Background

Primary cardiac tumours are relatively rare. Cardiac myxomas are the most prevalent and in a significant proportion of cases they are accidentally discovered in asymptomatic patients. Noninvasive definitive diagnosis remains challenging despite improvements provided by newer imaging tools. Our aim was to describe the long-term experience of a tertiary cardiac center managing cardiac tumours.

Methods

We analyzed 154 consecutive patients admitted to a single-tertiary center with the diagnosis of a cardiac mass or tumor between 1990 and 2018. Data files including clinical presentation, noninvasive investigations, presumptive diagnosis and histopathology were collected. The follow-up was obtained from clinical records or telephone contact.

Results

In 154 patients with a median age at diagnosis of 61 (51-71) years, 62% were females. Anatomopathology studywas obtained in 144 cases, from which 81% were benign tumours (106 myxomas; 11 papillary fibroelastomas). In comparison with malignant lesions, patients with benign tumours were older (62 versus 48 years) and more often women (65% versus 27%, P = .021). Incidental diagnosis of a benign tumor occurred in 36% of the cases. Transthoracic echocardiography was the initial technique for diagnostic suspicion in the great majority of patients. Both cardiac computed tomography and magnetic resonance were rarely performed before excision. Imaging based (mostly echocardiography) pre-operative presumptive diagnosis was discordant with histopathologic findings in 21% of the benign and in 55% of malignant lesions (previously considered as benign). Uncommon histologic findings were found in 18% of myxomas. During the follow-up period of 11 ± 12 years there were 12 recurrences.

Conclusion

Among surgically excised cardiac tumours benign cardiac tumors are far more common than both primary and secondary malignancies. In this series of patients, there was a significant proportion of asymptomatic lesions. Preoperative misdiagnosis could be related to the scarce use of adjunctive noninvasive imaging tools beyond echocardiography. Preoperative noninvasive investigation should be expanded to improve diagnostic presumption and better plan the best therapeutic approach.

中文翻译：

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心脏肿瘤：三级中心的三十年经验：我们是否正在使用新的成像工具来改变诊断工作？

背景

原发性心脏肿瘤相对罕见。心脏粘液瘤是最普遍的病例，在相当多的情况下，它们是在无症状患者中意外发现的。尽管较新的成像工具有所改进，但非侵入性明确诊断仍然具有挑战性。我们的目的是描述三级心脏中心处理心脏肿瘤的长期经验。

方法

我们分析了1990年至2018年间在三级中心住院的154例诊断为心脏肿块或肿瘤的患者。收集了包括临床表现，无创检查，推定诊断和组织病理学在内的数据文件。随访来自临床记录或电话联系。

结果

在154位诊断为中位年龄61（51-71）岁的患者中，女性占62％。144例获得了解剖病理学研究，其中81％为良性肿瘤（106例粘液瘤； 11例乳头状纤维弹性瘤）。与恶性病变相比，良性肿瘤患者年龄较大（62岁比48岁），女性更多（65％比27％，P= .021）。良性肿瘤的偶然诊断发生在36％的病例中。经胸超声心动图检查是大多数患者诊断可疑的最初技术。切除前很少进行心脏计算机断层扫描和磁共振检查。在21％的良性和55％的恶性病变（以前被认为是良性的）中，基于影像学（主要是超声心动图）的术前推定诊断与组织病理学结果不一致。在18％的粘液瘤中发现了罕见的组织学发现。在11±12年的随访期内，有12例复发。

结论

在手术切除的心脏肿瘤中，良性心脏肿瘤远比原发性和继发性恶性肿瘤更为普遍。在这一系列患者中，有相当一部分无症状病变。术前误诊可能与超声心动图以外很少使用辅助性无创成像工具有关。术前无创检查应扩大以改善诊断推定并更好地计划最佳治疗方法。