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Imai T, Shimoi T, Kawai A, Yonemori K. Diagnosis and treatment of cardiac tumors. Med Oncol 2025; 42:110. [PMID: 40095104 PMCID: PMC11914324 DOI: 10.1007/s12032-025-02661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 03/04/2025] [Indexed: 03/19/2025]
Abstract
Cardiac tumors, though rare, present significant diagnostic and therapeutic challenges due to their diverse nature and potential severity. These tumors, which can be primary or metastatic, are often detected incidentally through imaging modalities such as echocardiography or CT scans. Differentiating between benign and malignant forms is crucial for guiding appropriate management strategies. This review synthesizes current diagnostic approaches and treatment modalities for cardiac tumors, with a focus on the role of imaging techniques like UCG, CT, MRI, and PET in tumor characterization. Multidisciplinary treatment plans are necessary, including surgical resection for benign tumors, chemotherapy, and radiotherapy for malignant tumors, and novel targeted therapies such as MDM2 inhibitors for selected cases. While primary malignant tumors like sarcomas and mesotheliomas exhibit rapid progression and poor prognosis, recent advances in multimodal therapy offer potential improvements in survival. The incidence of primary cardiac tumors is low, with an autopsy-reported occurrence rate of 0.02%. Benign cardiac tumors, such as myxomas and fibromas, generally have favorable outcomes with surgical resection. In contrast, primary malignant tumors like sarcomas and mesotheliomas exhibit rapid progression and poor prognosis, necessitating aggressive treatment including surgery, chemotherapy, and radiotherapy. Metastatic cardiac tumors occur in approximately 10% of cancer patients at autopsy and are managed according to the treatment plan for the primary malignancy. The management of cardiac tumors requires a multidisciplinary approach tailored to tumor type, location, and systemic effects. While benign tumors often respond well to surgical management, malignant and metastatic tumors demand more complex strategies to optimize patient outcomes.
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Affiliation(s)
- Toru Imai
- Department of Medical Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kan Yonemori
- Department of Medical Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan
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Shu H, Xiao D, Han S, Du Y, Lin J, Li Q. A case of left atrial intimal sarcoma with rhabdomyosarcoma differentiation: a case report and literature review. Front Oncol 2024; 14:1340115. [PMID: 38835391 PMCID: PMC11148456 DOI: 10.3389/fonc.2024.1340115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
Primary cardiac malignancies are rare, with cardiac sarcomas being the main type. Among these, intimal sarcomas are the most common. However, they tend to occur in the great vessels and are rare in the heart, with only a few isolated cases reported. We report a challenging case of a patient with left atrial intimal sarcoma with rhabdomyosarcoma differentiation. The patient was admitted after a physical examination detected left heart occupancy, and initial imaging suspected a left atrial thrombus. The patient then underwent extracorporeal circulation-assisted open cardiac surgery with resection of an atrial mass. The postoperative pathological findings were suggestive of an arterial intimal sarcoma, which included areas of rhabdomyosarcoma differentiation within the tumor tissue. Unfortunately, the patient's tumor recurred 4 months later, and she died due to treatment failure. This case highlights the rarity and risk of misdiagnosis of cardiac intimal sarcoma. Additionally, we aim to improve the understanding of intimal sarcoma through a review of immunohistochemistry and gene amplification techniques.
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Affiliation(s)
- Hongyun Shu
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Duan Xiao
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sisi Han
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Yongkang Du
- Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Jinduan Lin
- Department of Laboratory Medicine, The Affiliated Qingyuan Hospital of Guangzhou Medical University, Qingyuan, China
| | - Qiaowen Li
- Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China
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Callaud A, Metrard G, Besse H, Bailly M, Thibault F. Extinction of Lipomatous Hypertrophy of the Interatrial Septum FDG Uptake With Propranolol Premedication. Clin Nucl Med 2023; 48:536-537. [PMID: 37019121 PMCID: PMC10184794 DOI: 10.1097/rlu.0000000000004640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/14/2023] [Indexed: 04/07/2023]
Abstract
ABSTRACT Lipomatous hypertrophy of the interatrial septum is a rare lesion of the heart. CT and cardiac MR are often sufficient to determine the benign lipomatous nature of the tumor and can avoid the need for histological confirmation. Lipomatous hypertrophy of the interatrial septum contains variable amounts of brown adipose tissue, resulting in different degrees of 18 F-FDG uptake in PET. We report the case of a patient with an interatrial lesion suspected of malignancy, discovered on CT and failing cardiac MR, with initial 18 F-FDG uptake. Final characterization was made thanks to 18 F-FDG PET with β-blocker premedication, avoiding an invasive procedure.
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Affiliation(s)
- Aurélien Callaud
- From the Nuclear Medicine Department, CHR Orleans, Orleans
- Nuclear Medicine Department, CHRU Tours
| | - Gilles Metrard
- From the Nuclear Medicine Department, CHR Orleans, Orleans
| | - Hélène Besse
- From the Nuclear Medicine Department, CHR Orleans, Orleans
| | - Matthieu Bailly
- From the Nuclear Medicine Department, CHR Orleans, Orleans
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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Grünig H, Strobel K, Zander A, Del Sol Pérez Lago M. Increased 18F-PSMA and 18F-FDG Uptake in Lipomatous Hypertrophy of the Interatrial Septum. Clin Nucl Med 2023; 48:248-249. [PMID: 36723886 DOI: 10.1097/rlu.0000000000004551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ABSTRACT Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign anomaly with low prevalence. Lipomatous hypertrophy of the interatrial septum is asymptomatic in most of the cases and rarely leads to atrial arrhythmias, obstructive flow symptoms, or sudden death. It is mostly diagnosed as an incidental finding in cross-sectional imaging and echocardiography, and increased 18F-FDG uptake on LHIS has been described. We present a case of repeated increased 18F-PSMA uptake in LHIS. Although very rare, familiarity with the typical features and prevalence of LHIS in PET/CT can avoid misinterpretation for metastatic disease.
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Affiliation(s)
- Hannes Grünig
- From the Department of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Karameh M, Golomb M, Yarkoni M, Rudis E, Keidar Haran T, Shadafny N, Cohen D, Beeri R, Gilon D, Asleh R, Durst R. Giant Intracardiac Lipoma: A Case Report and the Role of Multimodality Cardiac Imaging. Cureus 2022; 14:e29565. [PMID: 36312694 PMCID: PMC9595577 DOI: 10.7759/cureus.29565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/19/2022] Open
Abstract
Cardiac lipomas, especially ones originating from the left ventricle, are extremely rare. They may be asymptomatic or may present with various non-specific symptoms. Herein, we report a case of a giant lipoma of the left ventricle, with frequent ventricular premature beats on electrocardiogram. An echocardiogram demonstrated a large hyperechoic mass occupying a significant portion of the left ventricle. We further describe the diagnostic workup utilizing multimodality cardiac imaging and treatment options. Cardiac MRI demonstrated fat suppression, and cardiac CT showed a homogenous low-attenuation mass suggesting lipomatous matter. The mass was subsequently surgically removed for pathology examination in order to rule out liposarcoma. Histopathology demonstrated mature adipocytes, entrapped myocytes with hypertrophy, and interstitial fibrosis foci confirming the diagnosis of lipoma.
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Ji X, Nian S, Bai Y, Dong A. FDG PET/CT in Dendritic Fibromyxolipoma of the Thigh. Clin Nucl Med 2022; 47:e208-e209. [PMID: 34653047 DOI: 10.1097/rlu.0000000000003930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Dendritic fibromyxolipoma is a rare recently described benign soft tissue tumor, which may be misinterpreted histologically as myxoid liposarcoma or myxoid malignant fibrous histiocytoma. We describe FDG PET/CT and MRI findings of a dendritic fibromyxolipoma incidentally detected in a case with rectal adenocarcinoma. The dendritic fibromyxolipoma showed inhomogeneous FDG uptake with SUVmax of 4.0 mimicking malignancy.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province
| | | | | | - Aisheng Dong
- Nuclear Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
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Cely Cely A, Jiménez López-Guarch C, Charterina SA. Masas cardiacas: multimodalidad-resonancia magnética cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Interatrial septum: A pictorial review of congenital and acquired pathologies and their management. Clin Imaging 2019; 55:53-64. [PMID: 30754012 DOI: 10.1016/j.clinimag.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 11/21/2022]
Abstract
There are many different congenital abnormalities and acquired pathologies involving the interatrial septum. Differentiation of these pathologies significantly affects patient management. We have reviewed the various interatrial septal pathologies and discussed their congenital associates, clinical significance, and management. After reading this article, the reader should be able to better characterize the interatrial septal pathologies using the optimal imaging tools, and have a better understanding of their clinical significance and management.
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Fat-Containing Hypermetabolic Masses on FDG PET/CT: A Spectrum of Benign and Malignant Conditions. AJR Am J Roentgenol 2016; 207:1095-1104. [PMID: 27490138 DOI: 10.2214/ajr.16.16066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This article focuses on identifying the imaging appearances of hypermetabolic fatty masses and masslike lesions on PET/CT and understanding the diagnostic challenges radiologists may face while interpreting findings of these lesions on PET/CT. This article provides an approach to aid in the diagnosis of these lesions and the appropriate management of patients. CONCLUSION Both malignant and benign fat-containing masses and masslike lesions can show hypermetabolic activity on PET/CT. Although the differential diagnosis is broad, clinical history, anatomic location, and knowledge of anatomic variants and imaging features can help radiologists avoid misinterpretation of benign fatty lesions as malignancy.
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Sachpekidis C, Roumia S, Schwarzbach M, Dimitrakopoulou-Strauss A. Dynamic 18F-fluorodeoxyglucose positron emission tomography/CT in hibernoma: Enhanced tracer uptake mimicking liposarcoma. World J Radiol 2013; 5:498-502. [PMID: 24379937 PMCID: PMC3874507 DOI: 10.4329/wjr.v5.i12.498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/02/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
We report on two cases of patients with fat-equivalent masses in computed tomography (CT), referred to our department for dynamic positron emission tomography/CT (dPET/CT) with 18F-fluorodeoxyglucose (18F-FDG) in order to investigate their dignity. Both qualitative and quantitative information, as derived from dPET/CTs, couldn’t exclude a high-grade liposarcoma: Visual evaluation, revealed a large hypermetabolic focus of intense 18F-FDG uptake in each patient (average SUVs 8.3 and 11.3). Regression-based parametric imaging demonstrated an enhanced distribution volume, which correlates to perfusion, and a high phosphorylation rate that correlates to cell viability. Kinetic analysis, based on a two-tissue compartment model demonstrated an enhanced FDG transport k1 and an enhanced phosphorylation rate k3. A non-compartmental approach based on fractal dimension revealed also enhanced values. However, final diagnosis was based on biopsy, which revealed hibernoma, a benign brown fat tumor. Brown adipose contains increased numbers of mitochondria and a high-rate of glucose metabolism. Therefore, they have increased FDG uptake. The evaluation of lipomatous lesions on CT, with high FDG uptake, should include the possibility of hibernoma as a differential diagnosis.
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