Hamartoma differential diagnosis: Difference between revisions

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{{Hamartoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hamartoma]]


{{CMG}}{{AE}}{{MV}}
{{CMG}}{{AE}}{{MV}} {{HK}}
==Overview==
==Overview==


Hamartomas must be differentiated from other diseases that result on fat containing lesions such as lipomas and metastases.
Hamartomas must be differentiated from other diseases that cause abnormal tissue growth and calcifications, such as calcified [[metastases]] and [[lipomas]].<ref name="pmid7855339">{{cite journal |vauthors=Brown K, Mund DF, Aberle DR, Batra P, Young DA |title=Intrathoracic calcifications: radiographic features and differential diagnoses |journal=Radiographics |volume=14 |issue=6 |pages=1247–61 |year=1994 |pmid=7855339 |doi=10.1148/radiographics.14.6.7855339 |url=}}</ref>


==Differentiating Hamartoma from other Diseases==
==Differentiating Hamartoma from other Diseases==


'''Hypothalamic hamartomas'''
'''Hypothalamic Hamartomas'''


The differential diagnosis is broadly that of suprasellar and hypothalamic lesions, although the imaging characteristics of hypothalamic hamartomas significantly reduces the differential. Hypothalamic-chiasmatic glioma is the main differential. Most other lesions encountered in the region either have markedly different signal intensity or demonstrate enhancement on MRI.<ref name=“radio"> Hypothalamic hamartoma. Dr Donna D'Souza et al.http://radiopaedia.org/articles/hypothalamic-hamartoma Radiopedia Accessed on December 08, 2015 </ref>
*The differential diagnosis is broadly that of [[suprasellar]] and [[hypothalamic]] lesions, although the imaging characteristics of [[hypothalamic]] hamartomas significantly reduces the differential.  
*Hypothalamic-chiasmatic glioma is the main differential.  
*Other lesions encountered in the region either have markedly different signal intensity or demonstrate enhancement on [[MRI]].<ref name="“radio&quot;">Hypothalamic hamartoma. Dr Donna D'Souza et al.http://radiopaedia.org/articles/hypothalamic-hamartoma Radiopedia Accessed on December 08, 2015 </ref>
*The table below summarizes the findings that differentiate [[hypothalamic hamartoma]] from other conditions that are also [[suprasellar]] and hypothalamic lesions.<ref name="pmid16611766">{{cite journal |vauthors=Amstutz DR, Coons SW, Kerrigan JF, Rekate HL, Heiserman JE |title=Hypothalamic hamartomas: Correlation of MR imaging and spectroscopic findings with tumor glial content |journal=AJNR Am J Neuroradiol |volume=27 |issue=4 |pages=794–8 |year=2006 |pmid=16611766 |doi= |url=}}</ref>


The table below summarizes the findings that differentiate [[hypothalamic hamartoma]] from other conditions that are also suprasellar and hypothalamic lesions. <ref name="pmid16611766">{{cite journal |vauthors=Amstutz DR, Coons SW, Kerrigan JF, Rekate HL, Heiserman JE |title=Hypothalamic hamartomas: Correlation of MR imaging and spectroscopic findings with tumor glial content |journal=AJNR Am J Neuroradiol |volume=27 |issue=4 |pages=794–8 |year=2006 |pmid=16611766 |doi= |url=}}</ref>
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| style="padding: 5px 5px; background: #DCDCDC;" |'''Hypothalamic-chiasmatic [[glioma]]'''  
| style="padding: 5px 5px; background: #DCDCDC;" |'''Hypothalamic-chiasmatic [[glioma]]'''  
| style="padding: 5px 5px; background: #F5F5F5;" |Hypothalamic-optochiasmatic gliomas are a subset of astrocytic tumours which have tendency to occur in patients with [[neurofibromatosis type 1]]. These may involve the optic nerves, the optic chiasm, and the [[optic tracts]]. Between 20 and 50% of patients with hypothalamic [[gliomas]] have a positive family history of von Recklinghausen disease ([[NF-1]]).  
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*Hypothalamic-optochiasmatic gliomas are a subset of astrocytic tumors which have tendency to occur in patients with [[neurofibromatosis type 1]].
*These may involve the optic nerves, the optic chiasm, and the [[optic tracts]].
* Between 20 and 50% of patients with hypothalamic [[gliomas]] have a positive family history of von Recklinghausen disease ([[NF-1]]).  
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Craniopharyngioma]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Craniopharyngioma]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Craniopharyngioma is a type of brain tumor derived from pituitary gland embryonic tissue, that occurs most commonly in children but also in men and women between 50 and 60 years of age. People may present with bitemporal inferior [[quadrantanopia]] leading to bitemporal [[hemianopia]], as the tumor may compress the optic chiasm.
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*[[Craniopharyngioma]] is a type of [[brain tumor]] derived from [[pituitary gland]] embryonic tissue.
*Occurs most commonly in children but may also occur in adults 50-60 years of age.  
*Symptoms may present with bitemporal inferior [[quadrantanopia]] leading to bitemporal [[hemianopia]], as the tumor may compress the optic chiasm.
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Rathke's pouch|Rathke's cleft cyst]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Rathke's pouch|Rathke's cleft cyst]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Rathke's cleft cyst is a benign growth found on the pituitary gland in the brain, specifically a fluid-filled cyst in the posterior portion of the [[anterior pituitary gland]]. It occurs when the Rathke's pouch does not develop properly and ranges in size from 2 to 40mm in diameter. Asymptomatic cysts are commonly detected during autopsies in 2 to 26 percent of individuals who have died of unrelated causes. Females are twice as likely as males to develop a cyst.
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*Rathke's cleft cyst is a benign growth found on the pituitary gland in the brain, specifically a fluid-filled cyst in the posterior portion of the [[anterior pituitary gland]].
*Rathke's cleft cyst occurs when the [[Rathke's pouch]] does not develop properly and ranges in size from 2 to 40mm in diameter.
*Asymptomatic cysts are commonly detected during autopsies in 2-26% of individuals who have died of unrelated causes.
*Females are more commonly affected than males.
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Pituitary macroadenoma]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Pituitary macroadenoma]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Pituitary macroadenoma is a common pituitary gland tumor. Patients with pituitary adenoma may progress to develop lethargy, headache, nausea, and vomiting. Common complications of pituitary adenoma include bitemporal hemianopia, anosmia, acromegaly, and gigantism.
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*[[Pituitary adenoma|Pituitary macroadenoma]] is a common [[pituitary gland]] tumor.
*Patients with [[pituitary adenoma]] may progress to develop [[lethargy]], [[headache]], [[nausea]], and [[vomiting]].
*Common complications of [[pituitary adenoma]] include [[bitemporal hemianopia]], [[anosmia]], [[acromegaly]], and [[gigantism]].
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'''Pulmonary hamartomas'''
'''Pulmonary Hamartomas'''
*The differential diagnosis of pulmonary hamartoma is dependent on CT scan imaging features.
*The differential is dependent on whether fat or calcification is identifiable within the lesion. If fat is visualized then the differential is narrow, with almost all cases representing pulmonary hamartoma.
*If neither fat nor calcification is present, then the differential is that of a solitary pulmonary nodule and is significantly broader.
*The table below summarizes the findings that differentiate [[pulmonary hamartoma]] from other conditions that cause a fat containing solitary pulmonary nodule.


The differential is dependent on whether fat or calcification is identifiable within the lesion. If fat is visualised then the differential is narrow, with almost all cases representing pulmonary hamartoma. However, the presence of calcification also significantly narrows the differential, but to a lesser degree. If neither fat, nor calcification is present, then the differential is that of a solitary pulmonary nodule and is significantly broader.
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The table below summarizes the findings that differentiate [[pulmonary hamartoma]] from other conditions that cause  a fat containing solitary pulmonary nodule.
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lipoma]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lipoma]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Lipoma is  a fat exclusive, well circumcised mass. They are likely to have been present for many years, and may change size with weight fluctuation. They can also be an incidental finding. In 5-15% of patients lipomas are multiple, and approximately a third of these will be familial.<ref name=“radio"> Lipoma. Dr Ahmed Abd Rabou and A.Prof Frank Gaillard et al.http://radiopaedia.org/articles/lipoma Accessed on December 08, 2015</ref>
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*Lipoma is  a fat exclusive, well circumcised mass
*Lipomas are likely to have been present for many years and may change size with weight fluctuation  
*These can also be an incidental finding
*In 5-15% of patients lipomas are multiple and approximately a third of these will be familial<ref name="“radio&quot;">Lipoma. Dr Ahmed Abd Rabou and A.Prof Frank Gaillard et al.http://radiopaedia.org/articles/lipoma Accessed on December 08, 2015</ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Myelolipoma]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Myelolipoma]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Myelolipoma is a very rare, benign pulmonary lesion, usually presenting as an asymptomatic pulmonary nodule. Is mainly composed of mature adipose tissue and normal hematopoietic cells.<ref name="pmid25789022">{{cite journal |vauthors=Xu Q, Yin X, Huang W, Sun J, Wu X, Lu L |title=Intrapulmonary myelolipoma and its computed tomography features: A case report and literature review |journal=Oncol Lett |volume=9 |issue=4 |pages=1677–1680 |year=2015 |pmid=25789022 |pmc=4356384 |doi=10.3892/ol.2015.2913 |url=}}</ref>
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*Myelolipoma is a very rare, benign pulmonary lesion, usually presenting as an asymptomatic pulmonary nodule
*Myelolipoma is mainly composed of mature adipose tissue and normal hematopoietic cells.<ref name="pmid25789022">{{cite journal |vauthors=Xu Q, Yin X, Huang W, Sun J, Wu X, Lu L |title=Intrapulmonary myelolipoma and its computed tomography features: A case report and literature review |journal=Oncol Lett |volume=9 |issue=4 |pages=1677–1680 |year=2015 |pmid=25789022 |pmc=4356384 |doi=10.3892/ol.2015.2913 |url=}}</ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Metastatic disease]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Metastasis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Pulmonary metastases are common and usually asymptomatic, with constitutional symptoms relating to disseminated metastatic disease and those attributable to the primary tumour dominating. Haemoptysis and pneumothorax are sometimes the presenting symptom. They tend to be single or multiple.<ref name=“radio"> Pulmonary metastases. Dr Ahmed Abd Rabou and A.Prof Frank Gaillard et al.http://radiopaedia.org/articles/pulmonary-metastases Accessed on December 08, 2015</ref>
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*Pulmonary metastases are common and usually asymptomatic, with constitutional symptoms relating to disseminated metastatic disease and those attributable to the primary tumor dominating  
*Common symptoms include [[hemoptysis]] and [[pneumothorax]]
*Pulmonary metastases may be single or multiple<ref name="“radio&quot;">Pulmonary metastases. Dr Ahmed Abd Rabou and A.Prof Frank Gaillard et al.http://radiopaedia.org/articles/pulmonary-metastases Accessed on December 08, 2015</ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Pulmonary Chondroma'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Pulmonary Chondroma'''
| style="padding: 5px 5px; background: #F5F5F5;" |Pulmonary chondromas are usually associated with Carney’s triad. On CT scan, chondromas appear as smoothly marginated, round, or slightly lobulated, small areas of fat. Common in adolescents or young adults.<ref>Carneys triad.https://en.wikipedia.org/wiki/Carney's_triad  Accessed on December 08, 2015 </ref>
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*Pulmonary chondromas are usually associated with Carney’s triad
*On CT scan, chondromas appear as smoothly marginated, round, or slightly lobulated, small areas of fat
*Pulmonary chondromas are common in adolescents or young adults<ref>Carneys triad.https://en.wikipedia.org/wiki/Carney's_triad  Accessed on December 08, 2015 </ref>
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'''Heart'''
'''Heart Hamartomas'''
*The table below summarizes the findings that differentiate cardiac hamartoma from other conditions that cause a fat containing lesion within the striated muscle of the heart.


The table below summarizes the findings that differentiate [[cardiac hamartoma]] from other conditions that cause a fat containing lesion within the striated muscle of the heart.
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Hibernoma'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Hibernoma'''
| style="padding: 5px 5px; background: #F5F5F5;" | A hibernoma is a benign neoplasm of vestigial brown fat. Patients present with a slow-growing, painless, solitary mass, usually of the [[subcutaneous tissue]]s. It is much less frequently noted in the intramuscular tissue. It is not uncommon for symptoms to be present for years. In general, imaging studies show a well-defined, heterogeneous mass, usually showing a mass which is [[hypointense]] to [[subcutaneous fat]] on magnetic resonance T1-weight images. Serpentine, thin, low signal bands (septations or vessels) are often seen throughout the tumor.
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*Hibernoma is a benign neoplasm of vestigial brown fat.
*The majority of patients present with a slow-growing, painless, solitary mass, usually of the [[subcutaneous tissue]]s.
*In general, imaging studies show a well-defined, heterogeneous mass, usually showing a mass which is [[hypointense]] to [[subcutaneous fat]] on magnetic resonance [[T1]]-weight images. Serpentine, thin, low signal bands (septations or vessels) are often seen throughout the tumor.
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Metastasis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Metastasis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Secondary malignant tumor of the heart, arising by lymphatic or hematogenous spread of a primary neoplasm. Presents with [[dyspnea]],[[congestive heart failure]], [[hypotension]] and malignant [[pericardial effusion]]. Any primary malignancy may metastasize to the heart, however, lung cancer is among the most common.<ref>Secondary cardiac neoplasm. Radiopedia.http://radiopaedia.org/articles/secondary-cardiac-neoplasms Accessed on November 24, 2015 </ref>
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*Metastases are uncommon tumors of the heart, arising by lymphatic or hematogenous spread of a primary neoplasm.
*Presents with [[dyspnea]],[[congestive heart failure]], [[hypotension]] and malignant [[pericardial effusion]].
*Any primary malignancy may metastasize to the heart, however, lung cancer is among the most common.<ref>Secondary cardiac neoplasm. Radiopedia.http://radiopaedia.org/articles/secondary-cardiac-neoplasms Accessed on November 24, 2015 </ref>
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'''Spleen, kidneys and vascular organs'''
'''Spleen, Kidney and Vascular Organs'''


The table below summarizes the findings that differentiate [[spleen]], [[kidneys]] and vascular organs from other conditions that cause a incidental findings that resemble hamartoma.  
*The table below summarizes the findings that differentiate [[spleen]], [[kidneys]], and vascular organs from other conditions that cause incidental findings similar to  hamartoma.  


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| style="padding: 5px 5px; background: #DCDCDC;" |'''Splenic [[hemangioma]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Splenic [[hemangioma]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Splenic hemangiomas, are considered the second most common focal lesion on the spleen. Prevalence rate is thought to range around 0.1-14% 7-8.  Most [[hemangioma]]s tend to be discovered in adults from mid-30s to mid-50s years of age. They may be associated with splenomegaly, [[abdominal pain]], dyspnea,and [[diarrhea]].<ref name="“radio”">Splenic hemangioma. Dr Jan Frank Gerstenmaier and Dr Yuranga Weerakkody et al http://radiopaedia.org/articles/splenic-haemangioma Accessed on December 08, 2015 </ref>
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*[[Splenic]] [[hemangiomas]] are considered the second most common focal lesion on the [[spleen]].  
*Most [[hemangioma]]s tend to be discovered in adults from mid-30s to mid-50s years of age.  
*They may be associated with [[splenomegaly]], [[abdominal pain]], dyspnea, and [[diarrhea|diarrhea.]]<ref name="“radio”">Splenic hemangioma. Dr Jan Frank Gerstenmaier and Dr Yuranga Weerakkody et al http://radiopaedia.org/articles/splenic-haemangioma Accessed on December 08, 2015 </ref>
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Retroperitoneal liposarcoma]]'''   
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Retroperitoneal liposarcoma]]'''   
| style="padding: 5px 5px; background: #F5F5F5;" |It is one of the most common primary retroperitoneal neoplasms. Retroperitoneal liposarcoma is a subtype of liposarcoma, a malignant tumour of mesenchymal origin that may arise in any fat-containing region of the body.
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*Retroperitoneal liposarcoma is the most common primary retroperitoneal neoplasm.  
*Retroperitoneal liposarcoma is a subtype of liposarcoma, a [[malignant]] [[tumor]] of mesenchymal origin that may arise in any fat-containing region of the body.
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Adrenal myelolipoma]]'''  
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Adrenal myelolipoma]]'''  
| style="padding: 5px 5px; background: #F5F5F5;" |Adrenolipomas are rare benign neoplasms that histologically consist of fat and bone marrow in varying proportions. In general, they are small, unilateral, and hormonally inactive. They are rich in adipose tissue and hematopoietic elements. Most lesions are small and asymptomatic. Adrenolipomas are usually detected incidentally in autopsy or by imaging studies performed for other reasons. Most tumors are unilateral, they show no predilection to one peculiar side. Symptoms of [[adrenolipoma]] include abdominal pain, haematuria, and abdominal fullness.
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*Adrenolipomas are rare benign neoplasms that histologically consist of fat and [[bone marrow]] in varying proportions.
*In general most tumors are unilateral and they show no predilection to one particular side. Symptoms of [[adrenolipoma]] include [[abdominal pain]], [[hematuria]], and abdominal fullness.
*They are rich in [[adipose]] tissue and hematopoietic elements.
*Most lesions are small and [[asymptomatic]].
*Adrenolipomas are usually detected incidentally in autopsy or by imaging studies performed for other reasons.
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===Differential Diagnosis of Cardiac Fibroma or Fibrous Hamartoma===
Cardiac fibroma or fibrous hamartoma should be differentiated from other cardiac tumors that present as a cardiac mass. The following are the differentials:<ref name="pmid27600455">{{cite journal |vauthors=Mankad R, Herrmann J |title=Cardiac tumors: echo assessment |journal=Echo Res Pract |volume=3 |issue=4 |pages=R65–R77 |date=December 2016 |pmid=27600455 |pmc=5292983 |doi=10.1530/ERP-16-0035 |url=}}</ref><ref name="pmid22283202">{{cite journal |vauthors=Zaragoza-Macias E, Zaragosa-Macias E, Chen MA, Gill EA |title=Real time three-dimensional echocardiography evaluation of intracardiac masses |journal=Echocardiography |volume=29 |issue=2 |pages=207–19 |date=February 2012 |pmid=22283202 |doi=10.1111/j.1540-8175.2011.01627.x |url=}}</ref><ref name="pmid7062746">{{cite journal |vauthors=Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P |title=Primary cardiac tumors: experience with 25 cases |journal=J. Thorac. Cardiovasc. Surg. |volume=83 |issue=3 |pages=339–48 |date=March 1982 |pmid=7062746 |doi= |url=}}</ref><ref name="pmid2237900">{{cite journal |vauthors=Molina JE, Edwards JE, Ward HB |title=Primary cardiac tumors: experience at the University of Minnesota |journal=Thorac Cardiovasc Surg |volume=38 Suppl 2 |issue= |pages=183–91 |date=August 1990 |pmid=2237900 |doi=10.1055/s-2007-1014064 |url=}}</ref><ref name="pmid1434856">{{cite journal |vauthors=Tazelaar HD, Locke TJ, McGregor CG |title=Pathology of surgically excised primary cardiac tumors |journal=Mayo Clin. Proc. |volume=67 |issue=10 |pages=957–65 |date=October 1992 |pmid=1434856 |doi= |url=}}</ref><ref name="pmid14728061">{{cite journal |vauthors=Sarjeant JM, Butany J, Cusimano RJ |title=Cancer of the heart: epidemiology and management of primary tumors and metastases |journal=Am J Cardiovasc Drugs |volume=3 |issue=6 |pages=407–21 |date=2003 |pmid=14728061 |doi=10.2165/00129784-200303060-00004 |url=}}</ref><ref name="pmid7382545">{{cite journal |vauthors=St John Sutton MG, Mercier LA, Giuliani ER, Lie JT |title=Atrial myxomas: a review of clinical experience in 40 patients |journal=Mayo Clin. Proc. |volume=55 |issue=6 |pages=371–6 |date=June 1980 |pmid=7382545 |doi= |url=}}</ref><ref name="pmid11388092">{{cite journal |vauthors=Pinede L, Duhaut P, Loire R |title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases |journal=Medicine (Baltimore) |volume=80 |issue=3 |pages=159–72 |date=May 2001 |pmid=11388092 |doi= |url=}}</ref><ref name="pmid7477198">{{cite journal |vauthors=Reynen K |title=Cardiac myxomas |journal=N. Engl. J. Med. |volume=333 |issue=24 |pages=1610–7 |date=December 1995 |pmid=7477198 |doi=10.1056/NEJM199512143332407 |url=}}</ref><ref name="pmid24642215">{{cite journal |vauthors=Javed A, Zalawadiya S, Kovach J, Afonso L |title=Aortic valve myxoma at the extreme age: a review of literature |journal=BMJ Case Rep |volume=2014 |issue= |pages= |date=March 2014 |pmid=24642215 |pmc=3962858 |doi=10.1136/bcr-2013-202689 |url=}}</ref><ref name="pmid17698701">{{cite journal |vauthors=Lee VH, Connolly HM, Brown RD |title=Central nervous system manifestations of cardiac myxoma |journal=Arch. Neurol. |volume=64 |issue=8 |pages=1115–20 |date=August 2007 |pmid=17698701 |doi=10.1001/archneur.64.8.1115 |url=}}</ref><ref name="pmid4010501">{{cite journal |vauthors=Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL |title=The complex of myxomas, spotty pigmentation, and endocrine overactivity |journal=Medicine (Baltimore) |volume=64 |issue=4 |pages=270–83 |date=July 1985 |pmid=4010501 |doi= |url=}}</ref><ref name="pmid10028128">{{cite journal |vauthors=McAllister HA, Hall RJ, Cooley DA |title=Tumors of the heart and pericardium |journal=Curr Probl Cardiol |volume=24 |issue=2 |pages=57–116 |date=February 1999 |pmid=10028128 |doi= |url=}}</ref><ref name="pmid9283541">{{cite journal |vauthors=Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB |title=Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation |journal=J. Am. Coll. Cardiol. |volume=30 |issue=3 |pages=784–90 |date=September 1997 |pmid=9283541 |doi= |url=}}</ref><ref name="pmid26046736">{{cite journal |vauthors=Tamin SS, Maleszewski JJ, Scott CG, Khan SK, Edwards WD, Bruce CJ, Oh JK, Pellikka PA, Klarich KW |title=Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas |journal=J. Am. Coll. Cardiol. |volume=65 |issue=22 |pages=2420–9 |date=June 2015 |pmid=26046736 |doi=10.1016/j.jacc.2015.03.569 |url=}}</ref><ref name="pmid12947356">{{cite journal |vauthors=Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ |title=Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases |journal=Am. Heart J. |volume=146 |issue=3 |pages=404–10 |date=September 2003 |pmid=12947356 |doi=10.1016/S0002-8703(03)00249-7 |url=}}</ref><ref name="pmid9424072">{{cite journal |vauthors=Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM |title=Pediatric primary benign cardiac tumors: a 15-year review |journal=Am. Heart J. |volume=134 |issue=6 |pages=1107–14 |date=December 1997 |pmid=9424072 |doi= |url=}}</ref><ref name="pmid2239731">{{cite journal |vauthors=Smythe JF, Dyck JD, Smallhorn JF, Freedom RM |title=Natural history of cardiac rhabdomyoma in infancy and childhood |journal=Am. J. Cardiol. |volume=66 |issue=17 |pages=1247–9 |date=November 1990 |pmid=2239731 |doi= |url=}}</ref><ref name="pmid7979700">{{cite journal |vauthors=Jacobs JP, Konstantakos AK, Holland FW, Herskowitz K, Ferrer PL, Perryman RA |title=Surgical treatment for cardiac rhabdomyomas in children |journal=Ann. Thorac. 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{| class="wikitable"
|+
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Site of Tumor
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Malignant Potential
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Type of Tumor
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Tissue of Origin
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of Presentation
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Location
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Morphology
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs and Symptoms
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |MRI Findings
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Systemic Manifestations
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Cardiac Manifestations
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Embolic Manifestations
|-
| rowspan="13" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Primary Cardiac Tumor'''
| rowspan="9" |'''Primary Benign'''
|'''[[Myxoma]]'''
|
* [[Mesenchymal]]
|
* Between third to sixth decade of life
|
* [[Left atrium]] (75%)
* [[Right atrium]] (15-20%)
* Arise from border of [[fossa ovalis]]
|
* 1-15 cm in diameter
* Pedunculated
* Polypoid
* Smooth and lobulated
* Villous and pappillary appearance associated with [[embolization]]
|
* Constitutional symptoms
* [[Carney complex]]:
** Spotty skin pigmentation
** [[Endocrine tumors|Endocrinal tumors]] such as [[Sertoli Cell Tumor|sertoli testicular tumors]], [[pituitary adenomas]], [[Thyroid tumor|thyroid tumors]]
** [[Schwannoma]]
* NAME syndrome:
** [[Nevi]]
** [[Atrial myxoma]]
** Myxoid neurofibroma
** Ephelides
* LAMB syndrome:
** [[Lentigo]] (small brown patches on the [[skin]])
** [[Atrial myxoma]]
** [[Nevi|Blue nevi]]
|
* [[Dyspnea]]
* [[Mitral regurgitation]] (LA)
* [[Right heart failure]] (RA)
* [[Cardiomegaly]]
|
* [[Pulmonary hypertension]] and [[pulmonary emboli]] (RA)
|
* Oval mobile left [[atrial]] lesion
* Heterogenous enhancement
* Attachment to [[fossa ovalis]]
|-
|'''Rhabdomyoma'''
|
* Striated Muscle
|
* Majority (80%) in [[infants]] (<12 months)
* Most common [[cardiac]] mass in childhood
* 50-70% of all [[pediatric]] [[tumors]]
|
* [[Ventricles]]
* [[Interventricular septum]]
|
* 1-3 cm in size
* Yellow-gray color
* Firm
* Circumscribed lobulated
* Majority multiple if associated with [[tuberous sclerosis]] (of those with no association, 50% are single)
|
* Associated with [[tuberous sclerosis]]:
** [[Developmental delay]]
** Renal tumors ([[Angiomyolipoma|angiomyolipomas]]'')''
** [[Phakomatoses|Phakomas]] (white retinal spots)
** Hypomelanic macules (ash leaf spots)
** Ungal fibromas
** Facial [[Angiofibroma|angiofibromas]]
** [[Headache]]
** [[Blurred vision]]
** [[Cardiac arrhythmia|Arrhythmias]]
** [[Benign]] [[Brain tumor|brain tumors]] ([[Cerebral cortex|cortical]] tubers, [[Subependymal zone|subependymal]] nodules)
|
* Outflow obstruction (both [[Ventricle|right and left ventricles]])
* [[Cardiac arrhythmia|Arrhythmias]] (ventricular pre-excitation, [[Wolff-Parkinson-White syndrome|Wolff-Parkinson White syndrome]])
* Spontaneous regression in young cases (< 4 years); seldom regress in adult cases
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
|
* Multiple masses isointense to [[muscle tissue]] on T1 images
* Hyperintense on T2 images
|-
|'''Fibroma'''
|
* [[Fibrous]]
|
* Children (1/3rd in infants)
|
* [[Ventricles]]
* [[Interventricular septum|Ventricular septum]] >[[Left ventricular|Left ventricular free wall]] > [[Right ventricle]] > [[Atria]]
* Central [[calcification]]
|
* Solitary
|
* [[Asymptomatic]]
* [[Cyanosis]]
|
* Atypical [[chest pain]]
* [[Heart failure]]
* [[Cardiomegaly]]
* Biventricular [[hypertrophy]]
* [[Atrioventricular block|Atrioventricular nodal block]]
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
|
* Solitary mass
* Low intensity on T2 weighted image
|-
|'''Fibroelastoma'''
|
* Valvular [[endocardium]]
|
|
* Valvular [[endocardium]] (Adults-[[Aortic valve|Aortic]], children-[[Tricuspid valve|Tricuspid]])
* [[Ventricular]] surface of [[aortic]] and [[pulmonary valves]] and [[atrial]] surface of [[atrioventricular valves]]
|
* < 1 cm in diameter
* Solitary
* Papillary
* Flower-like appearance with multiple attachments to [[valve]]
* Short pedicle
*
|
* [[Asymptomatic]]
* Association with [[hypertrophic obstructive cardiomyopathy]] ([[Hypertrophic cardiomyopathy|HOCM]])
|
* [[Subacute bacterial endocarditis]]
|
* [[Pulmonary embolism]]
|
* T1 and T2 weighted images show uniform intermediate signal intensity similar to [[myocardium]]
* Homogeneous late gadolinium contrast enhancement
|-
|'''[[Hemangioma]]'''
|
* [[Vascular]]
|
* < 1 year to 70 years
* < 2 % of primary cardiac tumors
|
* [[Ventricle|Right Ventricle]]
* [[Left ventricle]]
* [[Right atrium]]
* Small percentage in [[interatrial septum]] and [[left atrium]]
|
* Polypoid
* Encapsulated
|
* [[Cyanosis]]
* [[Kasabach-Merritt syndrome]] (giant hemangiomas):
** [[Thrombosis]]
** [[Thrombocytopenia]]
** [[Coagulopathy]]
|
* [[Pericardial effusions]]
* [[CHF]]
* [[Arrhythmias]]
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
|
* Intermediate density on T1 images
* Hypointense on T2 images
* Multicystic enhancing lesion
* Involvement of [[epicardium]] or [[pericardium]]
|-
|'''[[Lipoma]]'''
|
* [[Adipose]]
|
* Between fourth to sixth decade of life
|
* [[Left ventricle]] (most commonly subendocardium)
* [[Right atrium]]
|
* Sessile and small (specially [[subendocardial]] that protrude into [[cardiac]] chambers)
* Broad pedicle
* Growth into [[pericardial space]]
|
* [[Asymptomatic]]
|
* [[Dyspnea]]
* Local compression (subepicardial)
* [[Arrhythmia]]
|
* [[Ischemic stroke]]
|
* [[Epicardial]] or intramural lesion
* High intensity on T1 weighted image
* Drop out on [[fat]] saturation images
|-
|'''[[Paraganglioma]]'''
|
* [[Nervous system|Nervous]] ([[chromaffin cells]] of the [[sympathetic ganglia]])
|
* Average age of presentation is 11-13 years
*
|
* [[Left atrium]] (under the aorta and the [[pulmonary artery]])
* [[Interatrial septum]]
* [[Left ventricle]]
* [[Right ventricular outflow tract]]
|
* 3-8 cm
* Well-defined
* Broad base
* Encapsulated
* [[Heterogeneous]]
* Hypervascular
|
* Majority [[asymptomatic]]
* May present with [[symptoms]] of [[catecholamine]] excess:
** [[Tachycardia]]
** [[Hypertension]]
** [[Palpitations]]
** [[Fever]]
** [[Diaphoresis]]
* Positive for [[chromogranin]] and [[synaptophysin]]
* Association with [[succinate dehydrogenase]] ([[Succinate dehydrogenase|SDH]]) [[mutation]]
|
* [[Dyspnea]]
* [[Valvular]] obstruction ([[murmurs]])
* [[Acute coronary syndromes|Acute coronary syndrome]] ([[Angina|anginal pain]])
|
* Enascement of [[coronary arteries]] by [[tumor]]
|
* Well defined lesion arising from [[Atrial|atrial walls]] or [[Interatrial septum|septum]]
* Bright on T2 weighted imaging
|-
|'''Atrioventricular Node Tumor'''
|
* [[Endoderm|Endodermal]]
|
* Average age of diagnosis is 38 years
* Female to male ratio 3:1
|
* [[Triangle of Koch]] in the [[AV node|AV nodal]] region of the [[atrial septum]]
|
* 2 mm to 2 cm
* Multiple
* Cystic
* Thickening of the [[atrial septum]]
|
* Most common [[Cardiac tumors|cardiac tumor]] leading to sudden death
* [[Emery-Dreifuss muscular dystrophy]]
* Midline developmental defects along the central vertical body axis:
** [[Thyroglossal cyst|Thyroglossal duct cysts]]
** Cysts in the [[ovaries]], [[breasts]]
** [[Ventricular septal defect]]
** [[Encephalocele]]
* Positive for:
** [[Cytokeratin]] CAM5.2
** [[Cytokeratin]] AE1/AE3
** [[Cytokeratin]] 34βE12
** [[Cytokeratin]] 5/6 (CK5/6)
** [[Cytokeratin]] 7 (CK7)
** Epithelial membrane antigen (EMA)
** [[Carcinoembryonic antigen]] ([[CEA]])
** [[CA 19-9|Carbohydrate antigen]] (CA)19.9, p63, [[bcl2]], [[Galectin-3|galectin 3]]
|
* [[Palpitations]]
* [[Dyspnea]]
* [[Chest pain]]
* [[Dizziness|Diziness]]
* [[Syncope]]
* [[Complete heart block]]
* Partial [[Atrioventricular block|AV block]]
* [[Paroxysmal atrial tachycardia]]
* Spontaneous intermittent pre-excitation
|
* [[Myocardial infarction]]
* [[Ischemic stroke]]
|
* Hypointense [[Cardiac mass causes|cardiac mass]] on standard imaging
* Hyperintensity on late gadolinium enhancement (LGE) images with heterogeneous contrast enhancement
|-
|'''Lipomatous hypertrophy of the interatrial septum'''
|
* [[Adipose]]
|
* > 60 years
|
* Limbus of the [[fossa ovalis]] (sparing [[fossa ovalis]] membrane)
|
* > 2 cm
* [[Interatrial septum]] maybe upto 7 cm in thickness
|
* Mostly [[asymptomatic]]
* May present with obstructive symptoms such as [[syncope]] in rare cases of extension into [[superior vena cava]]
* Associated with:
** Increased age
** [[Obesity]]
** [[Cardiac arrhythmia|Arrhythmias]]
|
* [[Palpitations]]
* [[Dyspnea]]
* [[Fatigue]]
|<nowiki>-</nowiki>
|
* Diffuse or nodular thickening of [[atrial]] walls
* Hyperintense to normal [[myocardium]]
* Hypointense to [[pericardial]] and posterior [[mediastinal]] fat
|-
| rowspan="4" |'''Primary Malignant'''
|'''[[Fibrosarcoma]]'''
|
* [[Fibrous]]
|
* 20 to 80 years
|
* Left sided ([[atrial]] mostly)
|
* Sessile or pedunculated protruding masses in [[ventricular]] cavities
* Soft
* Lobulated
* Gelatinous
|
* [[Fever]]
* [[Fatigue]]
* [[Malaise]]
* [[Weight loss]]
* Cytoplasmatic positivity for a-SMA
|
* [[CHF]]
* [[Pericardial]] infiltration ([[Pericardial effusion|effusions]])
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
* [[Metastasis]]
|
* Heterogenous or isointense to [[myocardium]] on T1 weighted images
|-
|'''[[Angiosarcoma]]'''
|
* [[Vascular]]
|
* 30 to 50 years
|
* [[Right atrium]]
|
* Broad-based
* Internal [[hemorrhage]]
|
* [[Fever]]
* [[Fatigue]]
* [[Weight loss]]
* [[Congestion]]
* [[Superior vena cava syndrome]]
* Embolic [[stroke]]
* Endothelial marker D2-40
|
* [[Dyspnea]]
* [[Congestive heart failure|CHF]]
* [[Pericardial effusions]]
* [[Cardiac tamponade]]
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
* [[Metastasis]]
|
* Arterial phase enhancement
|-
|'''[[Rhabdomyosarcoma]]'''
|
* [[Mesenchymal]]
|
* Most common primary [[sarcoma]] of children
* Average age of presentation is 20 years
|
* Left sided ([[atrial]] mostly)
|
* Multiple
* Three types:
** Embryonic
** Pleomorphic
** Alveolar
|
* [[Fever]]
* [[Fatigue]]
* [[Weight loss]]
* [[Metastasize]] to [[lung]] and [[lymph nodes]]
|
* [[CHF]]
* [[Arrhythmias]]
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
* [[Metastasis]]
|
* Intermediate-to-hypointensity compared with [[muscle]] on T1 images
* Hyperintense on T2-weighted imaging with heterogeneous contrast enhancement
|-
|'''[[Lymphoma]]'''
|
* [[Lymphoid]]
|
* 10 to 90 years
* Males > females
|
* Right sided mostly
|
* Majority solitary (1/3rd multiple)
|
* Associations:
** [[Immunosupression|Chronic immunosupression]]
** [[Epstein Barr virus]]
** [[HIV]]
** [[Diffuse large B cell lymphoma]]
|
* May involve [[epicardium]] and [[pericardium]]
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
* [[Metastasis]]
|
* Hypointense on T1-weighted images and hyperintense on T2-weighted images
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Secondary Cardiac Tumor'''
|'''Metastastatic Malignant'''
|'''[[Metastasis]]'''
|
* [[Skin]] ([[Melanoma]])
* [[Lung carcinoma]]
* [[Lymph]] ([[leukemia]] and [[lymphoma]])
* [[Breast carcinoma]]
* [[Smooth muscle]] ([[Esophageal carcinoma]])
|
* Any age
|
* [[Tumors]] [[metastasizing]] via hematogenous route present as multiple intramyocardial masses:
** [[Melanoma]]
** [[Leukemia]]
** [[Sarcoma]]
* [[Tumors]] [[metastasizing]] via venous system as right sided mass:
** [[Renal cell carcinoma]]
** [[Hepatocellular carcinoma]]
* [[Lung]] tumor [[Metastasize|metastasizes]] to [[left atrium]]
|
* Multiple
*
|
* [[Fever]]
* [[Fatigue]]
* [[Weight loss]]
* [[Dysphagia]]
* [[Lymphadenopathy]]
* [[Night sweats]]
|
* [[Pericardial effusions]]
* [[Dyspnea]]
* [[Arrhythmia]]
* Outflow obstruction
|
* [[Pulmonary embolism]]
* [[Ischemic stroke]]
* [[Metastasis]]
|
* Hyperintense relative to myocardium
* Cardiac mass displaces [[Epicardial fat pad|epicardial fat]] and [[pericardial effusion]] away from [[heart]]
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 16:04, 5 April 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Syed Hassan A. Kazmi BSc, MD [3]

Overview

Hamartomas must be differentiated from other diseases that cause abnormal tissue growth and calcifications, such as calcified metastases and lipomas.[1]

Differentiating Hamartoma from other Diseases

Hypothalamic Hamartomas

  • The differential diagnosis is broadly that of suprasellar and hypothalamic lesions, although the imaging characteristics of hypothalamic hamartomas significantly reduces the differential.
  • Hypothalamic-chiasmatic glioma is the main differential.
  • Other lesions encountered in the region either have markedly different signal intensity or demonstrate enhancement on MRI.[2]
  • The table below summarizes the findings that differentiate hypothalamic hamartoma from other conditions that are also suprasellar and hypothalamic lesions.[3]
Disease Findings
Hypothalamic-chiasmatic glioma
  • Hypothalamic-optochiasmatic gliomas are a subset of astrocytic tumors which have tendency to occur in patients with neurofibromatosis type 1.
  • These may involve the optic nerves, the optic chiasm, and the optic tracts.
  • Between 20 and 50% of patients with hypothalamic gliomas have a positive family history of von Recklinghausen disease (NF-1).
Craniopharyngioma
Rathke's cleft cyst
  • Rathke's cleft cyst is a benign growth found on the pituitary gland in the brain, specifically a fluid-filled cyst in the posterior portion of the anterior pituitary gland.
  • Rathke's cleft cyst occurs when the Rathke's pouch does not develop properly and ranges in size from 2 to 40mm in diameter.
  • Asymptomatic cysts are commonly detected during autopsies in 2-26% of individuals who have died of unrelated causes.
  • Females are more commonly affected than males.
Pituitary macroadenoma

Pulmonary Hamartomas

  • The differential diagnosis of pulmonary hamartoma is dependent on CT scan imaging features.
  • The differential is dependent on whether fat or calcification is identifiable within the lesion. If fat is visualized then the differential is narrow, with almost all cases representing pulmonary hamartoma.
  • If neither fat nor calcification is present, then the differential is that of a solitary pulmonary nodule and is significantly broader.
  • The table below summarizes the findings that differentiate pulmonary hamartoma from other conditions that cause a fat containing solitary pulmonary nodule.
Disease Findings
Lipoma
  • Lipoma is a fat exclusive, well circumcised mass
  • Lipomas are likely to have been present for many years and may change size with weight fluctuation
  • These can also be an incidental finding
  • In 5-15% of patients lipomas are multiple and approximately a third of these will be familial[2]
Myelolipoma
  • Myelolipoma is a very rare, benign pulmonary lesion, usually presenting as an asymptomatic pulmonary nodule
  • Myelolipoma is mainly composed of mature adipose tissue and normal hematopoietic cells.[4]
Metastasis
  • Pulmonary metastases are common and usually asymptomatic, with constitutional symptoms relating to disseminated metastatic disease and those attributable to the primary tumor dominating
  • Common symptoms include hemoptysis and pneumothorax
  • Pulmonary metastases may be single or multiple[2]
Pulmonary Chondroma
  • Pulmonary chondromas are usually associated with Carney’s triad
  • On CT scan, chondromas appear as smoothly marginated, round, or slightly lobulated, small areas of fat
  • Pulmonary chondromas are common in adolescents or young adults[5]

Heart Hamartomas

  • The table below summarizes the findings that differentiate cardiac hamartoma from other conditions that cause a fat containing lesion within the striated muscle of the heart.
Disease Findings
Hibernoma
  • Hibernoma is a benign neoplasm of vestigial brown fat.
  • The majority of patients present with a slow-growing, painless, solitary mass, usually of the subcutaneous tissues.
  • In general, imaging studies show a well-defined, heterogeneous mass, usually showing a mass which is hypointense to subcutaneous fat on magnetic resonance T1-weight images. Serpentine, thin, low signal bands (septations or vessels) are often seen throughout the tumor.
Metastasis

Spleen, Kidney and Vascular Organs

  • The table below summarizes the findings that differentiate spleen, kidneys, and vascular organs from other conditions that cause incidental findings similar to hamartoma.
Disease Findings
Splenic hemangioma
Retroperitoneal liposarcoma
  • Retroperitoneal liposarcoma is the most common primary retroperitoneal neoplasm.
  • Retroperitoneal liposarcoma is a subtype of liposarcoma, a malignant tumor of mesenchymal origin that may arise in any fat-containing region of the body.
Adrenal myelolipoma
  • Adrenolipomas are rare benign neoplasms that histologically consist of fat and bone marrow in varying proportions.
  • In general most tumors are unilateral and they show no predilection to one particular side. Symptoms of adrenolipoma include abdominal pain, hematuria, and abdominal fullness.
  • They are rich in adipose tissue and hematopoietic elements.
  • Most lesions are small and asymptomatic.
  • Adrenolipomas are usually detected incidentally in autopsy or by imaging studies performed for other reasons.

Differential Diagnosis of Cardiac Fibroma or Fibrous Hamartoma

Cardiac fibroma or fibrous hamartoma should be differentiated from other cardiac tumors that present as a cardiac mass. The following are the differentials:[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]

Site of Tumor Malignant Potential Type of Tumor Tissue of Origin Age of Presentation Location Morphology Signs and Symptoms MRI Findings
Systemic Manifestations Cardiac Manifestations Embolic Manifestations
Primary Cardiac Tumor Primary Benign Myxoma
  • Between third to sixth decade of life
  • 1-15 cm in diameter
  • Pedunculated
  • Polypoid
  • Smooth and lobulated
  • Villous and pappillary appearance associated with embolization
Rhabdomyoma
  • Striated Muscle
  • 1-3 cm in size
  • Yellow-gray color
  • Firm
  • Circumscribed lobulated
  • Majority multiple if associated with tuberous sclerosis (of those with no association, 50% are single)
  • Multiple masses isointense to muscle tissue on T1 images
  • Hyperintense on T2 images
Fibroma
  • Children (1/3rd in infants)
  • Solitary
  • Solitary mass
  • Low intensity on T2 weighted image
Fibroelastoma
  • < 1 cm in diameter
  • Solitary
  • Papillary
  • Flower-like appearance with multiple attachments to valve
  • Short pedicle
  • T1 and T2 weighted images show uniform intermediate signal intensity similar to myocardium
  • Homogeneous late gadolinium contrast enhancement
Hemangioma
  • < 1 year to 70 years
  • < 2 % of primary cardiac tumors
  • Polypoid
  • Encapsulated
  • Intermediate density on T1 images
  • Hypointense on T2 images
  • Multicystic enhancing lesion
  • Involvement of epicardium or pericardium
Lipoma
  • Between fourth to sixth decade of life
  • Epicardial or intramural lesion
  • High intensity on T1 weighted image
  • Drop out on fat saturation images
Paraganglioma
  • Average age of presentation is 11-13 years
  • 3-8 cm
  • Well-defined
  • Broad base
  • Encapsulated
  • Heterogeneous
  • Hypervascular
Atrioventricular Node Tumor
  • Average age of diagnosis is 38 years
  • Female to male ratio 3:1
  • Hypointense cardiac mass on standard imaging
  • Hyperintensity on late gadolinium enhancement (LGE) images with heterogeneous contrast enhancement
Lipomatous hypertrophy of the interatrial septum
  • > 60 years
 -
Primary Malignant Fibrosarcoma
  • 20 to 80 years
  • Sessile or pedunculated protruding masses in ventricular cavities
  • Soft
  • Lobulated
  • Gelatinous
  • Heterogenous or isointense to myocardium on T1 weighted images
Angiosarcoma
  • 30 to 50 years
  • Arterial phase enhancement
Rhabdomyosarcoma
  • Most common primary sarcoma of children
  • Average age of presentation is 20 years
  • Multiple
  • Three types:
    • Embryonic
    • Pleomorphic
    • Alveolar
  • Intermediate-to-hypointensity compared with muscle on T1 images
  • Hyperintense on T2-weighted imaging with heterogeneous contrast enhancement
Lymphoma
  • 10 to 90 years
  • Males > females
  • Right sided mostly
  • Majority solitary (1/3rd multiple)
  • Hypointense on T1-weighted images and hyperintense on T2-weighted images
Secondary Cardiac Tumor Metastastatic Malignant Metastasis
  • Any age
  • Multiple

References

  1. ↑ Brown K, Mund DF, Aberle DR, Batra P, Young DA (1994). "Intrathoracic calcifications: radiographic features and differential diagnoses". Radiographics. 14 (6): 1247–61. doi:10.1148/radiographics.14.6.7855339. PMID 7855339.
  2. ↑ 2.0 2.1 2.2 Hypothalamic hamartoma. Dr Donna D'Souza et al.http://radiopaedia.org/articles/hypothalamic-hamartoma Radiopedia Accessed on December 08, 2015
  3. ↑ Amstutz DR, Coons SW, Kerrigan JF, Rekate HL, Heiserman JE (2006). "Hypothalamic hamartomas: Correlation of MR imaging and spectroscopic findings with tumor glial content". AJNR Am J Neuroradiol. 27 (4): 794–8. PMID 16611766.
  4. ↑ Xu Q, Yin X, Huang W, Sun J, Wu X, Lu L (2015). "Intrapulmonary myelolipoma and its computed tomography features: A case report and literature review". Oncol Lett. 9 (4): 1677–1680. doi:10.3892/ol.2015.2913. PMC 4356384. PMID 25789022.
  5. ↑ Carneys triad.https://en.wikipedia.org/wiki/Carney's_triad Accessed on December 08, 2015
  6. ↑ Secondary cardiac neoplasm. Radiopedia.http://radiopaedia.org/articles/secondary-cardiac-neoplasms Accessed on November 24, 2015
  7. ↑ Splenic hemangioma. Dr Jan Frank Gerstenmaier and Dr Yuranga Weerakkody et al http://radiopaedia.org/articles/splenic-haemangioma Accessed on December 08, 2015
  8. ↑ Mankad R, Herrmann J (December 2016). "Cardiac tumors: echo assessment". Echo Res Pract. 3 (4): R65–R77. doi:10.1530/ERP-16-0035. PMC 5292983. PMID 27600455.
  9. ↑ Zaragoza-Macias E, Zaragosa-Macias E, Chen MA, Gill EA (February 2012). "Real time three-dimensional echocardiography evaluation of intracardiac masses". Echocardiography. 29 (2): 207–19. doi:10.1111/j.1540-8175.2011.01627.x. PMID 22283202.
  10. ↑ Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P (March 1982). "Primary cardiac tumors: experience with 25 cases". J. Thorac. Cardiovasc. Surg. 83 (3): 339–48. PMID 7062746.
  11. ↑ Molina JE, Edwards JE, Ward HB (August 1990). "Primary cardiac tumors: experience at the University of Minnesota". Thorac Cardiovasc Surg. 38 Suppl 2: 183–91. doi:10.1055/s-2007-1014064. PMID 2237900.
  12. ↑ Tazelaar HD, Locke TJ, McGregor CG (October 1992). "Pathology of surgically excised primary cardiac tumors". Mayo Clin. Proc. 67 (10): 957–65. PMID 1434856.
  13. ↑ Sarjeant JM, Butany J, Cusimano RJ (2003). "Cancer of the heart: epidemiology and management of primary tumors and metastases". Am J Cardiovasc Drugs. 3 (6): 407–21. doi:10.2165/00129784-200303060-00004. PMID 14728061.
  14. ↑ St John Sutton MG, Mercier LA, Giuliani ER, Lie JT (June 1980). "Atrial myxomas: a review of clinical experience in 40 patients". Mayo Clin. Proc. 55 (6): 371–6. PMID 7382545.
  15. ↑ Pinede L, Duhaut P, Loire R (May 2001). "Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases". Medicine (Baltimore). 80 (3): 159–72. PMID 11388092.
  16. ↑ Reynen K (December 1995). "Cardiac myxomas". N. Engl. J. Med. 333 (24): 1610–7. doi:10.1056/NEJM199512143332407. PMID 7477198.
  17. ↑ Javed A, Zalawadiya S, Kovach J, Afonso L (March 2014). "Aortic valve myxoma at the extreme age: a review of literature". BMJ Case Rep. 2014. doi:10.1136/bcr-2013-202689. PMC 3962858. PMID 24642215.
  18. ↑ Lee VH, Connolly HM, Brown RD (August 2007). "Central nervous system manifestations of cardiac myxoma". Arch. Neurol. 64 (8): 1115–20. doi:10.1001/archneur.64.8.1115. PMID 17698701.
  19. ↑ Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL (July 1985). "The complex of myxomas, spotty pigmentation, and endocrine overactivity". Medicine (Baltimore). 64 (4): 270–83. PMID 4010501.
  20. ↑ McAllister HA, Hall RJ, Cooley DA (February 1999). "Tumors of the heart and pericardium". Curr Probl Cardiol. 24 (2): 57–116. PMID 10028128.
  21. ↑ Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB (September 1997). "Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation". J. Am. Coll. Cardiol. 30 (3): 784–90. PMID 9283541.
  22. ↑ Tamin SS, Maleszewski JJ, Scott CG, Khan SK, Edwards WD, Bruce CJ, Oh JK, Pellikka PA, Klarich KW (June 2015). "Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas". J. Am. Coll. Cardiol. 65 (22): 2420–9. doi:10.1016/j.jacc.2015.03.569. PMID 26046736.
  23. ↑ Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ (September 2003). "Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases". Am. Heart J. 146 (3): 404–10. doi:10.1016/S0002-8703(03)00249-7. PMID 12947356.
  24. ↑ Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM (December 1997). "Pediatric primary benign cardiac tumors: a 15-year review". Am. Heart J. 134 (6): 1107–14. PMID 9424072.
  25. ↑ Smythe JF, Dyck JD, Smallhorn JF, Freedom RM (November 1990). "Natural history of cardiac rhabdomyoma in infancy and childhood". Am. J. Cardiol. 66 (17): 1247–9. PMID 2239731.
  26. ↑ Jacobs JP, Konstantakos AK, Holland FW, Herskowitz K, Ferrer PL, Perryman RA (November 1994). "Surgical treatment for cardiac rhabdomyomas in children". Ann. Thorac. Surg. 58 (5): 1552–5. PMID 7979700.
  27. ↑ Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV (September 2008). "Survival after resection of primary cardiac tumors: a 48-year experience". Circulation. 118 (14 Suppl): S7–15. doi:10.1161/CIRCULATIONAHA.107.783126. PMID 18824772.
  28. ↑ Basu S, Folliguet T, Anselmo M, Greengart A, Sabado M, Cunningham JN, Jacobowitz IJ (April 1994). "Lipomatous hypertrophy of the interatrial septum". Cardiovasc Surg. 2 (2): 229–31. PMID 8049952.
  29. ↑ Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner JC, Moynihan TJ (June 2008). "Malignant primary cardiac tumors: review of a single institution experience". Cancer. 112 (11): 2440–6. doi:10.1002/cncr.23459. PMID 18428209.
  30. ↑ Vander Salm TJ (April 2000). "Unusual primary tumors of the heart". Semin. Thorac. Cardiovasc. Surg. 12 (2): 89–100. PMID 10807431.
  31. ↑ Petersen CD, Robinson WA, Kurnick JE (1976). "Involvement of the heart and pericardium in the malignant lymphomas". Am. J. Med. Sci. 272 (2): 161–5. PMID 1008078.
  32. ↑ Ragland MM, Tak T (March 2006). "The role of echocardiography in diagnosing space-occupying lesions of the heart". Clin Med Res. 4 (1): 22–32. PMC 1447535. PMID 16595790.
  33. ↑ Miguel CE, Bestetti RB (June 2011). "Primary cardiac lymphoma". Int. J. Cardiol. 149 (3): 358–63. doi:10.1016/j.ijcard.2010.02.016. PMID 20227122.
  34. ↑ Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR (2000). "Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation". Radiographics. 20 (4): 1073–103, quiz 1110–1, 1112. doi:10.1148/radiographics.20.4.g00jl081073. PMID 10903697.
  35. ↑ Grinda JM, Couetil JP, Chauvaud S, D'Attellis N, Berrebi A, Fabiani JN, Deloche A, Carpentier A (January 1999). "Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization". J. Thorac. Cardiovasc. Surg. 117 (1): 106–10. PMID 9869763.
  36. ↑ Webb DW, Thomas RD, Osborne JP (March 1993). "Cardiac rhabdomyomas and their association with tuberous sclerosis". Arch. Dis. Child. 68 (3): 367–70. PMC 1793857. PMID 8466239.
  37. ↑ Yoshitake I, Hata M, Sezai A, Niino T, Unosawa S, Shimura K, Kasamaki Y, Minami K (September 2009). "Cardiac angiosarcoma with cardiac tamponade diagnosed as a ruptured aneurysm of the sinus valsalva". Jpn. J. Clin. Oncol. 39 (9): 612–5. doi:10.1093/jjco/hyp044. PMID 19493870.
  38. ↑ Parissis H, Akbar MT, Young V (October 2010). "Primary leiomyosarcoma of the right atrium: a case report and literature update". J Cardiothorac Surg. 5: 80. doi:10.1186/1749-8090-5-80. PMC 2964688. PMID 20939891.
  39. ↑ Gulati G, Sharma S, Kothari SS, Juneja R, Saxena A, Talwar KK (2004). "Comparison of echo and MRI in the imaging evaluation of intracardiac masses". Cardiovasc Intervent Radiol. 27 (5): 459–69. doi:10.1007/s00270-004-0123-4. PMID 15383848.
  40. ↑ Narin B, Arman A, Arslan D, Simşek M, Narin A (February 2010). "Assessment of cardiac masses: magnetic resonance imaging versus transthoracic echocardiography". Anadolu Kardiyol Derg. 10 (1): 69–74. PMID 20150010.
  41. ↑ "academic.oup.com".
  42. ↑ Ismail I, Al-Khafaji K, Mutyala M, Aggarwal S, Cotter W, Hakim H, Khosla S, Arora R (2015). "Cardiac lipoma". J Community Hosp Intern Med Perspect. 5 (5): 28449. doi:10.3402/jchimp.v5.28449. PMC 4612478. PMID 26486106.
  43. ↑ D'Souza J, Shah R, Abbass A, Burt JR, Goud A, Dahagam C (January 2017). "Invasive Cardiac Lipoma: a case report and review of literature". BMC Cardiovasc Disord. 17 (1): 28. doi:10.1186/s12872-016-0465-2. PMC 5237479. PMID 28088193.
  44. ↑ Yadav, Pradeep K.; Baquero, Giselle A.; Malysz, Jozef; Kelleman, John; Gilchrist, Ian C. (2014). "Cardiac Paraganglioma". Circulation: Cardiovascular Interventions. 7 (6): 851–856. doi:10.1161/CIRCINTERVENTIONS.114.001856. ISSN 1941-7640.
  45. ↑ Tahir M, Noor SJ, Herle A, Downing S (2009). "Right atrial paraganglioma: a rare primary cardiac neoplasm as a cause of chest pain". Tex Heart Inst J. 36 (6): 594–7. PMC 2801953. PMID 20069088.
  46. ↑ Hamilton BH, Francis IR, Gross BH, Korobkin M, Shapiro B, Shulkin BL, Deeb CM, Orringer MB (January 1997). "Intrapericardial paragangliomas (pheochromocytomas): imaging features". AJR Am J Roentgenol. 168 (1): 109–13. doi:10.2214/ajr.168.1.8976931. PMID 8976931.
  47. ↑ Shih, Wei-Jen; McCullough, Scott; Smith, Mary (1993). "Diagnostic imagings for primary cardiac fibrosarcoma". International Journal of Cardiology. 39 (2): 157–161. doi:10.1016/0167-5273(93)90028-F. ISSN 0167-5273.
  48. ↑ Arai T, Kurashima C, Wada S, Chida K, Ohkawa S (November 1998). "Histological evidence for cell proliferation activity in cystic tumor (endodermal heterotopia) of the atrioventricular node". Pathol. Int. 48 (11): 917–23. PMID 9832064.
  49. ↑ Wolf PL, Bing R (November 1965). "The smallest tumor which causes sudden death". JAMA. 194 (6): 674–5. PMID 5897246.
  50. ↑ Burke AP, Anderson PG, Virmani R, James TN, Herrera GA, Ceballos R (October 1990). "Tumor of the atrioventricular nodal region. A clinical and immunohistochemical study". Arch. Pathol. Lab. Med. 114 (10): 1057–62. PMID 2222148.
  51. ↑ Burke A, Tavora F (April 2016). "The 2015 WHO Classification of Tumors of the Heart and Pericardium". J Thorac Oncol. 11 (4): 441–52. doi:10.1016/j.jtho.2015.11.009. PMID 26725181.
  52. ↑ Tran, Thao T; Starnes, Vaughn; Wang, Xuedong; Getzen, James; Ross, Brian D (2009). "Cardiovascular magnetics resonance diagnosis of cystic tumor of the atrioventricular node". Journal of Cardiovascular Magnetic Resonance. 11 (1): 13. doi:10.1186/1532-429X-11-13. ISSN 1532-429X.
  53. ↑ Tatli, Servet; O'Gara, Patrick Thomas; Lambert, Jarvis; Kwong, Raymond; Byrne, John Gerald; Yucel, E. Kent (2004). "MRI of Atypical Lipomatous Hypertrophy of the Interatrial Septum". American Journal of Roentgenology. 182 (3): 598–600. doi:10.2214/ajr.182.3.1820598. ISSN 0361-803X.
  54. ↑ Saboo, Sachin S.; Krajewski, Katherine M.; Zukotynski, Katherine; Howard, Stephanie; Jagannathan, Jyothi P.; Hornick, Jason L.; Ramaiya, Nikhil (2012). "Imaging Features of Primary and Secondary Adult Rhabdomyosarcoma". American Journal of Roentgenology. 199 (6): W694–W703. doi:10.2214/AJR.11.8213. ISSN 0361-803X.


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