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Irina Alexandrovna Zborovskaya – doctor of medical sciences, professor,cathedral professor of hospital therapy with the course of clinical rheumatology of the doctors improvement faculty of Volgograd state medical university, director of the Federal Budgetary State Institution (FBSI) “Research and development institute of clinical and experimental rheumatology” of the RAMS, head of the regional Osteoporosis Center, presidium member of the Association of rheumatologists of Russia, member of the editorial boards of the magazines “Scientific and practical rheumatology” and “Modern rheumatology” In general, primary as well as secondary tumors of the heart are rare. Cardiac neoplasms may be benign or malignant. The most common malignant myocardial tumor is cardiac sarcoma. The most common benign primary myocardial tumors are myxoma and rhabdomyoma, the latter usually arising from the heart muscle (that is granular cell [Abrikosov’s] tumor). Fibromas, lipomas and leiomyomas are less common. The other less common site is the pericardium. Myxoma. Myxomas are considered to be the most common tumors in patients aged 30 – 60 years. They occur less commonly in children and the elderly. Myxomas tend to occur 3 times more often in women than in men. They are located on a narrow or broad base and are characteristically attached to the interatrial septum. Myxomas can also arise from cardiac valves. They are clinically manifested by a dense or jelly-like mass which may be either round or oval in shape and have an even or villiferous surface. Clumps of this mass may separate and cause arterial embolism which can be fatal. During the systole the tumor penetrates into the atrioventricular opening resulting in its stenosis or complete obstruction. Clinical presentations. Clinical presentations of myxomas are varying. Conventionally they are divided into:
- clinical presentations which reflect the body’s response to tumor growth;
- clinical presentations which are due to unfavourable effects of the tumor on the heart;
- and clinical presentations which occur as a result of thromboembolic complications.
- sudden detection of mitral valvular disease with a rapidly progressing course and unexpected recurrences in a patient without rheumatic diseases in the past history;
- the extent of severity of clinical presentations of valvular disease is inconsistent with the small size of the heart; the link between the attack and a certain body position;
- peripheral embolism in patients without pronounced clinical presentations of valvular disease, rhythm disturbances or bacterial endocarditis;
- unexplained increase of body temperature, anemia, elevated ESR in patients with the above mentioned clinical presentations;
- cardiac myxoma may be suspected if the radiologist reveals any cardiac calcifications or indirect symptoms of mitral stenosis.
- Rhabdomyosarcoma is considered as a malignant analogue of rhabdomyoma. However, all cardiac sarcomas are rare and only few have the structure which is similar to that of rhabdomyosarcoma.
- Pericardium is one of the least common sites of malignant cardiac tumors. Most commonly they arise from the epicardium in the area of the transient fold. Pericardial sarcomas and mesotheliomas are typically singled out. Pericardial sarcomas may be large in size and they rarely metastasize. Primary sarcomas of the heart sac (i.e. mesotheliomas) may cause thickening of the cardiac walls, the so-called “cancerous frosted heart”. They are small in size, most often metastasize to the lungs, pleura, mediastinal lymph nodes.
- Metastatic cardiac and pericardial tumors are more frequent than primary malignant tumors. It is essential to know that lung and breast cancer metastasize to the heart in 40% of cases; melanoma in 33-50% of cases; malignant lymphoma – 15-37% of cases.