Image Description
Location: Cardiac myxomas are usually located in the atria and project into the atrial chamber. Three-fourths are found in the left atrium as shown in this image. Most of the remainder arise in the right atrium. They are attached to the interatrial septum near the rim of fossa ovalis via a narrow stalk or a broad-based attachment. Non-septal sites within atrium include posterior left atrial wall, anterior wall and atrial appendage.
Rare sites of involvement, including ventricles, inferior vena cava and valve leaflets or cusps, are usually seen in the setting of myxoma syndrome (Carney Complex). Any myxoma arising in an unusual site should be carefully examined to rule out myxoid sarcomas.
Image courtesy of: Dr. Ibrahim Zardawi; used with permission.
About the Disease
Primary cardiac tumors are extremely uncommon. Secondary tumors (metastases to heart) are 20-50 times more common than primary cardiac tumors and yet still relatively rare. Of primary cardiac tumors, almost 75% are benign and the remaining 25% are malignant.Benign Primary Cardiac Tumors: Myxoma (50-70% of cases), rhabdomyoma, lipoma and lipomatous hypertrophy of interatrial septum, papillary fibroelastoma, and fibroma. Angiomas and teratomas are found mainly in children. Malignant Primary Cardiac Tumors: Mostly sarcomas, including angiosarcoma (30%), rhabdomyosarcoma (20%), leiomyosarcoma, liposarcoma, osteosarcoma, fibrosarcoma, and undifferentiated pleomorphic sarcoma. Other tumors include mesothelioma and lymphoma.Secondary cardiac tumors are far more frequent than primary cardiac tumors. The most common primary sites include melanoma, lung, breast, kidney, and lymphomas. Pericardium is usually affected, resulting in pericardial effusion.Cardiac tumors may be asymptomatic and found incidentally or present with obstructive, embolic, arrhythmic or systemic symptoms, depending upon the size and location of the mass. References: 1. Miller, D. V. & Revelo M. P. (2023). Diagnostic Pathology - Cardiovascular. 3rd Edition, Elsevier.2. Sheppard, M. N. (2022). Practical Cardiovascular Pathology 3rd Edition, CRC Press.3. Maximilian B. & Butany J. (2022). Cardiovascular Pathology 5th Edition, Academic Press.