic carcinoid tissue in the liver produces biologically active substances, including serotonin, which cause abnormalities of the right-sided cardiac valves and endocardium. This leads to thickening, retraction, and increased rigidity of the tricuspid and pulmonic valve leaflets, resulting in valvular regurgitation or, less often, valvular stenosis.
Slide 105-

Left-sided valvular involvement is rarely seen, possibly because of a lower concentration of the active molecules after passage through the lungs. Echocardiographic findings are pathognomonic and may lead to the diagnosis in a patient in whom it was not considered previously.
Slide 106-

Question time
Slide 107-

Hall mark cells in Myxomas? Cause for constitutional symptoms in myxoma? Most common PMCT? Tumor that makes Tricuspid valve immobile? Strongest predictor of mortality in PCT? Most common site affected by secondaries in heart ? Spider cells seen in----? Most common tumor affecting heart valves? Rhabdomyoma is associated with ------in 80-90% cases Order of incidence of myxoma in cardiac chamber---- Very high concentration of ------ in ------- leads to its self regression in most of the cases. Primary malignant cardiac tumor with 90% involvement RA is----- Leimyosarcoma most commonly involve ---- chamber Pericardial cytology yield diagnosis in----% of malignant effusion. Tiger stripes in pulse wave doppler is seen in -------
Slide 108-

Thank you
Slide 109-

ppt slide no 109 content not found
Slide 110-

The most common PMCTs are sarcomas (64.8%), followed by lymphomas (27%) and mesotheliomas (8%). After a median follow-up of 80 months, >85% patients died. The 1-, 3-, and 5-year survival rates were 50%, 24%, and 19% for 2000 to 2011. Conclusions PMCTs are extremely rare and continue to be associated with poor prognosis. Over the past 5 decades, the incidence and survival of patients diagnosed with PMCT appear to have increased. Compared with those with extracardiac cancers of similar histopathology, patients with PMCTs are often younger and have worse survival.
Slide 111-

ppt slide no 111 content not found
Slide 112-

ppt slide no 112 content not found
Slide 113-

ppt slide no 113 content not found
Slide 114-

Conclusions Cardiac tumors can be resected with minimal morbidity and mortality. The strongest predictors of mortality are closely linked to tumor histology, symptomatology and duration CPB time. Patients with cardiac myxomas, the most common cardiac tumor, enjoy survival that is not significantly different than that of a standard population.
Slide 115-

Myxoma patients after resection, should be closely followed with echocardiograms for a minimum of 4 years to evaluate for tumor recurrence, particularly in younger patients. Whereas the majority of benign tumors enjoy excellent survival. Patients with malignant tumors have a dismal prognosis and younger patients with malignant tumors have particularly poor survival characteristics