Surgical treatment of a giant symptomatic cardiac lipoma

Report of a giant invasive, wall-penetrating cardiac lipoma

BACKGROUND

Cardiac lipoma, a seldom-encountered benign tumor positioned beneath the endocardium, has the potential to impair electrophysiological functions. Diagnosis is principally based on imaging modalities. The uniqueness of this case lies in the tumor's extension both internally and externally within the right atrium, rendering it of special interest. From a clinical standpoint, surgical removal is commonly advocated, wherein early intervention is pivotal in improving patients' long-term prognoses.

CASE PRESENTATION

A 35-year-old male was admitted to the hospital for treatment subsequent to the identification of a cardiac mass two days prior. Initial diagnostic assessments, encompassing CT scans and echocardiography, identified a space-occupying lesion within the heart. The patient underwent surgical excision of the cardiac tumor, utilizing mild hypothermic extracorporeal circulation via femoral vessel access. Intraoperative findings revealed adipose-like tissue of a "dumbbell-shaped" configuration situated both within and external to the right atrium, measuring approximately 8 cm*9 cm internally and 7 cm*6 cm externally, with the extracardiac mass being marginally larger. Postoperative pathological analysis confirmed a cardiac lipoma diagnosis. A follow-up echocardiogram conducted three months post-surgery exhibited no notable abnormalities. The patient is under continuous observation to monitor for any recurrence or potential long-term complications.

CONCLUSION

In this case report, we detail with precision a rare cardiac pathology manifested by an expansive infiltrative lipoma that pervades the endocardial and epicardial layers of the right atrium. After thorough preoperative diagnostic workup and evaluation, we contend that surgical intervention represents the optimal therapeutic approach for managing such conditions, with the goal of preemptively reducing the likelihood of cardiac compression or intracardiac obstruction.

Approach to Surgery for Cardiac Tumors: Primary Simple, Primary Complex, and Secondary

Cardiac tumors are rare. Most surgeons will encounter few primary cardiac tumors outside of myxomas. This article offers the authors' approach to simple and complex primary and secondary cardiac tumors. Symptoms of primary cardiac tumors are primarily determined by tumor size and anatomic location. Most simple primary tumors and some complex primary tumors are best managed by surgical resection. Secondary tumors are 30 times more frequent than primary cardiac tumors. Surgical resection of secondary tumors is rational in a few highly selected patients. For complex primary and secondary tumors, the authors recommend referral to an experienced multidisciplinary cardiac tumor team.

Surgery for Tumors of the Heart

Most surgeons will encounter only a handful of primary cardiac tumors outside of myxomas. Approximately 3 quarters of primary cardiac tumors are benign and 1 quarter is malignant. In most cases, cardiac tumors are silent but when symptoms do occur, they are primarily determined by tumor size and anatomical location, not by histopathology. The diagnosis and preoperative imaging relies heavily on multimodal imaging including echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Surgical resection is the most common treatment for most simple primary cardiac tumors and for some complex benign tumors. Surgical resection of primary cardiac tumors frequently involves the need for complex cardiac reconstruction, particularly when malignant. Secondary tumors to the heart are 30 times more frequent than primary cardiac tumors, and their incidence is increasing, largely as a result of advances in cancer diagnosis and therapy. Surgical resection is feasible in only a small fraction of highly-selected patients with secondary tumors to the heart. For complex benign tumors-such as paraganglioma or large fibromas-and all primary and secondary malignant tumors, a multidisciplinary cardiac tumor team review in experienced centers of excellence is recommended.

Analysis of giant thoracic neoplasms: Correlations between imaging, pathology and surgical management

Background

A giant thoracic neoplasm is extremely rare and poorly understood. Our systemic study introduced computed tomography angiography (CTA) with three‐dimensional (3D) reconstruction imaging and evaluated correlations between imaging, pathology, and surgical management.

Methods

Data from 45 patients undergoing surgery for giant thoracic neoplasm in our institution between May 2007 and November 2015 were collected. The clinical characteristics, imaging manifestations, preoperative biopsy, surgical management, postoperative pathology, and prognosis and their correlation were analyzed.

Results

The clinical characteristics, imaging manifestations, and pathological types were complicated. Four patients underwent CTA with 3D reconstruction imaging and feeding vessels were found in three cases. Twenty‐four selected patients accepted preoperative biopsy, eight of which were inconsistent with postoperative pathology. Complete resection was performed in 39 cases, 20 of which underwent extended excision. The median survival duration of all patients was 58 months (range 3.0–118.0). The one, three, and five‐year survival rates were 86.0%, 64.4%, and 47.0%, respectively. Univariate analyses showed tumor size and resection status were prognostic factors for survival (P = 0.003 and P < 0.001, respectively).

Conclusions

A giant thoracic neoplasm should preferably be treated in experienced centers for precise diagnosis and optimal therapy schemes with comprehensive consideration of clinical characters, imaging manifestations, pathology, surgical management, and prognosis. Innovative CTA with 3D reconstruction imaging together with preoperative biopsy are feasible and effective in therapeutic decision‐making and surgical planning. Complete surgical resection remains the mainstay of curative therapy for all resectable tumors.

Lipoma of the Mitral Valve

Described herein is a 67-year-old morbidly obese man who had a lipoma excised from his posterior mitral leaflet after it was found by echocardiogram. Findings in 6 other previously reported cases are reviewed.

Giant Cardiac Lipoma: Refined Hypothesis Proposes Invagination from Extracardiac to Intracardiac Sites

Cardiac lipomas are rare and usually present as benign, encapsulated masses outside the heart; however, they can also be found within the atria. No single theory-including molecular genetic mutation-adequately explains why this occurs. Extensive career experience and broadened knowledge in embryology and cardiac physiology have helped us to develop a hypothesis based on invagination of extracardiac tumors. This report describes a vexing case of a giant right atrial lipoma, from 1985, in which the diagnosis was made incidentally during management of a patient's acute limb ischemia. In addition, we discuss the imaging and treatment of cardiac lipoma.

Infiltrating Lipoma of the Right Ventricle Involving the Interventricular Septum and Tricuspid Valve: Report of a Rare Case and Literature Review

Cardiac lipoma, which are primary cardiac tumors, are rare entities often detected incidentally during imaging. There have been very few reports on the right ventricle (RV) lipoma. Here, we present a case of RV infiltrating lipoma involving the interventricular septum (IVS) and the tricuspid valve. Clinical symptoms, diagnostic procedures, multimodality imaging characteristics, and treatment are discussed, and the complete clinical data of this case and relevant details of retrospective literature are reviewed. The study described the case of a 48-year-old woman who suffered from occasional palpitation after exertion for 10 years. Imaging examinations, including echocardiography and cardiovascular magnetic resonance imaging (MRI), revealed a large mass adherent to the IVS and the right ventricular wall that was consistent with lipoma. The patient underwent surgical repair of the tricuspid valve and excision of the partial mass. The gross specimen revealed piles of 5 × 4 × 3 cm fragments with yellowish appearance and pathological results showed infiltrating lipoma.Lipoma is often asymptomatic and diagnosed incidentally. Surgical excision is the main therapeutic intervention, which is always performed in cases of symptomatic lipoma or when malignancy is suspected. Multimodality imaging would be great help in the diagnosis of cardiac lipoma. Echocardiography is a convenient method for follow-up.

A giant symptomatic cardiac lipoma recurring at the fifth year

Cardiac lipomas are extremely rare in the heart diseases and only few present with a wide spectrum of clinical signs, including life-threatening arrhythmias and sudden death. We report a 48-year-old woman who with a 2-year history of recurrent dyspnea with mild anemia was admitted to our hospital as a huge mass was found in her mediastinum. After complete surgical tumor resection, she was recurred at the fifth year. This case underlines the giant cardiac lipomas had a slightly higher risk of recurrence over the next five years.