The patient got a screening with a CT scan of the thorax and a sonography of the abdomen without providing hints for a neoplasm or an adenopathy. The urologic work-up showed normal values for ß- HCG and α-fetoprotein and ruled out a germ cell tumor. A gastroscopy showed an impression of the esophagus at 30 cm. Because of the vascularisation and the size of the tumor we did not perform a biopsy. Therefore, the patient was transferred to surgery. Intraoperatively, the tumor showed an extension covering half the left atrium with contact to the superior cava vein, the pulmonary artery and the pulmonary veins as well as an adhesion to the lateral atrial wall. The tumor was totally resected and the walls of the left atrium and great vessels partially replaced by Dacron. The tumor had a weight of about 200 g and a size of 7x4x5 cm. Histologically, the pathologists observed a angiolipomatous proliferation with nerve fascicles and proliferating lymphatic tissue and fibrotic septa, multiple vessels and nerves. The final diagnosis was a cardiac hamartoma with an adjacent mediastinitis.
Figure 6: cardiac hamartoma
Secondary cardiac tumors (i.e. metastatic malignant tumors) are much more common than primary cardiac tumors. Tumors of cardiac origin are very seldom (0.3 % of autopsies). About 75 % of them are benign. The most common benign tumors in adults are myxomas. Primary cardiac tumors can lead to a wide variety of symptoms and systemic reactions like fever, malaise or arthralgias. The specific symptoms are mainly related to their anatomical location. Because of their size or their location they can lead to an intracavitary or valvular obstruction. Furthermore, they can produce rhythm disorders like atrial fibrillation or flutter, AV blocks or ventricular arrhythmias. Also, fragments of the tumor or thrombi can embolize, concerning to their location to the systemic or pulmonary circulation.The differentiation between benign or malignant tumors is often difficult. Usually, benign tumors are more often on left side, show a slow growth, no invasion of cardiac or mediastinal structures and no pericardial effusion. Therefore, a total resection is the therapy of choice.Hamartomas are very rare (< 1 % of the benign cardiac tumors) and can be diagnosed at any age. They usually remain asymptomatic for a long time. Mostly, they are located in the left ventricle. There are only few case reports in literature.
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