Epidemiological and Pathological Characteristics of Cardiovascular Tumors: A 10-Year Study
DM Gadingan, PP Belen, MR Ribo, AM De Luna. Philippine Heart Center, Quezon City, National Capital Region, Metro Manila, Philippines
Background: Primary tumors of the heart and pericardium are rare (about 5%) compared to secondary tumors. Nomenclature for these tumors evolved in the past years distinguishing well differentiated tumors from myofibroblastic and from undifferentiated sarcomas. This study reviewed the center's experience, and evaluated the pathological characteristics, proliferation indices and clinical outcome.
Design: Review of surgeries and databases was performed from 1999 to 2009. H&E slides were reviewed and tumor classification was updated using immunostains when necessary. Variables like age, sex, tumor location, and histology were analyzed using the chi-square and Mann- Whitney tests to detect significant differences among them. The myxomas were grouped into classic and cellular subgroups. Proliferation markers (p53, MIB-1) and BCL-2 were done on cellular myxomas, inflammatory myofibroblastic tumors (IMT), and sarcomas to determine any relation to clinical outcome.
Results: There were 212 cardiovascular tumors with 165(77%) arising from the heart, 2(0.9%) from the great vessels and 45(21%) as metastatic. The incidences were 0.5% for primary tumors and 0.2% for secondary. Most primary tumors were excisions and 2 were autopsies. Myxomas were the most common (62.3%), mostly in females (p<0.002), more in the left atrium (p<0.000), and were seen in all ages. Benign tumors are IMTs (2.8%), rhabdomyomas (1.4%), hemangiomas (0.9%), and others (0.5%). Primary cardiac malignancies were 5(2.4%) myofibroblastic sarcomas, 2(0.9%) leiomyosarcomas, and 1(0.5%) each for angiosarcoma, liposarcoma, and undifferentiated sarcoma. There were 2 pulmonary artery sarcomas. Most metastatic tumors were pericardial (95.6%), mostly in males (p<0.002), and aged 40-59 years (p<0.000). Cellular myxomas had rare reactivity (<1%) for p53 and BCL-2, and 1-5% reactivity for MIB-1. Similar reactivity is seen with IMTs. Sarcomas showed higher reactivity and deaths occurred at >6% reactivity for p53, >60% for BCL-2 and >22% for MIB-1.
Conclusions: Primary cardiovascular tumors were more common than secondary tumors in our center. Myxoma was the most common benign neoplasm in all age groups. Metastatic tumors were more common than primary malignancies. Cellular myxomas and IMTs have similar clinical behavior. Among the primary malignancies, myofibroblastic sarcomas predominate. Prognostic markers that may predict poor outcome regardless of tumor size were p53 at >6% reactivity, MIB-1 at >33%, and BCL-2 at >60%.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 36, Wednesday Afternoon