Invasive Cardiac Lipoma: a case report and review of literature. [Review]

MedStar author(s):
Citation: BMC Cardiovascular Disorders. 17(1):28, 2017 Jan 14PMID: 28088193Institution: MedStar Franklin Square Medical CenterDepartment: MedicineForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal Article | ReviewSubject headings: *Heart Atria/dg [Diagnostic Imaging] | *Heart Neoplasms/dg [Diagnostic Imaging] | *Lipoma/dg [Diagnostic Imaging] | *Magnetic Resonance Imaging | Adult | Biopsy | Diagnosis, Differential | Dyspnea/et [Etiology] | Echocardiography | Heart Atria/pa [Pathology] | Heart Atria/su [Surgery] | Heart Neoplasms/co [Complications] | Heart Neoplasms/pa [Pathology] | Heart Neoplasms/su [Surgery] | Humans | Lipoma/co [Complications] | Lipoma/pa [Pathology] | Lipoma/su [Surgery] | Male | Neoplasm Invasiveness | Predictive Value of Tests | Treatment Outcome | Tumor BurdenYear: 2017Local holdings: Available online from MWHC library: 2001 - presentISSN:
  • 1471-2261
Name of journal: BMC cardiovascular disordersAbstract: BACKGROUND: Cardiac lipomas are rare benign tumors of the heart. They are usually asymptomatic and are thus most often diagnosed on autopsies. Symptoms, when present, depend upon the location within the heart. Typical locations are the endocardium of the right atrium and the left ventricle. Diagnostic modality of choice is cardiac MRI. Treatment guidelines have not yet been established due to the very low prevalence of these tumors and are thus guided by the patient's symptomatology.CASE PRESENTATION: We describe a case of an invasive cardiac lipoma, wherein the initial symptom of the patient was shortness of breath. Although the echocardiogram visualized the tumor in the right atrium, a cardiac MRI was performed for better tissue characterization. The MRI revealed a large, fat containing, septated mass in the right atrium with invasion into the inter-atrial septum and inferior cavoatrial junction. There was also invasion of the coronary sinus along the inferior and left lateral aspect of the posterior atrioventricular groove. Although the mass appeared to represent a lipoma by imaging characteristics, the unusual extension into the coronary sinus led to consideration of a low-grade liposarcoma in the differential. Thus a pre-operative biopsy was performed along with MDM2 gene amplification to rule out a liposarcoma preceding surgical excision.CONCLUSION: Cardiac lipomas are well-characterized on cardiac MRI, which is the diagnostic modality of choice. Typical locations are the right atrium and the left ventricle. However, in those with atypical features such as invasion of the coronary sinus, pre-operative biopsy for histopathologic confirmation is imperative to exclude well-differentiated liposarcoma. Our patient with a simple lipoma underwent partial resection to relieve symptoms. We discuss prognosis and treatment of symptomatic cardiac lipomas.All authors: Abbass A, Burt JR, D'Souza J, Dahagam C, Goud A, Shah RFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-10-16
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28088193 Available 28088193

Available online from MWHC library: 2001 - present

BACKGROUND: Cardiac lipomas are rare benign tumors of the heart. They are usually asymptomatic and are thus most often diagnosed on autopsies. Symptoms, when present, depend upon the location within the heart. Typical locations are the endocardium of the right atrium and the left ventricle. Diagnostic modality of choice is cardiac MRI. Treatment guidelines have not yet been established due to the very low prevalence of these tumors and are thus guided by the patient's symptomatology.

CASE PRESENTATION: We describe a case of an invasive cardiac lipoma, wherein the initial symptom of the patient was shortness of breath. Although the echocardiogram visualized the tumor in the right atrium, a cardiac MRI was performed for better tissue characterization. The MRI revealed a large, fat containing, septated mass in the right atrium with invasion into the inter-atrial septum and inferior cavoatrial junction. There was also invasion of the coronary sinus along the inferior and left lateral aspect of the posterior atrioventricular groove. Although the mass appeared to represent a lipoma by imaging characteristics, the unusual extension into the coronary sinus led to consideration of a low-grade liposarcoma in the differential. Thus a pre-operative biopsy was performed along with MDM2 gene amplification to rule out a liposarcoma preceding surgical excision.

CONCLUSION: Cardiac lipomas are well-characterized on cardiac MRI, which is the diagnostic modality of choice. Typical locations are the right atrium and the left ventricle. However, in those with atypical features such as invasion of the coronary sinus, pre-operative biopsy for histopathologic confirmation is imperative to exclude well-differentiated liposarcoma. Our patient with a simple lipoma underwent partial resection to relieve symptoms. We discuss prognosis and treatment of symptomatic cardiac lipomas.

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