Right Atrial Tumors and Tumor-Like Lesions, a Clinicopathologic Study of 54 Cases
F Tavora, S Papamitrou, N Cresswell, M Franco, A Burke. Paulista Medical School, Federal University of Sao Paulo, Sao Paulo, SP, Brazil; Armed Forces Institute of Pathology, Washington, DC; University of Maryland, Baltimore, MD
Background: Cardiac tumors are rare, and those arising in the right atrium form a heterogenous group of tumor and tumor-like conditions that have not yet been studied extensively in a single series.
Design: Fifty-four cases of tumors arising in the right atrium were collected retrospectively from 1995 to 2009 from the files of the Armed Forces Institute of Pathology. The clinicopathological characteristic of benign and malignant proliferations of tumors primarily centered in the right atrium were studied.
Results: Patients range from 6 to 81 years (mean 48.8, SD 18), with 28 males and 26 females. Tumor size ranged from 3 to 20cm. Most common presentation was shortness of breath (18%), followed by chest pain (11%), and other included hemoptysis, pericardial effusion, syncope and arrhythmias. Neurologic symptoms were present only in myxomas (2 cases). Ten cases were incidentally found on imaging or during surgery. There were 31 benign proliferation that included 9 thrombus, 5 fibroinflammatory proliferations (2 of which were associated with clinical and histologic features of sclerosing mediastinitis), 4 cardiac myxomas, 4 lipomatous hypertrophy of the atrial septum, 2 hamartomas of mature myocytes, 2 paragangliomas, 1 nodular tuberculous infiltrate, 1 inflammatory myofibroblastic tumor, 1 cardiac fibroma, 1 hemangioma and 1 leiomyoma. Malignant tumors were 16 primary sarcomas (13 angiosarcomas, 2 synovial sarcomas, 1 pleomorphic sarcoma), 4 lymphomas and 3 metastases (2 melanomas, 1 metastatic adenocarcinoma). Clinical presentation, age, tumor size and sex did not correlate with malignant diagnosis.
Conclusions: Right atrial tumors represent a variety of benign and malignant condition with varied clinical presentation and histologic appearance. Most are benign and include non-neoplastic proliferations. Malignant cases are more homogeneous with angiosarcomas most common, followed by lymphoma and metastases.
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