Heart tumors – the new growths, diverse on a histologic structure, which are initially arising from tissues of heart or sprouting in them from other bodies. Heart tumors, depending on their type, localization and the size, can cause short wind, cough, tachycardia, arrhythmias, pains behind a breast, heart failure, a tamponada of heart, a thrombembolia. Diagnosis of tumors of heart is carried out taking into account these EhoKG, a X-ray analysis, a ventrikulografiya, MRT and MSKT of heart, the ECG, a biopsy. At detection of primary benign tumors of heart their radical excision is made; treatment of primary malignant and metastatic new growths usually palliative (radiation therapy, chemotherapy).
Heart tumors – the heterogeneous group of new growths growing from fabrics and covers of heart. Tumors can develop from any tissues of heart and arise at any age. New growths can sprout a cardiac muscle, a pericardium, to strike valves and partitions of heart. They can be found in a fruit by means of a fetalny echocardiography, since 16-20 weeks of pre-natal development. Primary tumors of heart meet in cardiology frequency of 0,001-0,2%; secondary (metastatic) - are 25-30 times more often. All tumors of heart bear potential danger of emergence of deadly complications - heart failure, arrhythmias, a perikardit, a tamponada of heart, system embolisms.
Classification of tumors of heart
The heart tumors representing independent diseases are primary; the tumors spreading on blood and lymphatic vessels or sprouting from the next bodies - secondary. The reasons of development of primary tumors of heart are unknown. Secondary tumors of heart are more often presented by metastasises of a breast cancer, a stomach, lungs, is more rare - cancer of a thyroid gland and kidneys.
By the morphological principle of a tumor of heart are subdivided on good-quality (make 75%) and malignant (make 25%). By origin malignant new growths can be both primary, and metastatic, secondary. Heart miksoma (50-80%), teratoma, rabdomioma, fibromas, gemangioma, lipomas, sosochkovy fibroelastoma, cysts of a pericardium, a paraganglioma, etc. occur among benign tumors. Sarcomas, mesotheliomas of a pericardium and a lymphoma are among malignant new growths.
Foreign matters of heart, organized blood clots, formations of inflammatory character (abscesses, gumma, granulomas), ekhinokokkovy and other parasitic cysts, conglomerates of a kaltsinoz belong to pseudo-tumors. The separate group is made by the ekstrakardialny tumors of a sredosteniye and pericardium squeezing heart.
Primary benign tumors of heart
A half of cases among all primary tumors of heart are necessary on miksy. Sporadic miksoma of heart 2-4 times more often are found in women. The hereditary complex of Carney with autosomno-prepotent type of inheritance which is characterized by multicentric tumors of various localization – heart miksoma, pigmentary tumors of skin, a fibroadenomama of mammary glands, cysts of ovaries, a nodal dysplasia of adrenal glands, miksoidny tumors of testicles, adenomas of a hypophysis, a shvannomama of peripheral nerves meets.
Primary localization by a mix is the left auricle (about 75%). Miksoma, having a leg, prolabirut via the mitralny valve, complicating depletion of the left auricle and filling of a ventricle during a diastola. Macroscopically miksoma can have slizevidny, firm, lobular or friable structure. Not properly executed friable miksoma constitute the greatest danger in the development plan for a system embolism.
Among primary tumors of heart the good-quality sosochkovy fibroelastoma which are mainly striking aortal and mitralny valves are the second for frequency. Morphologically they represent bessosudisty papillomas with the branches reminding actinium, departing from the central kernel. Most often they have a leg, however unlike a mix, do not cause dysfunction of valves, but increase probability of an embolism.
Rabdomioma among all benign tumors of heart make 20% and are the most frequent new growth at children. Usually rabdomioma are multiple, have intramuralny localization in a partition or a wall of the left ventricle, strike the carrying-out system of heart. A current of a rabdomioma can be followed by tachycardia, arrhythmias, heart failure. These tumors of heart are often associated with a tuberozny sclerosis, adenomas of sebaceous glands, dobroyokachestvenny new growths of kidneys.
Soyedinitelnotkanny tumors of heart also, mainly, occur at children. Can strike valves and the carrying-out system of heart, to cause mechanical obstruction, imitating a valvate stenosis, a clinical picture of heart failure, a gipertroficheyosky cardiomyopathy, a konstriktivny perikardit. Fibromas of heart can be a part of a syndrome of a basal and cellular nevus (Gorlin's syndrome).
Other benign tumors of heart
Gemangioma meet in 5-10% of cases of all primary tumors of heart. More often they do not cause clinical symptomatology and come to light at planned inspection. Less often vnutrimiokardialny gemangioma are followed by violations of atrioventricular conductivity, and at germination of predyoserdno-ventricular knot can lead to sudden death.
Lipomas of heart can develop at any age. Usually it is the tumors on the wide basis which are localized in an epikarda or an endokarda. Current of lipomas more often asymptomatic; at achievement of the big sizes they can cause arrhythmias, conductivity violations, the change of a shape of heart revealed radiological.
Feokhromotsitoma can have intraperikardialny or miokardialny localization, be followed by secretion of catecholamines. Pericardium cysts on roentgenograms of a thorax often imitate tumors of heart or ekssudativny perikardit. More often they proceed asymptomatically, can sometimes cause symptoms of a compression of bodies of a thorax.
Malignant tumors of heart
Sarcomas - the most frequent primary malignant tumors of heart. They meet, mainly, at young age (average age of 40 years). Sarcomas of heart can be presented by angiosarkoma (40%), undifferentiated sarcomas (25%), malignant fibrous gistiotsitoma (11-24%), leyomiosarkoma (8-9%), rabdomiosarkoma, fibrosarkoma, liposarkoma, osteosarcomas. Malignant tumors of heart arise in the left auricle more often, leading to obstruction of a mitralny opening, a tamponada of heart, heart failure, metastasis in lungs.
Mesotheliomas of a pericardium are rather rare and occur mainly at men. They usually spread in a pleura, a backbone, a brain, surrounding soft fabrics.
Primary lymphoma strike the persons suffering from an immunodeficiency more often (including HIV infection). These tumors of heart are inclined to extremely rapid growth and are followed by heart failure, arrhythmias, tamponady and a syndrome of the top hollow vein.
Metastatic tumors of heart most often affect a pericardium, is more rare – a cardiac muscle, and heart valves. As well as primary tumors of heart, they can cause short wind, sharp perikardit, a tamponada of heart, violation of a rhythm, atrioventricular blockade, stagnant heart failure. In heart lung cancer, breasts, renal cancer, sarcoma of soft fabrics, a leukosis, a melanoma, a lymphoma, Kaposha's sarcoma can spread.
Symptoms of tumors of heart
Displays of tumors of heart are caused by new growth type, its localization, size, ability to disintegration. Extra cardiac tumors are shown by fever, a fever, decrease in body weight, an artralgiya, skin rashes. At a sdavleniye short wind, breast pains arise a tumor of cameras of heart or coronal arteries. Growth of a tumor or bleeding can lead to development of a tamponada of heart.
The heart tumors with intramiokardialny growth (rabdomioma, fibromas) squeezing or which are taking root into the carrying-out system are followed by atrioventricular or intraventrikulyarny blockade, paroksizmalny tachycardias (supraventricular or ventricular).
Intracavitary tumors of heart, mainly, break function of valves and interfere with blood current from heart cameras. They can cause the phenomena of a mitralny and trikuspidalny stenosis or insufficiency, heart failure. The symptomatology of intracavitary tumors of heart usually arises when changing position of a body in connection with change of haemo dynamics and the physical forces operating on a tumor.
Often as the first displays of tumors of heart serve a thrombembolia in vessels of a system or pulmonary circle of blood circulation. Tumors from the right departments of heart can cause an embolism of a pulmonary artery, pulmonary hypertensia and pulmonary heart; tumors of the left departments of heart - passing brain ischemia and a stroke, a myocardial infarction, ischemia of extremities, etc. Developing of heart attacks of internals at persons of young age in the absence of the congenital and acquired heart diseases, vibrating arrhythmia and an infectious endocarditis forces to think of existence of a tumor of heart.
Diagnosis of tumors of heart
In view of variability of a clinical picture and plurality of morphological forms of tumors of heart, their diagnostics is a difficult task.
The given ECGs at tumors of heart of a polimorfna and malospetsifichna: they can reflect signs of a hypertrophy of cameras of heart, violation of conductivity and a rhythm, myocardium ischemia etc. The X-ray analysis of bodies of a thorax most often reveals increase in the sizes of heart and symptoms of pulmonary hypertensia. More sensitive method of diagnosis of tumors is ultrasonography of heart: by means of a chrespishchevodny EhoKG tumors of auricles, by a transthoracic EhoKG – a tumor of ventricles are better visualized.
At doubtful results of diagnostics heart MPT and MCKT, radio isotope scanning, sounding of cavities of heart and a ventrikulografiya is carried out. For verification of histologic structure of a tumor of heart the biopsy in the course of a kateterization or a diagnostic torakotomiya is carried out it. At an ekssudativny perikardit the cytologic research of the liquid received at a pericardium puncture can give valuable diagnostic information. Differential diagnosis of tumors of heart is carried out with VPS, myocarditis, cardiomyopathies, perikardity, amiloidozy hearts.
Treatment of tumors of heart
Tumors of heart are treated in the surgical way. Operations at tumors of heart can include removal of an intracavitary tumor, removal of a tumor of a myocardium or a pericardium, a perikardektomiya, removal of a cyst of a pericardium. During radical operation excision of a tumor of heart with adjacent surrounding fabrics, an ushivaniye or plasticity of defect is made. Benign tumors of heart in most cases can be removed considerably. In certain cases patients can need plasticity or prosthetics of valves.
Removal of primary malignant tumors of heart is ineffective. In this case most often resort to partial (palliative) removal of a tumor with the subsequent carrying out beam or chemotherapy. At secondary tumors of heart treatment also palliative.
Forecast of tumors of heart
Removal of single benign tumors of heart usually is followed by the good separated results – 3-hletny survival makes 95%. Further observation of the cardiologist and heart surgeon with annual carrying out an echocardiography for timely identification of a recurrence of a tumor of heart is shown to patients. Multiple tumors of heart reduce survival within the next 5 years to 15%. At primary and metastatic tumors of heart the forecast very adverse; surgical treatment is ineffective, the chemotherapy and radiation therapy practically do not influence the forecast.